Contraception

Contraception

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If you are at able to get pregnant but don’t want to be, you should be using some form of contraception. One kind is hormonal contraception, such as the pill. There are two main types of pill: the combined pill, which contains both a progestogen hormone, and a POP, which contains just the progestogen hormone. The first of these has a 7 day break - or 7 days where you take inactive pills - during which time you get your period. This is the more common of the two types. The POP is more common among older women, women who smoke, or women who have a history of migraines, blood clots of heart disease in the family. As these pills have their effect by altering your hormones, they will include side effects such as mood changes, weight gain and the risk of blood clots. Your doctor will speak to you about these risks when you are prescribed the medication. The type of pill you are allowed to take will depend on your age and you and your family's medical history.

There are two types of pill based hormonal contraception a woman can take: the CCP and the POP. These are the combined contraceptive pill and the progestogen only pill. Taken correctly, both these types of pills are highly effective and give you 99% protection against pregnancy. Bear in mind that the contraceptive pill does not protect you against sexually transmitted infections, and you should use a condom to protect against this, as well as having regular STI checks, which are available for free from your GP. Whether you take the CCP or the POP will depend on your medical history - there are several types of both pills available from iMeds.

What is contraception?

Contraception is any kind of method you use to prevent pregnancy. These methods can be either physical barriers such as condoms, female condoms, or diaphragms, or you can get hormonal types of contraception. Hormonal forms of contraception include The Pill, hormonal patches, and implants. Hormonal types of contraception work by altering the chemicals in your body to trick the worm into thinking it is already pregnant. Much like when you're actually pregnant, this means your womb cannot then fertilise another egg. The main difference between these types of hormonal contraceptives is the length of time they are effective for. To stay protected, you have to take The Pill every day. This may seem like a lot to remember for something as important as preventing sex, but it does mean that if you experienced adverse side effects, you can stop taking The Pill and remove the hormones in your body within 24 hours. If you are taking the pill, you should take it everyday even if you don't intend to have sex, to reduce the side effects you may experience and to make sure it is most effective when you need it.

The patch and the hormonal implant need changing less regularly. You usually use one patch a week for three weeks, and then don’t use one for a week, during which time you have your period. This means you don't have to remember to do something everyday, but it does mean you have a patch on your arm for most of every month. The longest lasting type of hormonal contraceptive is the hormonal implant. These can last for up to 3 years and need a local anaesthetic to be used when they are being put in or taken out. If you experience adverse side-effects it is less easy to remove the implant than it is to stop taking the pill, but if you know it is right for you, the implant can give you long-term, hassle free protection from pregnancy. This might be the best option for you if you're in a long-term relationship.

There are also what is known as “natural” forms of contraception. These usually involve only having sex when the woman is least likely to get pregnant, or the man withdrawing his penis before he ejaculates. These are the least reliable types of contraception, but some people's lifestyles mean these are the only ones they can use. There are also very long-term forms of contraception, the most common of these being the male vasectomy. Sometimes known as "getting your tubes tied", this is a non-reversible operation which means the man can no longer impregnate a woman. There is currently no form of male hormonal contraceptive.

The best known and most widely used form of contraception is the male condom. Not only does it protect against pregnancy, it also keeps you safe from STIs (sexually transmitted infections). When choosing your preferred type of contraceptive, bear in mind that hormonal ones will not protect against STIs.

Do I need to use contraception?

The majority of people need to use some kind of contraception if they want to avoid getting pregnant or avoid getting an STI, which is equally important. If you are between the ages of puberty and the menopause, both you and your partner are fertile, and you want to avoid pregnancy, you should be using some kind of contraception. If you have gone through the menopause and don’t have periods, you cannot get pregnant, but you can still get an STI. You should still use protection unless you know your partner is clean. Some religions and cultures do not allow contraceptives to be used, in which case you should be extra vigilant and go for an STI check after every new sexual partner - you can’t be too careful.

However not every kind of contraception is suitable for every person. For example, if you have a latex allergy you might not be able to use all types of condoms. Not all women can use all types of hormonal contraceptive either, but there are many variations and your doctor can help you find the one that is right for you.

Should I take The Pill?

As a form of contraceptive, The Pill is one of the most reliable forms of reversible protection you can get. It's easy to take, and there all kinds of reminder apps for your smartphone if you think you are likely to forget a pill. The Pill also doesn't interrupt sex, which is why some people don't like to use condoms - they feel it can spoil the mood or the moment. However, bearing mind that Tel does not protect against STIs, so you should only use it if you know that you and your partner are clean. A lot of women prefer to use The Pill if they are in a long-term monogamous relationship.

As well as its primary use as a hormonal contraceptive, there are other reasons why women choose to take The Pill. If you suffer from particularly heavy or irregular periods, the combined pill which includes a seven day break may help you to regulate these. Some women also find that taking the POP (progestogen only pill) can alter their periods to make them lighter and less painful, but may change their regularity. If you regularly experience painful periods to the point where they leave you incapacitated, there may be a more serious problem. A small amount of women have a condition called endometriosis. This is a painful illness where the lining that should be inside your womb grows outside of the womb. It can be resolved with surgery to remove the excess tissue, and you should speak to your doctor if you think you may be suffering from it.

What are the different types of Pill?

There are two main types of Pill: the combined pill and the POP (progestogen only pill, sometimes known as the mini pill). The combined pill is the more common type of contraceptive as it helps to keep your periods regular, but it is not suitable for everyone.

The combined pill

As the name implies, the combined pill contains two types of hormones: an oestrogen and a progestogen hormone. With most types of combined pill, you take one pill a day for twenty one days and then have a seven day break. During this break you should have your period, although it is unlikely to last the whole week. It is important that you restart taking the pill after your break, regardless of if, when, and how much you bleed. It may take a few months for your period to totally settle, but this is natural. This type of Pill is sometimes taken to ease the pain or irregularity of uncomfortable periods.

Understandably, some people worry they won't remember to restart taking the pill after that break. If you think you're likely to do this, some brands of the Pill also offer what is known as ED version. ED stands for every day, and with this type of pill you take one inactive tablet seven days instead of having a break from taking any. This means your body still gets the hormonal break but you don't have to change your routine.

Some brands of the pill have various colour tablets in their blister packs. If your pill is like this that's because each colour tablet has a different ratio of oestrogen and progestogen hormones. If you take your pills in the order outlined in the patient information leaflet, the ratio of hormones in each colour tablet will match the stage you are at in your menstrual cycle. Some people find this reduces the side-effects, but it may add problems if you miss a pill. Again, these changing ratio pills are also available as ED (every day) pills.

The dozens of different brand of pill. Most of them contain different variations of the two hormones, or different ratios of them. The human body is a very finely tuned machine and once you start manipulating hormones, the side effects can sometimes be unpleasant. If you experience adverse side effects when taking the pill, speak with your doctor about it and they may prescribe you a different one. However, they're in mind that in most cases it takes 3 to 6 months for side effects to settle down and become normal. You shouldn't be too concerned if your first menstrual cycle on the pill feels very different to usual.

The POP

The POP, sometimes known as the progestogen only pill (or the minipill as it is physically smaller), contains only one hormone. There are less variations of the POP available than there are of the combined pill. When you take the progestogen only pill, you take one pill every day for 28 days. When you finish your blister pack, you start the next one the next day without the gap. Because you do not have a break in the tablet, the timing of your period may change. Your periods may get more or less regular, heavier or lighter, or stop completely. Most people prefer not to use this type of pill because of these changes. However, as the minipill contains only one hormone, it affects your body less and means more women can use it. Certain women can't take the combined pill as it is more dangerous for high-risk groups.

Why is Dianette different?

Dianette is the type of pill which also contains an anti androgen, which has the second function of the progestogen hormone. This anti androgen works alongside oestrogen hormone (making it a combined pill) to prevent pregnancy as well as managing severe acne and excessive hair growth. It should generally only be used when antibiotics haven't helped to clear up the problem. Although it may sound like a silver bullet to fix multiple problems, it isn't very often prescribed, as it carries with it a higher risk of blood clots and certain types of cancer.

Which Pill is right for me?

The Pill is right for the majority of women wanting to protect themselves from getting pregnant, but your age and medical history will affect which is the better type of Pill for you to be on.

As a general rule, you should not take the combined pill if:

  • You’re pregnant
  • You smoke and are over 35, or stopped smoking less than a year ago and are over 35
  • You’re very overweight
  • You have a history of blood clots
  • Anyone in your close family has had a blood clot before the age of 45
  • You have had a stroke, heart disease, or high blood pressure
  • You get severe migraines
  • You have or have had breast cancer
  • You have a disease of the gallbladder or liver
  • You have certain severities of diabetes

Speak to your doctor if any of the above affect you.

As for the POP, you should not take it if:

  • You are pregnant
  • You have unexplained vaginal bleeding
  • You have heart disease, an illness in the arteries, or have had a stroke
  • You have a liver disease
  • You have or have had breast cancer
  • You have severe cirrhosis or liver tumours

How effective is The Pill?

Taken correctly, the pill is 99% effective. When you're prescribed pill your doctor will tell you how much leeway you have in taking it. Some pills only have a window of a few hours, but some may allow you to take it up to 8 hours later than you should. For maximum effectiveness, the pill should be taken exactly the same time of day each day, although it doesn't matter when the day this is. Read your patient information leaflet thoroughly as this will explain what to do if you should miss a pill. If you're taking a combined pill, what to do will be affected by how far through your cycle (or your blister pack) you are. If you think you're likely to forget to take your pill, you should consider being on an ED pill or the minipill. There are also apps for your smartphone to help you remember when to take a pill.

Bear in mind that The Pill does not protect you against STIs, and you should use a condom if you do not know for certain that your partner is clean. You should get an STI test done after every new sexual partner, just to be safe.

How safe is The Pill?

As The Pill is effective because it affects your hormones, it does come with some side effects. Dependent on your medical history, you will be put on a variation of the pill which is least likely to give you adverse side-effects. However, side effects can include headaches, mood swings, higher risk of depression (especially among young women), changes to your periods, and more serious side-effects such as the risk of blood clots and certain types of cancer. Read the patient information leaflet thoroughly so you are aware of the symptoms of a blood clot. Your doctor will talk you through all the potential side-effects when they are helping with your prescription.