Family planning

Contraceptive Choices at D2 Medical

How effective is contraception?

All the methods of contraception listed below are effective and all are available in our clinic. However, no method is absolutely 100% reliable. The reliability for each method is given in percentages. For example, the contraceptive injection is more than 99% effective. This means that less than 1 woman in 100 will become pregnant each year using this method of contraception. The effectiveness of some methods depend on how you use them. You have to use them properly, or they may lose their effect. For example, the 'pill' is more than 99% effective if taken correctly. If it is not (for example, if you miss a pill, etc) then it becomes less effective. Other 'user dependent' methods are barrier methods, the progestogen only pill, and natural family planning. Some methods are not so 'user dependent' and need to be renewed only infrequently or never. These methods are: the contraceptive injection, implant, intrauterine devices, and sterilisation.

When no contraception is used, more than 80 in 100 sexually active women become pregnant within 1 year.

What are the different methods of contraception available at the D2 Medical?

Choosing a method of contraception involves a balance between.

  • how effective it is
  • possible risks and side-effects
  • plans for future pregnancies
  • personal preference
  • if you have a medical condition that needs to be considered.

Combined pill

Often just called 'the pill'. It is more than 99% effective if used properly. Contains oestrogen and progestogen. Works mainly by stopping ovulation. It is very popular. Different brands suit different people.

  • Some advantages - Very effective. Side-effects uncommon. Helps ease painful and heavy periods. Reduces the chance of some cancers.
  • Some disadvantages - Small risk of serious problems (eg thrombosis). Some women get side-effects. Have to remember to take it. Can't be used by women with certain medical conditions.

Progestogen only pill (POP)

Used to be called the 'mini-pill'. Contains just a progestogen hormone. More than 99% effective if used properly. Is commonly taken if the combined pill is not suitable. For example: breast-feeding women, smokers over the age of 35, and some women with migraine. Works mainly by causing a plug of mucus in the cervix that blocks sperm, and by thinning the lining of the uterus. May also stop ovulation.

  • Some advantages - Less risk of serious problems than the combined pill.
  • Some disadvantages - Periods often become irregular. Some women have side-effects. Not quite as reliable as the combined pill. May be less effective if you weigh over 70kg (11stone).

Barrier methods

These include male condoms, female condom, diaphragms, and caps. Prevents sperm entering the uterus. Male condoms are about 98% effective if used properly. Other barrier methods are slightly less effective than this.

  • Some advantages - No serious medical risks or side-effects. Helps protect from sexually transmitted infections. Condoms are widely available.
  • Some disadvantages - Not quite as reliable as other methods. Needs to be used properly every time you have sex. Male condoms occasionally split or come off.

Contraceptive injections (eg Depoprovera) at the D2 medical

Contains a progestogen hormone which slowly releases into the body. More than 99% effective. Works by preventing ovulation and also has similar actions as the POP. An injection is needed every 8-12 weeks.

  • Some advantages - Very effective. Don't have to remember to take pills.
  • Some disadvantages - Periods may become irregular (but often lighter or stop altogether). Some women have side-effects. Normal fertility after stopping may be delayed by several months. Can't undo the injection, so if side-effects occur they may persist for 8-12 weeks or slightly longer.

Contraceptive implants (eg Implanon) available in the D2 Medical

An implant is a small device placed under the skin. Contains a progestogen hormone which slowly releases into the body. Is more than 99% effective. Works in a similar way to the contraceptive injection. Involves a small minor operation using local anaesthetic. Each one lasts 3 years.

  • Some advantages - Very effective. Don't have to remember to take pills.
  • Some disadvantages - Periods may become irregular (but often lighter or stop altogether). Some women develop side-effects but these tend to settle after the first few months.

Intrauterine device (IUD) available in the D2 Medical,
A plastic and copper device is put into the uterus. Lasts 5 or more years. It works mainly by stopping the egg and sperm from meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus. The copper also has a spermicidal effect (kills sperm).

  • Some advantages - Very effective. Don't have to remember to take pills.
  • Some disadvantages - Periods may get heavier or more painful. Small risk of serious problems.

Hormone releasing intrauterine device (eg Mirena) in the D2 Medical

Otherwise called the intrauterine system (IUS). A plastic device that contains a progestogen hormone is put into the uterus. The progestogen is releasedata slow but constant rate. More than 99% effective. Works in a similar way to the POP. Is also used to treat heavy periods (menorrhagia).

  • Some advantages - Very effective. Don't have to remember to take pills. Periods become light or stop altogether.
  • Some disadvantages - Side-effects may occur as with other progestogen methods such as the POP, implant and injection. However, they are much less likely as the hormone is mainly confined to the uterus (little gets into the bloodstream).

Natural methods

This involves fertility awareness. Effective if done correctly. Requires commitment and regular checking of fertility indicators such as body temperature and cervical secretions.

  • Some advantages - No side-effects or medical risks.
  • Some disadvantages - May not be as reliable as other methods. Fertility awareness needs proper instruction and takes 3-6 menstrual cycles to learn properly.

Sterilisation

Involves an operation. Is more than 99% effective. Vasectomy (male sterilisation) stops sperm travelling from the testes. Female sterilisation prevents the egg from travelling along the Fallopian tubes to meet a sperm. Vasectomy is easier and more effective than female sterilisation. Popular when family is complete.

  • Some advantages - Very effective. Don't have to think further about contraception.
  • Some disadvantages - Very difficult to reverse. Female sterilisation usually needs a general anaesthetic.

Emergency contraception

Can be used if you had sex without using contraception. Also, if you had sex but there was a mistake with contraception. For example, a split condom or if you missed taking your usual contraceptive pills.

  • Emergency contraception pills - are usually effective if started within 72 hours of unprotected sex. It works either by preventing or postponing ovulation, or by preventing the fertilised egg from settling in the uterus (womb).

Combined Oral Contraceptive Pill at the D2 medical

How does the pill work?

The pill works mainly by changing the body's hormone balance so that you do not ovulate. That is, you do not release an egg (ovum) each month from an ovary. In addition, it causes the mucus made by the cervix to thicken and form a 'mucus plug' in the cervix. This makes it difficult for sperm to get through to the uterus (womb) to fertilise an egg. The pill also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

How effective is the pill?

It is over 99% effective if used correctly. This means that less than 1 woman in 100 using the pill correctly will become pregnant each year. Correct use means not missing any pills, and taking extra contraceptive precautions when necessary (for example, when taking antibiotics - see below).

Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.

What are the advantages of the pill?

It is very effective. It does not interfere with sex. Periods are often lighter, less painful, and more regular. It may relieve pre-menstrual tension. It reduces the risk of developing cancers of the ovary, colon and uterus (womb). In particular, the protection against cancer of the ovary is quite marked, and the protection seems to continue for many years after stopping the pill. It may also reduce the risk of pelvic infection (as the 'mucus plug' may prevent bacteria, as well as sperm, from getting into the uterus). It may help to protect against some benign (non-cancerous) breast disease. It may reduce the risk of developing certain types of cyst in the ovary.

Are there any side effects when taking the pill?

Most women who take the pill do not develop any side-effects. However, some women develop nausea (feeling sick), headaches, or sore breasts. These usually go away within days or weeks of starting the pill. If they persist, a different brand of pill may suit better.

Other side-effects are uncommon and include tiredness, change in sex drive, skin changes, and mood changes. These are unusual and you should tell your doctor or practice nurse if you have any persisting side-effects.

Blood pressure

The pill sometimes causes a rise in blood pressure. Therefore, if you take the pill you should have your blood pressure checked about every six months. The pill may need to be stopped if your blood pressure becomes high.

Who cannot take the pill?

Most women can take the pill. The D2 medical will discuss any current and past diseases that you have had. Some diseases cause an increased risk or other problems with taking the pill. Therefore, the pill will not be prescribed to some women with a history of certain diseases or who are at increased risk of developing certain diseases. For example, some women with an increased risk of having a blood clot (thrombosis) may be advised not to take the pill (see below).

If you are breastfeeding you should not take the pill as it can reduce the amount of milk. Other forms of contraception are available if you are breastfeeding.

Are there any risks in taking the pill?

For most woman the benefits far outweigh the disadvantages as the risks are small. However, a small number of women who take the pill develop serious problems. These include the following:

  • Thrombosis which means a blood clot in a blood vessel. This can be very serious and cause a stroke, a blood clot in the lung (pulmonary embolus), or other serious problems. The following situations increase the risk of thrombosis if you take the pill. The pill may not be advised in these circumstances:
    • If you have had a previous thrombosis.
    • Severe obesity.
    • Immobility (for example, wheelchair bound).
    • Severe varicose veins.
    • Poorly controlled diabetes.
    • High blood pressure.
    • If you have a close family member who has had a thrombosis, heart attack, or stroke before the age of 45.
    • Severe migraine.
    • If you have any complications from diabetes or have had diabetes for more than 20 years.
    • Smoking - particularly if you are over 35.
    • Some other rare conditions.

Call the D2 medical straight away if you have any of the following: severe headache, bad pains in the chest or leg, leg swelling, breathing difficulty, if you cough up blood, sudden problems with sight or speech, weakness or numbness in an arm or leg, collapse.

  • Cancer. There is a small increased risk of developing breast cancer in women who use the pill. Some studies also suggest a possible link between the pill and a slight increased risk of cancer of the liver or cervix. These have to be balanced against the much reduced risk of developing cancer of the ovary, and of the reduced risk of developing cancer of the uterus and colon mentioned in 'advantages'. When all cancers are grouped together, the overall risk of developing a cancer is reduced if you take the pill.

How do I take the pill?

There are different brands of pill which contain varying amounts and types of oestrogen and progestogen. There is usually a leaflet inside the packet of pills. Read the leaflet carefully and make sure you understand how to take the pill and what to do in special situations such as if you miss a pill or vomit. The following gives a general guide.

Brands with 21 day pills

Most brands of pill come in packs of 21. To start, it is best to take the first pill on the first day of your next period. You will be protected against pregnancy from then on. If you start the pill on any other day, you need an additional contraceptive method (such as condoms) for the first seven days. Take your pill at about the same time each day for the 21 days.

You then have a break of seven days before starting your next pack. You will usually have some bleeding in the seven day break. This is called a 'withdrawal bleed' and is like a period, although strictly speaking it is not a 'menstrual period'. You will be protected from pregnancy during the seven day break provided you have taken your pills correctly and you start the next pack on time. Start the next pack after the seven day break whether you are still bleeding or not. If you take the pill correctly, you will start the first pill of each pack on the same day of the week.

Most 21 day pills have the same amount of oestrogen and progestogen in each pill. Some brands called phasic pills vary the dose in two or three steps throughout the 21 days. The pills in these packets have to be taken in the correct order as directed on the packet.

Brands with everyday pills

These contain 21 active and seven 'dummy' pills. Instead of a seven day break, you carry on taking the dummy pills. The idea is that you don't have to remember to re-start the pill after a seven day break. So, you get in a routine of taking a pill everyday. The pills have to be taken in the correct order. Read the instructions carefully, particularly on when to start, which pill to start with, and how long it takes for the contraceptive effect to begin.

What if I miss or forget to take one or more pills?

Read the leaflet that comes with your brand of pill for advice on what to do. Ovulation (and therefore pregnancy) may occur if you miss pills, particularly if the missed pills are at the end or beginning of the packet. Generally, the advice depends on how many pills you have missed, and when they were missed in the cycle.

If you are unsure as to what to do, or if you are unsure that you have taken the pill correctly, then use other forms of contraception (such as condoms) and seek advice from a doctor or nurse.

Do other medicines interfere with the pill?

Yes, some do but most do not. Therefore, before you take any other medicines, including those available to buy without a prescription, herbal and complementary medicines, ask your doctor or pharmacist if they stop the pill from working properly. He or she will advise you what to do. For example, certain antibiotics are the most common example of medicines that can stop the pill from working properly. Other examples include some medicines that are used to treat epilepsy and TB. St John's Wort is an example of a commonly used herbal remedy that can affect the pill.

Antibiotics

Your doctor will normally advise on what to do if you are prescribed an antibiotic. Generally, when prescribed a short course of antibiotics (up to three weeks) you should carry on taking your pill. But, in addition, you should use another method of contraception (usually condoms) whilst you are on the antibiotics, and also for a further seven days after you have finished the course of antibiotics.

Further, when you stop the course of antibiotics, if you have less than seven pills left in the packet you should not have the usual seven day break from taking the pill. You should start the next packet straight away. (If you are taking an 'everyday' brand and you have less than seven active pills left, then throw away the dummy pills and go straight onto the active pills of the next packet.)

Further, if you are in the first week of your pill packet, and you start some antibiotics, and you have had sex in the last few days, then seek advice from your doctor or nurse. You may need emergency contraception.

For long courses of antibiotics such as those given for acne, ask your doctor for advice.

What if I vomit or have diarrhoea?

If you vomit within 2-3 hours of taking a pill, the pill will not have been absorbed. If you are well enough, take another pill as soon as possible. Provided that you do not vomit this second pill and it is taken on the same day, then you will remain protected from pregnancy. If you continue to vomit, then it is the same as 'missing pills' (see above).

Mild diarrhoea does not affect the absorption of the pill. Severe diarrhoea may do so, and so if you have severe diarrhoea, consider this as the same as 'missing pills' (see above).

What happens if I don't have a withdrawal bleed (like a period) between packs?

It is normal to have bleeding (like a period) during the seven day break between pill packs (or when taking the 'dummy' pills in everyday pills). However, it is quite common for there to be no bleeding between pill packs. You are not likely to be pregnant if you have taken the pill correctly and have not vomited or taken any medicines that can interfere with the pill. Start the next pack after the usual seven day break and continue to take your pill as usual.

See your doctor or nurse if: you don't have any bleeding after the next pack (two packs in total), or you have not taken the pill correctly, or you have any reason to think that you may be pregnant. A pregnancy test may be advised.

Bleeding whilst on the pill (breakthrough bleeding)

During the first few months while your body is adjusting to the pill you may have some vaginal bleeding in addition to the usual bleeding between packs. This is not serious but more of a nuisance. It may vary from 'spotting' to a heavier loss like a light period. Do not stop taking your pill. This usually settles after the first 2-3 months. If it persists, see your doctor or nurse. Another brand of pill may be more suitable for you.

Can I delay or skip a withdrawal bleed (period)?

There are times when it is useful not to have vaginal bleeding (a 'period' between packs). For example, during exams or holidays. Check with your doctor or nurse about the best way to do this with your particular brand of pill. For the commonly used pill types (that is, not 'bi-phasic' or 'tri-phasic' or 'everyday' types) you can go straight into your next pack without a break. Have the usual seven day break at the end of the second packet. If you just want to delay the withdrawal bleed, begin the new pack without the seven day gap and when you want your bleeding to start, stop taking the pill. Have a seven day gap in the usual way and then start a new pack after this. (You should only do these modifications now and again as regular monthly withdrawal bleeds are normally recommended.)

Intrauterine Device (IUD) at the D2 Medical

What is an IUD?

An IUD is a small device made from plastic and copper. It was previously known as 'the coil'. It can be placed quite easily into the uterus (womb) by a trained doctor at the D2 Medical..

How does the IUD work?

It works mainly by stopping the egg and sperm from meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus. The copper also has a spermicidal effect (kills sperm).

How effective is the IUD?

Modern IUDs are 99% effective or more. This means that up to 1 women in 100 will become pregnant each year using this method of contraception. (Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.) There are different types of IUD. Older ones were slightly less reliable - about 98% effective.

What are the advantages of the IUD?

Once an IUD is inserted you can forget about contraception. So, unlike the pill, you don't need to think about contraception every day. It does not interfere with sex. It is not a hormonal method so it has no side-effects on the rest of the body. Most women can have an IUD if they wish.

What are the disadvantages of the IUD?

Most women with an IUD have no problems, but the following occasionally occur.

  • Periods - some women find that their periods become heavier, longer, or more painful with an IUD. This tends to be in the first few months after insertion, and then often settles. So the IUD may not be suitable if you already have heavy or painful periods. However, painful and heavy periods can still be treated in the same way as in women who don't have an IUD. For example, by taking anti-inflammatory painkillers or other drugs during periods. Also, there is a special IUD called the intrauterine system (IUS). This device is like an IUD, but it also releases a progestogen hormone into the uterus. This is an effective treatment for heavy periods as well as a contraceptive.
  • Infection - there is a small risk of an infection of the uterus (pelvic infection). The main risk is within the first 20 days after insertion. A check for infection of the vagina or cervix may be advised before an IUD is inserted. A sample (swab) may be taken and sent for testing. This may include checking for chlamydia infection. The risk of a pelvic infection from a sexually transmitted infection is also greater in women with a IUD. Therefore, an IUD may not be advisable if you have an increased risk of getting a sexually transmitted infection. For example, if you have more than one sexual partner. An IUD is not advisable if you have previously had a pelvic infection.
  • Ectopic pregnancy - the chance of becoming pregnant is very small if you use an IUD. However, if you do become pregnant, there is a higher than normal chance that the pregnancy will be ectopic. This means the pregnancy is in the fallopian tube and not in the uterus. This is rare, but serious. See a doctor urgently if you miss a period and develop lower abdominal pain. An IUD is not advisable if you have previously had an ectopic pregnancy.
  • Expulsion - rarely the IUD may come out without you noticing.
  • Damage - the fitting of an IUD can (rarely) cause damage to the uterus.

How is the IUD fitted?

This is usually done towards the end of a period or shortly after. However, it can be fittedatany 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 crampy pains 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.

Follow up

The doctor or nurse will usually want to check that there are no problems a few weeks after fitting an IUD. After this, there is no need for any routine check until it is time to remove the IUD. However, return to see your doctor or nurse at any time if you have any problems or queries. Most women have no problems, and the IUD can remain in place for several years.

An IUD can be removedatany time by a trained doctor or nurse. If you plan to have it removed, but do not want to get pregnant, then use other methods of contraception (such as condoms) for seven days before it is removed. This is because sperm can last up to seven days in the uterus and can fertilise an egg after the IUD is removed.

You can use sanitary towels or tampons for periods with an IUD in place.

Progestogen Only Pill at the D2 Medical

How does the POP work?

The POP contains a progestogen hormone. This is similar to the progesterone hormone made by the ovaries. It works mainly by thickening the mucus made by the cervix which forms a 'mucus plug' in the cervix. This stops sperm from getting through to the uterus (womb) to fertilise an egg. The POP also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus. It also has some effect on the ovary and ovulation may not occur (the release of egg each month).

How effective is the POP?

The POP is 99% effective if used correctly. This means that 1 woman in 100 using the POP correctly will become pregnant each year. Correct use includes taking it at the same time every day. If it is not taken correctly, more women will become pregnant. Some studies suggest it may be less effective in women who weigh more than 11st (70kg).

What are the advantages of the POP?

It does not interfere with sex. You can take it when you are breastfeeding. The risks associated with the oestrogen in the combined pill (eg blood clots) do not occur. It can therefore be used by some women who cannot take the combined pill. For example, women over 35 who smoke.

What happens to your periods when you take the POP?

The effect on periods can vary. Some women have regular normal periods. Some have irregular periods which may be longer and heavier, or shorter and lighter, than usual. Some women continue to have regular periods but may have occasional 'spotting' between periods. Some women have very infrequent, or no, periods. Irregular or unpredictable periods can be a nuisance, but is of no medical concern. Keep taking the POP everyday, including when you have periods.

Are there any side-effects with taking the POP?

Side-effects are uncommon. If one or more do occur, they often settle down over a couple of months or so. Examples of possible side-effects include: headaches, mood swings, weight gain, reduced sex drive, fluid retention, increase in acne, and breast discomfort.

Are there any risks with taking the POP?

If you become pregnant while taking the POP, you have an increased risk of ectopic pregnancy (pregnancy inside the fallopian tube and not in the uterus). This is uncommon, but serious. If you develop pain in the lower abdomen (tummy), particularly shortly after a missed or light period, see a doctor at the D2 medical quickly. This is to check an ectopic pregnancy has not occurred.

The POP also increases the risk of developing small, benign (non-cancerous) cysts in the ovary. These are not serious but sometimes cause pain.

Who cannot take the POP?

Most women can take the POP. The D2 medical will discuss any current and past illnesses. Some illnesses may mean that there is an increased risk with taking the POP. In particular, tell the doctor or nurse if you have a history of heart disease, liver disease, cancer, ovarian cysts, unexplained vaginal bleeding, or ectopic pregnancy.

How do I take the POP?

Start taking the pill on the first day of your next period. It is immediately effective from then on. If you start on any other day, you should use additional contraceptive methods (such as condoms) for the first 2 days until the POP has become effective. If you have just had a baby the POP is immediately effective if you start taking it before day 21 after the birth.

You should take the POP at the same time of day, every day. Any time of day will do, but the most important thing is to get into a routine. Do not stop taking it when you have a period. You should take it every day. When you finish one pack, start another the next day.

What if I am ill with vomiting or diarrhoea?

If you vomit within 3 hours of taking your POP, or have severe diarrhoea, the pill will not be absorbed. Carry on taking the POP as usual, but you will need to use other forms of contraception (such as condoms) for the duration of the illness plus a further 7 days after the vomiting or diarrhoea have stopped.

Do other medicines interfere with the POP?

Some medicines may interfere with the POP and make it less effective. Tell the doctor or pharmacist that you take the POP if you are prescribed or buy another medicine.

Contraceptive Patch at the D2 Medical.

What is the contraceptive patch?

The contraceptive patch is a combined hormone form of contraception, containing oestrogen and progestogen hormones. It is essentially the same type of contraception as the combined oral contraceptive pill but it is used in a patch form instead of taking pills by mouth. The contraceptive patch is stuck onto the skin so that the two hormones are continuously delivered to the body. This gives contraceptive cover.

There is one combined contraceptive patch available in the Ireland called Evra. The contraceptive patch is available from the D2 Medical, family planning clinic or sexual health clinic. You should remember that the contraceptive patch will not protect you from sexually transmitted infections. You should use condoms to protect against these.

How does the contraceptive patch work?

The contraceptive patch works mainly by changing the body's hormone balance so that you do not ovulate. That is, you do not release an egg (ovum) each month from an ovary. In addition, it causes the mucus made by the cervix to thicken and form a 'mucus plug' in the cervix. This makes it difficult for sperm to get through to the uterus (womb) to fertilise an egg. The contraceptive patch also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

How effective is the contraceptive patch?

It is over 99% effective if used correctly. This means that less than 1 woman in 100 using the contraceptive patch correctly will become pregnant each year. Compare this to when no contraception is used: more than 80 in 100 sexually active women who do not use contraception become pregnant within one year.

What are the advantages of the contraceptive patch?

It is very effective and easy to use. It does not interfere with sex. You do not have to remember to take a pill every day but just have to remember to change the patch once a week. The patch is small and discreet so people won't easily notice that you are wearing it. It is skin coloured and is about 5cm x 5cm in size. The patch sticks well to your skin. It can be worn continuously, even while you are bathing, showering, exercising and swimming.

Your periods are often lighter, less painful, and more regular when you are using the contraceptive patch. If you have vomiting or diarrhoea, the contraceptive patch is still effective (unlike when you are taking the pill). This is because the hormones are absorbed into your bloodstream through your skin, rather than through your gastrointestinal tract (stomach and gut).

The other advantages of the contraceptive patch are thought to be similar to those of the combined contraceptive pill. However, because it is a newer form of contraception, there have not been as many research studies with the contraceptive patch as there have been with the pill. For example, the contraceptive patch may relieve pre-menstrual tension. It may also reduce the risk of pelvic infection (as the 'mucus plug' may prevent bacteria, as well as sperm, from getting into the uterus). It may help to protect against some benign (non-cancerous) breast disease. It may reduce the risk of developing certain types of cyst in the ovary. It may reduce the risk of developing cancers of the ovary, colon and uterus (womb).

What are the disadvantages of the contraceptive patch?

Some women have skin irritation when they use the contraceptive patch. This is usually itching, redness or soreness. About 2 in 100 women have to stop using the patch because of skin irritation. Even though the patch sticks well most of the time, there is a possibility that it can become detached from the skin, either totally or partially. This is not common but can mean that its effectiveness as contraception can be lost. Despite its discreet design, some women still feel that the contraceptive patch can be seen.

Are there any side effects of the contraceptive patch?

Some women get some mild side effects when they first start using the contraceptive patch. If side effects do occur, they tend to settle down within the first few months. Possible side effects can include:

  • Breast discomfort and tenderness.
  • Slight changes in body weight (these are small and are similar to those that can occur with the pill).
  • Headaches.
  • Nausea (feeling sick).
  • Mood changes.
  • Breakthrough bleeding (bleeding between your periods) and spotting (light, irregular bleeding).

The Contraceptive Injection at D2 Medical

What is the contraceptive injection?

The contraceptive injection contains a progestogen hormone. It has been used since the 1960's and is widely used world-wide. Depoprovera is the brand used at D2 Medical, and is given every 12 weeks.

How does the contraceptive injection work?

The progestogen is injected into a muscle and is gradually released into the bloodstream. It works mainly by stopping ovulation (the release of the egg from the ovary). It also thickens the mucus made by the cervix which forms a 'mucus plug' in the cervix. This stops sperm getting through to the uterus (womb) to fertilise an egg. It also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

How effective is the contraceptive injection?

It is more than 99% effective. This means that less than 1 woman in 100 who use this method of contraception will become pregnant each year. (Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.)

What are the advantages of the contraceptive injection?

  • You do not have to remember to take a pill every day.
  • You only have to think about contraception every 2-3 months.
  • It does not interfere with sex.
  • It can be used when breastfeeding.
  • It may help some of the problems of periods, such as pre-menstrual tension, heavy periods, and pain.
  • It can used by some women who cannot take the combined pill (which contains oestrogen).
  • It may help protect against pelvic infection. (The mucus plug in the cervix may help stop bacteria travel into the uterus.)

What are the disadvantages of the contraceptive injection?

  • The injection cannot be removed once given, so its effect lasts 2-3 months. If side-effects occur there is little that can be done about them.
  • Because the injection is long acting, it takes some time after the last injection for its effect to wear off. This time varies from woman to woman. Some women take 6-8 months after the last injection before fertility returns. Rarely, it can take up to 2 years before fertility returns. This delay is not related to the length of time you use this method of contraception.
  • Your periods are likely to change. During the first few months some women have irregular bleeding which can be heavier and longer than normal. But, it is unusual for heavy periods to persist. After the first few months it is more common for the periods to become lighter than usual, although they may be irregular. Many women have no periods at all. The longer it is used, the more likely periods will stop. Periods stop in about half of users within 12 months of use. Some women worry about changes to their periods, but they are of no consequence. However, unpredictable or irregular periods can be a nuisance.

Who cannot have the contraceptive injection?

Your doctor will discuss any current and past illnesses. Some illnesses may mean you cannot use the contraceptive injection. However, the number of women this affects is small.

Are there any side effects with the contraceptive injection?

Apart from changes to periods, side-effects are uncommon. If one or more do occur, they often settle down over a couple of months or so. Examples of possible side-effects include: headaches, mood swings, weight gain, reduced sex drive, fluid retention, increase in acne, and breast discomfort.

How is the contraceptive injection given?

The injection is given into a muscle, usually in the buttock. It should not be given during pregnancy. It is therefore important to be sure you are not pregnant when you have your first injection.

For this reason the first injection is usually given during the first 1-3 days of a period. If you have the injection within 5 days of starting a period, you will be protected against pregnancy from then on. Further injections are then given up to 12 weeks apart depending on the type used.

The Intrauterine System – IUS at the D2 medical

What is the IUS?

The IUS is a small device made from plastic and contains progestogen hormone. Therefore, it is called an intrauterine system (IUS) and not just an intrauterine device (IUD). Mirena is the one used at the D2 medical, although others will probably become available. It works for five years before needing replacing.

How does the IUS work as a contraceptive?

It works differently to an IUD as an IUS includes a progestogen hormone. It works mainly by thickening the mucus made by the cervix which forms a 'mucus plug' in the cervix. This stops sperm getting through to the uterus (womb) to fertilise an egg. The progestogen also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus. It may also have some effect on the ovary, and ovulation may not occur (the release of the egg each month).

How effective is the IUS for contraception?

It is more than 99% effective. This means that less than 1 women in 100 who use the IUS will become pregnant each year. (Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.)

What are the advantages of the IUS?

Once it is inserted you can forget about contraception for five years. It does not interfere with sex. Periods usually get lighter, less painful, and often stop (unlike the IUD). After 12 months most users only have a light bleed for one day per month, and about 1 in 5 users have no bleeding at all. Fertility returns as soon as it is removed.

What are the disadvantages of the IUS?

Most women have no problems, but the following occasionally occur.

  • Irregular bleeding - may occur for the first three months or so, but usually settles down.
  • Expulsion - rarely the device may come out without you noticing.
  • Damage - the fitting of the device can (rarely) cause damage to the uterus. Also, there is possibly a very small risk of an infection of the uterus (pelvic infection) developing soon after the fitting of the device.

Are there any side-effects?

Side-effects are uncommon. The progestogen released by the IUS mainly stays around the uterus and very little gets into the bloodstream. Therefore, side-effects are less common than with other progestogen forms of contraception such as the progestogen only pill and the contraceptive injection or implant. If side-effects do occur, they tend to develop just in the first 3-6 months, and then tend to ease and go. Examples of possible side-effects include: headaches, mood swings, weight gain, reduced sex drive, fluid retention, increase in acne, and breast discomfort.

Who cannot use the IUS?

A doctor at the D2 medical will discuss any current and past illnesses. Some illnesses may mean you cannot use progestogen based contraceptives such as the IUS. However, the number of women this affects is small.

The IUS as a treatment for heavy periods (menorrhagia)

The IUS has become popular as a treatment for heavy periods (menorrhagia). In most treated women, bleeding becomes very light, or stops altogether, within 3-9 months. In one study, the IUS was inserted into women on a waiting list for hysterectomy for heavy periods. 8 in 10 of these women then decided against having a hysterectomy as the IUS worked so well. It has been mainly studied in women who have heavy periods due to 'Dysfunctional Uterine Bleeding'. This is the commonest cause of heavy periods. It may not be suitable for heavy periods due to other causes such as fibroids.

How is the IUS fitted?

It is usually fitted within seven days after the start of a period. It is then immediately effective. If it is fitted after the 7th day then you need to use other forms of contraception such as condoms for seven days.

You will need a vaginal examination, and the doctor or nurse will pass a small instrument into the uterus to check its size and position. An IUS is then fitted. You will be taught how to feel the threads of the device 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.

The Contraceptive Implant implanon at the D2 Medical

What is the contraceptive implant?

A contraceptive implant is a small tube that is put under the skin. It contains a progestogen hormone. Implanon is the only one prescribed at our clinic.

How does the implant work?

The progestogen hormone in the implant is released slowly into the bloodstream at a steady rate. The progestogen works mainly by stopping ovulation (the release of the egg from the ovary). It also thickens the mucus made by the cervix which forms a 'mucus plug' in the cervix. This stops sperm getting through to the uterus (womb) to fertilise an egg. It also makes the lining of the uterus thinner. This means that if an egg was to fertilise, it is not likely to be able to attach to the uterus.

How effective is the contraceptive implant?

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. (Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.)

What are the advantages of using an implant such as Implanon?

  • You do not have to remember to take a pill every day.
  • You only have to think about contraception every 3 years.
  • It does not interfere with sex.
  • It can be used when breastfeeding.
  • Period pain is usually less than usual.
  • It can used by some women who cannot take pills that contain oestrogen.
  • It may help protect against pelvic infection. (The mucus plug in the cervix may help to prevent bacteria from travelling into the uterus.)

What are the disadvantages of using an implant such as Implanon?

The release of progestogen will usually cause changes to the pattern of periods. During the first year it is common to have irregular bleeding. Sometimes periods are heavier and longer than before. They usually settle back into a regular pattern after the first year, but may remain irregular. In some women the periods become infrequent and light, or even stop altogether.

Some women worry about irregular or changed periods, but it does not mean anything is wrong and is of no consequence. However, unpredictable or irregular periods can be a nuisance.

Who cannot have a contraceptive implant?

Your doctor in the D2 Medical will discuss any current and past illnesses. Some illnesses may mean you cannot use progestogen based contraceptives such as Implanon. However, the number of women this affects is small.

Are there any side-effects with the contraceptive implant?

As with all hormonal contraceptives, some women report side-effects such as mood changes, breast discomfort, fluid retention, weight gain, headaches, and increase in acne. However, these are uncommon. If they do occur they tend to develop in the first few months only. They often go after 3-6 months if the implant remains. As with all small cuts to the skin there is a slight risk of a wound infection. The possible effects on periods are mentioned above.

How is the implant put under the skin?

  • It is put in the inner side of the upper arm.
  • It is usually first inserted within 5 days of a period starting. (This ensures that you are not pregnant.) It is effective from then on.
  • An injection of local anaesthetic is used to numb the skin. A small cut is made and the implant placed under the skin. The wound is dressed and will soon heal just like any other small cut.
  • The area around the implant may be bruised and sore for a few days, but this soon goes.

When is the implant taken out?

A replacement is needed every 3 years if you wish to continue with this form of contraception. It requires a small operation under local anaesthetic to remove it and put in a new one.

The implant can be taken out at any time if you request. It loses its effect immediately after being removed. So, if required, use other forms of contraception afterwards and for 7 days before it is removed. This is because sperm can survive for up to 7 days after sex.

Do other medicines interfere with the contraceptive implant?

Some prescribed medicines may interfere with the progestogen (mainly some used for epilepsy and TB). Tell the doctor or pharmacist that you have a progestogen implant if you are prescribed another medicine. It is unlikely that a medicine bought without the need of a prescription will interfere. If in doubt, ask the pharmacist.

Dr John J Ryan Medical Director.

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