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DR. DAWN HARPER CONTRACEPTION

DR. DAWN HARPER | CONTRACEPTION


CONTRACEPTION Most sexual activity is for pleasure and not procreation and with that comes an obvious need for contraception. Whole books have been written about contraception and there is more choice today than ever before, so let’s take a quick look at what is available.

The Male Condom: An excellent form of contraception (up to 98% effective if used properly) that also protects against many sexually transmitted infections. Make sure you always use ones with the British Standard kite mark or the European CE marking. The best are those containing the spermicide nonoxinol-9. If you are using condoms, avoid oil-based lubricants such as massage oils or petroleum jelly as they can weaken the rubber. The Female Condom: This is a one-size female condom that can be inserted into the vagina. It works, but most women I have met who have it liken it to making love through a crisp packet!

Caps and Diaphragms: These can be placed in the vagina several hours before sex so you need not interrupt lovemaking. They are quoted as being up to 96% effective but this does rely on them being used properly, which some women may find tricky. In my opinion, they are a great form of contraception for anyone not wanting to use hormones, but for whom pregnancy wouldn’t be a disaster.

The Pill: This usually means the combined contraceptive pill (COC), which contains both oestrogen and progestogen. It works predominantly by stopping ovulation. There are lots of brands available, containing different amounts of oestrogen and progestogen, so if you don’t get on with one then ask your doctor about an alternative. The COC

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isn’t for everyone though, and you shouldn’t take it if you: • • • • • • • •

Have a family history of blood clots Have a high blood pressure Are over 35 and smoke Are severely obese (BMI of over 39) Have known liver disease Have migraine with aura Are pregnant or breast feeding Have breast cancer

Side effects such as bloating, breast tenderness, mood swings, weight gain, and headaches are common in the early stages of use, but tend to disappear with time. The Patch: Like the pill, the patch contains both oestrogen and progestogen, so has similar side effects


and cautions. The patch only needs replacing every week so is a good option for anyone who finds taking a pill every day difficult to remember. The Mini-pill: Also known as the progestogen only pill (POP), this is an excellent alternative for women who can’t take oestrogen. Unlike the COC, it really must be taken at the same time or within three hours of that time every day (with the exception of one of the newer brands, which must be taken within 12 hours) and instead of giving a regular light bleed, some women find they have erratic bleeding using the POP. Common side effects include weight gain, breast tenderness, and spotty skin.

The Intrauterine System (IUS): This is a small T-shaped device that is placed in the uterus and secretes tiny amounts of progestogen (about the same as two mini-pills a week) directly where it is needed - the uterine lining. It may cause erratic bleeding for a few months, but most women find the bleeding settles and many stop their periods altogether after six months. The IUS needs to be replaced every five years. The Coil: This looks similar to the IUS but does not contain any hormone. There are several brands available, lasting anything up to 10 years. They are very effective, but shouldn’t be used by women at high risk of sexually transmitted infection or ectopic pregnancy. Some women find their periods are heavier using the coil, but since many women go from using the pill, which tends to cause lighter periods, they are not necessarily comparing like for like.

The Injection: What about the ‘Morning After Pill’? There are two contraceptive injections used in the UK. They are The ‘morning after pill’ is something of a misnomer as it given every eight or 12 weeks, usually implies that it must be taken the following morning. In fact into the buttocks. They contain just it can be taken anything up to 72 hours after unprotected progestogen and are particularly sex, although the earlier the better, It does not require a useful for women who forget to take doctor’s prescription and can be bought over the counter pills. They can cause erratic bleeding at pharmacies; many ‘out of hours’ centres and, although they have no longalso carry stock. In addition there is also a term effect on fertility, unlike other newer post coital contraceptive pill that can progestogen only methods, it can take up to a be taken up to five days after unprotected year for fertility to return completely to normal, sex. so contraceptive injections are best avoided by women planning a family in the near future. There has also been concern about their effect on bone Where can I go for contraception? mass and, although there is no proven link between their use and the development of osteoporosis Your doctor can prescribe pills and patches later in life, I am cautious about using them in and give injections. Many can also fit coils, women who are at a high risk of osteoporosis. implants, and the intrauterine system. If you don’t want to see your family doctor, you can actually see any GP for contraceptive The Implant: services (you don’t have to be registered at the practice) or you can make your own Another progestogen only method, this is a small appointment at your local family planning rod the size of a matchstick that is inserted (under clinic; to find your nearest clinic (and for local anaesthetic) beneath the skin in the upper more information about contraceptive arm. It needs to be replaced after three years. choices) visit www.fpa.org.uk. D

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Contraception Guide