Birth Control
Natural Family Planning
Temperature - raised after ovulation
Cervical position and mucous consistency - thinner mucous during ovulation
LH testing - detection of ovulation
Lactational Amenorrhea - prolactin during breastfeeding inhibits menstrual cycle
Barrier Contraception
Condoms - Made of Latex, so should be avoided in those with a latex allergy. Using oil-based lubricants can make it more likely to tear. It offers very good protection against STIs.
Caps/Diaphragms:
Diaphragm (Vaginal) Caps made of Latex
Suction (Cervical) Caps made of Plastic
Important to use spermicide with these and leave it in at least 6 hours after sex. It offers very little protection against STIs, so condoms will still needed.
Combined Oral Contraption (COCP)
Oestrogen acts on the Anterior Pituitary, Hypothalamus, Ovary, and Endometrium
Progesterone acts on the Anterior Pituitary, Hypothalamus, Endometrium, Uterine tubes, and Cervical mucous.
The COCP works to:
Stop ovaries producing an egg each month
Thicken cervical mucus to stop sperm entering the womb
Thin the lining of the womb, making it less likely for a fertilised egg to implant and grow
It can be taken as a:
Monophasic 21-day pill - each pill has the same amount of hormone, so a pill is taken for 21 days followed by a 7-day break
Phasic 21-day pill – each pill has a different amount of hormone, so the pill have to be taken in the correct order for 21 days followed by a 7-day break
Everyday pill – 21 hormone-containing pills, and 7 hormone-free pills, so a pill is taken for 28 days without a break
Everyday pill is a better option if you feel you may forget to take a pill or feel you’ll benefit from knowing you’ve taken a pill everyday
What is done if a pill is missed:
1 pill missed – Take the missed pill straight away and continue taking the rest of the pack as normal (may mean taking 2 pills in the same day); still take the next pill at the usual time
2-7 pills missed
Week 1/2 – Same as if 1 pill was missed (ignore the other missed pills), but also use condoms/abstain from sex for the next 7 days.
Week 3 – Same as if 1 pill was missed (ignore the other missed pills), but also use condoms/abstain from sex for the next 7 days. SKIP THE PFI. Seek emergency contraception if have had UPSI in the last 7 days.
Advantages:
99% effective – But, its effectiveness depends on compliance!
Non-invasive method, unlike others like the coil
Improves any problems with periods e.g. more regular, lighter, less painful
May help with any symptoms of premenstrual syndrome
Disadvantages:
User-dependent – does rely on you remembering to take the pill daily
Common side-effects of headache, mood changes, or breast tenderness
Breakthrough bleeding in first few months (unexpected spotting)
No protection from STIs
Increases the risk of:
VTE
Breast cancer
Cervical cancer
Contraindications:
Pregnancy
Breastfeeding up to 6 weeks
35+ years and smoker
BMI 35+
Migraine w/aura
CVS and VTE risk factors
Family history of breast cancer
Progestogen Only Methods
Come in the form of Pills (POP), Implants, IUDs, and Injections. It works the same way as the COCP, just without the effects of the oestrogen. It's characteristics include:
As effective and predictable as the COCP
New generation POPs have favourable side effect profile, and less contraindications due to the absence of oestrogens
12-hour window vs 3-hour window for COCPs
What is done if a pill is missed:
1 pill missed < 3 hours late – Take the missed pill straight away and continue taking the rest of the pack as normal
1 pill missed > 3 hours late – Take the missed pill straight away and continue taking the rest of the pack as normal. Won’t be completely protected so use condoms for the next 2 days.
If had sex in the same period as the missed pill, seek advice on emergency contraception.
Advantages:
99% effective – But, its effectiveness depends on compliance!
Non-invasive method
Improves any problems with periods e.g. more regular, lighter, less painful
Useful if can’t take oestrogens
Safe during breastfeeding
Disadvantages:
User-dependent – does rely on you remembering to take the pill daily
Common side-effects of headache, mood changes, or breast tenderness
No protection from STIs
Increases the risk of:
Ovarian cysts – not dangerous and often resolve on its own
Breast cancer
Contraindications:
Pregnancy
Breast ca.
Liver cirrhosis
Liver ca.
Intrauterine Devices/System (IUD/IUS)
Can be Copper bearing or Hormone bearing, and is a small device inserted and left in the uterus long-term.
Contraindications:
Current Pelvic inflammatory disease
Suspected/Known pregnancy
Unexplained Vaginal bleeding
Abnormal cervical/uterine anatomy
Emergency Contraception
UPSI = Unprotected Sexual Intercourse
The options for emergency contraception are Levonelle, EllaOne, and the Copper-bearing IUD.
Levonelle
Works by delaying ovulation for around 5 days (any sperm would’ve died off by the time an egg is released). It can be taken up to 72 hours after UPSI, but becomes less effective the longer its delayed.
It's the least effective of the 3 options. For most, it’s a very safe option, but for some it can cause them to feel a little nauseous, and their period might be early or late.
Advantages:
Safe
Can be used as a bridge to start ongoing contraception to reduce the risk of future pregnancies
Disadvantages:
Least effective
Shorter window to take it
EllaOne
Works by delaying ovulation for around 5 days (any sperm would’ve died off by the time an egg is released). It can be taken up to 120 hours/5 days after UPSI,
For most, it’s a very safe option, but for some it can cause them to feel a little nauseous, and their period might be early or late.
Advantages:
Safe
Has a longer window for it to be taken
More effective than Levonelle
Disadvantages
Not the most effective of the 3
Made less effective by progestogen use e.g. taking POP within last 7 days
Copper-bearing IUD
Small T-shaped device that’s inserted into the womb during a quick procedure. Contains copper, which has a toxic effect to prevent fertilisation (kills sperm) and implantation. It can be used up to 5 days after UPSI OR 5 days after likely ovulation date (14 days before the next cycle). This device has to be left in for a minimum of 21 days.
It's the most effective of the 3 options.
Advantages:
Extremely effective (< 1% of women become pregnant)
Can be kept in as regular contraception for up to 10 years
If kept in, it can make the periods heavier and more painful
Has a longer window for it to be taken
Disadvantages:
Procedure required, which carries a small risk of infection and perforation
Some experience irregular bleeding for a few days after the fitting of the IUD, and periods may be heavier, longer and more painful, especially in the first few months
