Today, there are a wealth of options available for persons seeking contraception. These include pills, barrier methods such as condoms, and even more permanent options including surgery.
This should ideally mean that, in theory, there is a method of contraception out there to suit anyone who wishes to protect against pregnancy.
In this article, we will outline the various types of contraceptive approach, and how each works. We have categorised these as follows:
Non-pill methods include:
The contraceptive implant is a small flexible tube about the size of a hair clip (40mm in length) which is inserted underneath the skin of the upper arm.
It prevents pregnancy by releasing a steady amount of a progestogen. This hormone prevents the release of eggs from the ovaries, thickens the mucus that lines the cervix and thins the lining of the womb making it difficult for any released eggs to attach themselves.
It is often favoured by women who cannot tolerate oestrogen and those who know that they do not wish to conceive for some time as the implant can be left in place for up to three years.
Opting to use the implant means that you don’t have to worry about contraception for the time it is in-situ, but fertility levels should quickly return to normal once the device is removed. Those who usually experience heavy and painful periods may notice a reduction in these symptoms when using the contraceptive implant.
The contraceptive injection is a highly effective method of preventing pregnancy which only requires repeat application around every 12 weeks. When used correctly it provides protection from 99 per cent of unwanted pregnancies.
The progestogen is administered via a simple injection and is gradually released into the system to prevent ovulation, thicken cervical mucus and thin the lining of the womb.
This particular contraceptive method is again often favoured by women who prefer not to have to remember to take the pill every day or cannot use oestrogen products.
Patients who are thinking about having children in the near future might want to consider alternative contraception as following the injection it can take several months for fertility to return to normal.
Some users may notice a change in their periods where they become heavier for a while, although the majority of women, as noted by the Faculty of Sexual and Reproductive Healthcare, tend to notice a reduction in heavy painful periods or they may completely lose their menstruation.
The contraceptive ring, known commercially as NuvaRing, is a small (55mm diameter), pliable and plastic ring which is placed inside the vagina where it releases a mix of oestrogen and progestogen hormones to prevent pregnancy.
The ring is left in-situ for 21 consecutive days, after which it is removed for seven days when most women will experience a period-like withdrawal bleed.
The combination of the two ingredients is the same as that found in combined oral contraceptive pills (COCPs) and so the ring tends to attribute similar side effects.
For this reason, women who are at risk of thrombosis should look to use an alternative contraceptive because, much like the combined pill, the contraceptive ring has been linked to blood clotting and strokes.
Prudent users will see a 99 per cent success rate of avoiding pregnancy, however, if the ring is not replaced after the seven day break the chances of getting pregnant will increase.
The contraceptive cover by the ring is not affected by sickness or diarrhoea unlike its pill counterpart.
You might know the IUD method by its more commonly used name of ‘coil’. The name ‘coil’ came about due to the device’s original spiralling shape.
Today most devices are a small, matchstick-sized T-shape made from plastic and copper and are inserted into the womb by a trained health professional.
The insertion process does require help from a medical professional and can take up to 20 minutes to complete, but once situated the IUD offers instant protection from pregnancy. It does this by creating a less hospitable environment in the womb for eggs and sperm.
This means that sperm are less likely to penetrate the womb, and any fertilised eggs which do make it to the uterus will struggle to attach themselves to the thin womb lining.
All IUDs are extremely effective and come with very low failure rates. The IUD is part of the long-acting reversible contraceptive group (LARC), and can remain inside the womb for between five and 10 years, depending on the particular IUD that has been fitted.
Women who experience heavy periods may be advised to opt for a different type of contraception however, as there is a small chance that the IUD may exacerbate these symptoms.
The IUS may look similar to the IUD, in that it is also a small plastic T-shaped product, but it is fundamentally different in how it works.
The IUS is also inserted into the womb and gradually releases a progestogen hormone into the body’s system via the womb. This hormone encourages the female body to thicken the entrance of the uterus making it difficult for sperm to pass whilst also thinning the lining of the womb so that eggs struggle to attach themselves.
There are currently two types of IUS available in the UK; Mirena and Jaydess. Both are classed as LARCs and can be left in-situ for five and three years respectively.
The IUS is set in place inside the uterus by a doctor or nurse and can initially be painful or cause some bleeding, but this stops relatively quickly for the majority of users.
An IUS should not interfere with sexual intercourse but each user should be taught how to feel for the strings at the top of their vagina to check that the IUS maintains its correct position.
The IUS method is just as effective as the contraceptive pill and is favoured by women who don’t want to have to think about their contraception every day.
The male condom is one of the most favoured methods of contraception in the UK.
It offers a high level of protection against pregnancy as well as numerous STIs. The condom is placed over the penis prior to sex to form a barrier which prevents sperm from entering the vagina.
One oft-cited disadvantage of the condom is that it has to be put in place prior to the penis coming into any contact with the vagina. Some people feel that this application method can disrupt sex.
In the UK the female condom is marketed under the brand name Femidom.
When used consistently and correctly the female condom can protect users from becoming pregnant and are 95 per cent effective at doing so. As another form of barrier protection, the female condom is worn inside the vagina to inhibit sperm from passing from the penis through to the vagina where it would usually enter the cervix.
By keeping the sperm out of the womb any ovulating eggs are protected from fertilisation.
This contraceptive option also provides protection from a wealth of STIs and can be worn inside the vagina for up to eight hours prior to any sexual activity so that it does not disrupt the flow of sexual urges.
Female condoms, just like the male version, are not reusable and should be thrown away after use. They are not as widely available to buy in the UK and can be more expensive than the male counterpart.
The diaphragm and cervical cap options are classed as a female barrier method and are used alongside spermicide.
The user places the diaphragm or cap inside the vagina to cover the cervix in order to prevent sperm from passing. They are sometimes favoured over other barrier methods such as the male condom because they can be put in place before sex is initiated and cleaned and reused.
That being said, they do not provide the same level of protection as other barrier methods; they are estimated to offer between 92 and 96 per cent efficiency against pregnancy when used correctly alongside spermicide.
Most users will not experience any serious health conditions following use of a cap, although the use of a diaphragm has been linked to bladder infections.
Some women may find the insertion process and the use of spermicide difficult; whereas others favour this option as it offers protection for women with a latex allergy.
The most widely available pills are:
Often referred to simply as ‘the pill’, the combined oral contraceptive pill is a small daily tablet containing a mixture of two artificial female hormones, progesterone and oestrogen.
The pill is available in many variations, some containing different amounts of the active ingredients.
The combination of hormones stop the ovaries from releasing an egg. This means that if sperm enters the womb it is much less likely to come into contact with an egg and therefore prevents fertilisation.
Combined pills are one of the most commonly used contraceptives in the UK. When taken correctly it offers up to 99 per cent protection against pregnancy.
An advantage of the pill is that it can help ease heavy periods and so may be prescribed to women diagnosed with menorrhagia.
Using the pill as a contraceptive means that you have to remember to take it at the same time every day.
Progestogen-only pills have been given the name ‘mini pill’ and have been shown in trials to have a comparable efficacy to the regular pill.
A single progestogen-only pill is taken by the user every day without any breaks.
It works by causing the cervix to produce a thicker mucus which prevents sperm from passing through. As the mini pill is taken daily, you do not need to interrupt sex to administer it (as you might with barrier protection).
This type of pill doesn’t contain oestrogen and so can be prescribed to women who are unable to tolerate pills that contain it.
There are some disadvantages to using the progestogen-only contraceptive pill as sickness and diarrhoea can affect its performance, so if you experience these symptoms at any point you would need to use additional precautions such as a barrier method.
The sterilisation option for women involves an operation under either local or general anaesthetic.
The aim of the procedure is to block the fallopian tubes so that eggs cannot pass from the ovaries to the uterus.
There are two main types of female sterilisation: the first is called tubal occlusion, and this is when the tubes are blocked with clips or rings; the second is hysteroscopic sterilisation, which involves implants being inserted into the tubes under local anaesthetic.
The chances of becoming pregnant after a sterilisation operation are very slim. The NHS estimates that out of 200 women only one will become pregnant following sterilisation in her lifetime.
Sterilisation should only be considered an option for women who are certain that they do not wish to have any (more) children, because it has a high success rate and is very difficult to reverse.
Every type of operation comes with risks and sterilisation is not an exception. There is a small risk of internal or vaginal bleeding, pain, or incorrect insertion of the implants.
A vasectomy, or male sterilisation, is a small operation performed by a surgeon on the male reproductive system.
The majority of vasectomies are carried out under a local anaesthetic administered to the testicular area. Two incisions are then made to the scrotum. This allows the surgeon to locate the tubes, known medically as ‘vas deferens’, that transport the sperm from the testicals to the penis. The tubes are then cut and closed up, with incisions customarily sealed with dissolvable stitches.
This process effectively blocks the sperm’s path so that it can no longer enter the vagina, reducing the chances of a woman becoming pregnant.
Your doctor will want to talk to you prior to referring you for a vasectomy to make sure that you understand the procedure and the outcome. This may involve your partner if appropriate.
Vasectomy failure rates are low but the operation itself does not come without risks.
There is a small chance that the operation could fail, and the tubes reconnect making the man fertile once more. The man can also go on to develop problems ranging from haematoma and infection through to long-term testicular pain.
If you have concerns about the procedure and the side effects, you should discuss these with your doctor prior to surgery.
As you can see there are many different contraceptive options available to choose from. Your decision to choose one particular contraceptive over another may be influenced by the method by which it is used or applied, whether or not an operation is involved, or if you have any particular intolerances. Your doctor should be able to help you come to an informed decision.