Contraception

Contraception

The type of contraception that works best for you will depend on your health and circumstances. There are several issues to consider when deciding which method of contraception is right for you.

Experienced Northway Clinic gynaecologists will discuss the available and most suitable options with you.

Intra – Uterine Devices (IUD)

An IUD is a small plastic and copper device that is put into your womb. It has two soft threads on the end which hang through the opening at the entrance of your womb (cervix) into the top of your vagina. There are different types and sizes of IUD to suit different women. An IUD can stay in for 5-10 years, depending on the type. If you are aged 40 or older when the IUD is fitted, it can be left in until the menopause. It prevents the sperm from reaching the egg and it also stops a fertilised egg from implanting. It will not cause an abortion if you are already pregnant.

It is more than 99% effective. This means that less than 1 woman in 100 who uses this method of contraception will become pregnant each year. (More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.)

Advantages of using an Intra – Uterine Device (IUD)

• It works as soon as it is put in.
• It works for 5-10 years depending on type.
• It does not interfere with sex.
• It can be used when breastfeeding.
• Your normal fertility returns as soon as the IUD is removed.
• It is not affected by other medicines.

Disadvantages of using an Intra – Uterine Device (IUD)

• Your periods may be heavier, longer, or more painful. This may improve after a few months.
• You will need an internal examination to check it is suitable before it is fitted.
• The IUD does not protect you from sexually transmitted infections, so you may have to use condoms as well. If you get an infection when an IUD is in place this could lead to pelvic infection if not treated.

Risks

• There is a very small chance of you getting an infection during the first twenty days after the IUD has been fitted.
• The IUD might be pushed out by your womb (expulsion) but this is not common. The doctor who fits the IUD will teach you how to check your IUD threads every month.
• It is not common but there is a risk that an IUD might damage (perforate) your womb or cervix when it is put in.
• If you do become pregnant while you are using an IUD there is a small risk of you having an ectopic pregnancy, this means the pregnancy is in the fallopian tubes and not in the uterus. This is rare but serious. See a doctor urgently if you miss a period and develop lower abdominal pain.

Fitting the IUD

This is usually done towards the end of a period or shortly after. However, it can be fitted at any time provided that you are certain you are not pregnant. You will need to have a vaginal examination. The doctor will pass a small instrument into your uterus to check its size and position. An IUD is then fitted. You will be taught how to feel the threads of the IUD so you can check it is in place. It is best to check the threads regularly, for example, once a month just after a period.

Fitting an IUD can sometimes be uncomfortable. Once the IUD has been inserted some women have cramps like period pains for a few hours afterwards. These can be eased by painkillers such as paracetamol. Light vaginal bleeding may also occur for a short while.

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Intra-Uterine Systems (IUS)

The IUS is similar to an IUD BUT it releases a progesterone hormone. There are different types of IUS in the UK (Mirena or Jaydess) and the consultant will help you decide which one is best for you. The IUS works for up to five years. If you are aged 45 or older when the IUS is fitted, it can be left in until the menopause. In the UK it is used for contraception, heavy periods, and part treatment for HRT.

• It makes the lining of your uterus thinner so it is less likely to accept a fertilised egg.
• It also thickens the mucus from your cervix. This makes it difficult for sperm to move through it to reach an egg.
• In some women, it stops the ovaries releasing an egg.

Advantages of using an IUS

• It works for 5 years.
• It does not interfere with sex.
• It can be used when breastfeeding.
• Your normal fertility returns as soon as the IUS is removed.
• It is not affected by other medicines.
• It is useful if you cannot use oestrogen hormones.
• Your period usually becomes lighter and shorter and sometimes less painful. They may stop completely after the first year of use. An IUS can be useful for heavy periods.

Disadvantages of using an IUS

• Your periods may change in a way that is not acceptable to you.
• Some women report having acne, headaches, and breast tenderness.
• Some women develop small fluid-filled cysts on the ovaries. These are not dangerous and usually do not need treatment.

IUS is fitted the same way as IUD but it must be fitted with your period.

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Preparation for IUS/IUD insertion or removal

Insertion needs to be performed during your period unless you are already using reliable contraception like condoms or the pill. Take Ibuprofen/Paracetamol 30 mins prior to your appointment as patients find this helpful as pain relief.

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Contraceptive Implant

An implant is a small flexible rod that is placed just under the skin in your upper arm. It releases a hormone called progesterone which is similar to the natural hormones that are produced by your body. The implant works for three years. It is a very effective contraceptive method.

The main way the implant works is to stop your ovaries releasing an egg each month (ovulation). It also thickens the mucus from your cervix, which makes it difficult for sperm to enter the uterus (womb) and makes the lining of your womb thinner so it is less likely to accept a fertilized egg.

The procedure

Removal

• The doctor or nurse will feel your arm to locate the implant, clean the area with antiseptic solution and give you a small local anesthetic injection. They will then make a tiny cut in your skin and gently pull the implant out. A dressing is then applied which needs to be kept clean and dry.
• If you want to carry on using an implant, the doctor or nurse can put a new one in at the same time.
• Occasionally, an implant is difficult to feel under the skin and is not so easy to remove. If this happens, you may be referred to a specialist clinic.

Risks of having an implant fitted or removed

Having an implant fitted or removed is a very safe and simple procedure. With any medical intervention there are always some risks, which you must be aware of before proceeding: Bleeding and bruising at the removal site; Infection at the removal site; Scarring; Damage to blood vessels and nerves (very rare).

Other most common contraceptives that are effective if used correctly:

• female sterilisation (permanent)
• male sterilisation or vasectomy (permanent)
• contraceptive injection (renewed every eight weeks or every 12 weeks, depending on the type)
• combined pill (taken every day for three weeks out of every month)
• progestogen-only pill (taken every day)
• contraceptive patch (renewed each week for three weeks in every month)
• vaginal ring (renewed once a month)
• male condom (every time you have sex)
• female condom (every time you have sex)
• diaphragm with spermicide (every time you have sex)
• cap with spermicide (every time you have sex)