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Sexual health
Contraception, birth control and family planning are just different names for methods that allow a woman and her partner to choose if and when to become pregnant and have a baby.

There are a number of methods of contraception available. All methods are more reliable if used properly, but no method is totally 100% effective in preventing pregnancy. The method chosen will depend upon personal choice, life-stage and the ease of use, reliability and side effects of the contraceptive. The choice of contraception may change as the person or couple gets older when fertility and chances of getting pregnant decline, the frequency of sexual intercourse changes, or decisions about when or if to start a family or have another baby change.

Only one method of contraception, the condom, will help reduce the spread of sexually transmitted infections such as Chlamydia, genital herpes, gonorrhoea and HIV.
Methods of contraception
Barrier methods
Barrier methods of contraception include condoms, diaphragms and cervical caps. They form a physical barrier which prevents the man’s sperm from reaching and fertilising the woman’s egg.

Condoms - There are two kinds of condom available, male and female. Men wear condoms over the penis during intercourse. The condom traps the sperm after ejaculation and prevents it from entering the vagina. Male condoms are about 98% effective in preventing a pregnancy. This means that only about 2 in every 100 women would get pregnant in a year if the male condom was used as the method of contraception. Male condoms are widely available from pharmacies, supermarkets, vending machines or may be obtained free from family planning clinics.

Female condoms are worn by the woman during intercourse. The female condom lines the vagina and works in the same way as the male condom by trapping sperm. If used according to instructions the female condom is 95% effective. This means that 5 women in 100 will get pregnant in a year if the female condom was used as the method of contraception. Female condoms are not as widely available as male condoms, but they may be obtained from pharmacies and are free from family planning clinics.

As there is no direct contact between the penis and vagina and no exchange of body fluids during sexual intercourse, condoms are the only methods of contraception that also help protect men and women from sexually transmitted infections, including HIV.

Diaphragms and cervical caps – Diaphragms and cervical caps are round, flexible, rubber or silicone devices that are inserted into the vagina before intercourse to prevent sperm from entering the uterus through the cervix.

A cervical cap is smaller than a diaphragm and needs to be positioned directly onto the cervix. Cervical caps are mainly used by women who find it difficult to keep a diaphragm in place. Diaphragms and cervical caps must always be used with a spermicide, a gel or cream that kills sperm. The diaphragm or cap must be left in place for at least 6 hours after intercourse to ensure that all the sperm have been killed.

Diaphragms and cervical caps are 92-96% effective if used according to instructions and together with a spermicide. This means that between 4 and 8 women in 100 will get pregnant in a year using these forms of contraception.

A doctor or family planning nurse must measure the size of the vagina in order to select the right size of diaphragm or cervical cap. They will also show the woman how to insert the diaphragm or cervical cap and how to apply the spermicide correctly.

Hormone methods
Hormone methods of contraception work by changing how a woman’s body responds during her menstrual cycle. All hormone contraceptives are free and available from a doctor or family planning clinic. The hormone method chosen will depend upon the woman’s medical history, age, lifestyle and personal preference.

The types of hormone contraception available include:
The pill or oral contraceptives There are two types of oral contraceptive pill available. One is the 'combined pill' which contains two types of hormones, a progestogen and an oestrogen. The combined pill works by stopping ovulation, the process by which an egg is released from the ovaries into the uterus. Combined pills also thicken the mucus in the cervix, making it difficult for sperm to pass through into the uterus to fertilise the egg. Combined pills also thin the lining of the uterus making it more difficult for a fertilised egg to stay in the uterus. If the combined pill is taken according to instructions it is over 99% effective. This means that less than one woman in 100 will get pregnant in a year using this method.

The second type of oral contraceptive pill is called the ‘progestogen-only pill’ or 'mini pill' which contains only one type of hormone, a progestogen. The progestogen-only pill works by thickening the mucus in the cervix and by thinning the lining of the uterus. With the exception of a pill called Cerazette, progestogen-only pills do not depend on preventing ovulation. If the progestogen-only pill is taken according to instructions it is over 99% effective. This means that less than one woman in 100 will get pregnant in a year using this method.

Oral contraceptive pills must be taken each day, and they are most effective if the pill is taken at the same time each day. If a pill is forgotten or taken late then it may no longer be effective and the woman may not be protected against becoming pregnant.

The patch – The contraceptive patch, Evra, contains an oestrogen and progestogen. It works in the same way as a combined pill, but has the advantage that it only needs to be applied once a week for three weeks each month. It is as reliable as the combined pill.

Vaginal ring - The contraceptive vaginal ring, Nuvaring, is a flexible plastic ring that releases the oestrogen and the progestogen over a period of 3 weeks. Once the ring has been inserted it is left in the vagina continuously for 3 weeks. It is then removed and replaced one week later by a new ring. If the vaginal ring is used correctly and according to instructions it is over 99 per cent effective. This means that less than one woman in 100 will get pregnant in a year using this method.

Injection – A progestogen, either norethisterone or medroxyprogesterone, is injected once every 8 or 12 weeks. The hormone is released slowly during that time, stopping ovulation, thickening cervical mucus and thinning the lining of the uterus. Contraceptive injections are over 99% effective, which means that less than 1 woman in a 100 will get pregnant in a year. An injection has the advantage that the user does not have to remember to take the pill each day. Its disadvantage is that it cannot be removed once it has been injected and the user will have to continue with this method of contraception for as long as its effects last.

Implant – These are small tubes containing a progestogen, etonogestrel, which are inserted under the skin once every 3 years. The hormone is released slowly into the blood stream over that period. Implants are 99% effective and have the advantage that the user does not have to remember to take or use other forms of contraception.

Intra-uterine system – This is a T-shaped intrauterine device that slowly releases a progestogen, levonorgestrel. It is replaced every 5 years. It works by increasing the thickness of cervical mucus and by thinning the lining of the uterus. Most women continue to ovulate while using the system. It is 99% effective and, like other long term contraceptive methods, has the advantage that the user does not need to remember to take or use other forms of contraception.

Mechanical methods

altIntra-uterine devices – An intra-uterine device or IUD is a small plastic device carrying thin copper wire that is inserted into the uterus. The device has 1 or 2 soft threads at its end that allows the IUD to be withdrawn from the uterus when it is no longer required or needs to be replaced. IUDs work by preventing sperm from surviving in the uterus and by preventing a fertilised egg from implanting in the uterus. IUDs are over 99% effective. An IUD needs to be fitted by a doctor or family planning nurse and replaced every 5 to 10 years depending on the device.

For women – Sterilisation involves cutting or blocking the fallopian tubes that connect the ovaries to the uterus. This means there is no way for the eggs that are released by the ovaries to reach the uterus and become implanted.
For men – Sterilisation for men is called a vasectomy. This involves cutting the tubes that carry the sperm from the testicles to the penis. This form of contraception is not effective immediately, but takes a few months until tests have shown that all sperm have gone from the man’s semen.

Natural family planning
Natural family planning is also known as the rhythm method. This method involves keeping a diary of the days of the menstrual cycle, and taking daily temperature and/or hormonal measurements, to determine when the woman is most fertile and likely to become pregnant if she had unprotected sexual intercourse. It is not a reliable method of contraception.

Emergency contraception
Emergency contraception is a type of hormone contraception but it should not be used as a usual method of contraception. It can be used following unprotected sex or if the usual method of contraception has failed.

There are two choices:

Emergency hormonal contraception – Emergency hormonal contraception, also known as the 'morning after pill', can be used for up to 72 hours after unprotected sex but is more effective the sooner it is used. It consists of a single tablet containing 1500mg of the progestogen, levonorgestrel. It can be bought from a pharmacy if certain criteria are met, or it can be obtained free from a doctor or family planning clinic.

IUD – An IUD can be fitted up to five days after unprotected sex. The emergency IUD is the most effective form of emergency contraception.

When to see your pharmacist
In addition to being able to obtain condoms and emergency hormonal contraception from your local pharmacy, your pharmacist will be able to advise you on the types of contraception that are available.

If purchasing over the counter medicines or receiving prescribed medicines you should always let your pharmacist know if you are taking or using any form of hormone contraception. Some medicines interfere with the actions of the hormones in the contraceptives and may prevent them from working properly, increasing the risks of becoming pregnant.

When to see your doctor
You should discuss your choice of contraceptive with the local family planning clinic, or the nurse or doctor at your surgery. It is important to talk through the choices available to find out what best suits you and your partner. All forms of contraception obtained from your surgery, other than condoms, are free on the NHS. Condoms are supplied free by family planning clinics.

Choosing the right method of contraception
Given the different methods of contraception and the large number of types of contraceptive of each method that are available, deciding on which contraceptive to use can be confusing. However, remember that it is your and your partner’s personal choice and it is important to select a method that suits you. Find out as much as you feel that you need to know about each method. If you are unsure or want further advice, talk to your doctor, nurse or pharmacist or call in to your local Family Planning Clinic. Confidential advice may be obtained by calling the FPA Helpline (see below).

If you find that the method or type of contraception chosen does not suit you, do not be afraid to ask your doctor or nurse to change it, and keep doing so until you find one that suits you best. Having made the right choice it does not mean that you have to continue with the same method indefinitely. As your circumstances change, for example you change partner or change your lifestyle, think about changing your method of contraception too.

If you do decide to have a baby, rethink about the methods of contraception after the baby is born.

Further information
The FPA or Family Planning Association is a charity that provides information, advice and support to all people across the UK on all aspects of sexual health, sex and relationships.

The FPA’s website provides advice and a wide range of booklets on individual methods of contraception, common sexually transmitted infections, pregnancy choices, abortion and planning a pregnancy.
FPA Helpline England: 0845 122 8690
FPA Helpline Northern Ireland: 0845 122 8687

See also ‘Contraception and you’ for video clips, advice, choices and frequently asked questions about contraception:

altSponsored by Bayer Schering Pharma as a service to medicine

Reviewed on 20 March 2011

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