It’s one of life’s biggest annoyances: finding a method of contraception that works for both your body and lifestyle.
With so many options on the market these days (15 to be exact), it can be pretty confusing (and down-right overwhelming) to sift through all the info out there.
That’s why we hit up Dr Deborah Bateson from Family Planning NSW to answer all your most asked questions.
How do you know which contraceptive method is right for you?
There are many factors that can affect finding the best contraceptive for your individual circumstances – for example, you may lead a busy lifestyle and remembering to take something every day is not going to work out for you so you may prefer something more long term such as an implant or an IUD, or you may have certain medical conditions which may make some types of contraception unsuitable. You may experience side-effects such as mood swings or bloating on one type of contraception but not on others and may prefer a method that reduces or even gets rid of your periods altogether.
While some women find their ‘perfect match’ straight away, other women may need to try out a few different types (and remember what suits you when you are in your twenties may be different to what suits you best in your 40s so asking your doctor about what’s new is useful).
The best way to know what contraceptive method is right for you is to find out about all the different types, their pros and cons, so you can go armed with a set of questions to your doctor. It is important to discuss not only to discuss any medical conditions you have but also to let the doctor know what features of a contraceptive method are the most important to you so you can work out what is likely to suit you best.
Do you need to change up your method of contraception regularly so you don’t become ‘immune’?
While it’s important to be aware that there many different types of contraception available there is absolutely no need to change your contraceptive method regularly. The body does not become ‘immune’ to contraception. This is a common myth of contraception - that it will lose its effectiveness over time. If a contraceptive option is working for you, it fits into your lifestyle and you aren’t getting any troublesome side-effects then there is no need to change.
Similarly, there is no need to have a break from the pill – that is unless you do want to become pregnant! With the introduction of Long-Acting Reversible Contraceptives (LARC) as well, a method like the hormonal or copper IUD can be inserted to last up to 5 or 10 years – but of course it doesn’t have to stay in for that long and when it is removed your fertility returns to normal straight away.
If a contraceptive works for you and you are happy there is no need to change!
What is the most effective form of contraception?
The LARC methods have been proven to be very effective forms of contraception with the hormonal IUD being 99.8% effective and the copper IUD being 99.2% effective – this means fewer than 1 woman out of every 100 will become pregnant in a year.
The implant, which can stay in place under the skin of the upper inner arm for up to 3 years, is also very effective, at 99.9%. In fact, these LARC methods are as effective as sterilization – either female tubal ligation or male vasectomy – but they have the advantage of being completely and immediately reversible.
While the pill and the vaginal ring can be over 99% effective when they are used perfectly, in real life up to 9 women in a 100 can fall pregnant using this method, often because a pill is missed or the pill pack runs out. Understanding how effective the different methods are is an important part of working out what will suit your lifestyle best.
Aside from condoms, do any methods of contraception protect against STIs?
No, condoms are the only method that protect against STI’s as well as pregnancy. Male condoms are made of either latex or other non-latex materials and the female condom is made of a special material called nitrile. As they are not as effective as some of the other methods of contraception (that’s because they may not always be used, may be used incorrectly or they might sometimes slip off or break), we recommend that women who are at risk of STIs double up a condom with another more effective form of contraception such as a pill or vaginal ring, an implant or an IUD.
Can hormonal contraception affect long-term fertility?
This is another big myth of contraception. No method of contraception is going to affect your future fertility, except for the permanent ones (tubal ligation or vasectomy) because of course that’s what they are designed to do.
When a woman stops using a contraceptive pill, vaginal ring, implant or IUD her fertility will return to normal straight away. The only exception is the 3-monthly injection as it can take up to a year for your periods and fertility to return to normal but after that there is no long-term effect.
Importantly the emergency contraceptive pill which is taken within 5 days after unprotected sex and can be bought at the pharmacy without a prescription also does not have any effect on long-term fertility and it is safe to use if needed more than one in a cycle.
Is it Ok to skip your period using the contraceptive pill?
Yes, it’s completely fine to skip your period. The combined hormonal contraceptive pill contains two hormones, an oestrogen and a progestogen, with either 7 days or 4 days of non-hormone sugar pills. During this hormone-free break women will usually have a withdrawal bleed like a period, but it’s very common these days for women to skip the sugar pills by running their pill packs together for 3 months or even longer. Sometimes women worry about blood building up inside the uterus but the opposite happens and the lining becomes thinner and thinner over time. Extended use of the pill (or vaginal ring) is safe and can be very useful for women who experience heavy periods, who are managing a busy lifestyle or who simply prefer to skip their periods.
Are there any non-hormonal reversible methods of contraception aside from condoms?
Yes, there is also the copper IUD, the diaphragm as well as traditional methods including fertility awareness methods. The copper-IUD is a very effective LARC method which can last up to 10 years and is immediately reversible when it is removed. It is very useful for women who don’t want to use hormones or can’t because of a medical condition although it can make your periods heavier and last longer.
There is a single sized silicone diaphragm which is inserted into the vagina to cover the cervix at the time of sex although it isn’t as effective as most other methods. Fertility awareness methods involve a daily commitment to recording fertility signs such as temperature and cervical mucus and monitoring the days of your menstrual cycles – you (and your partner) have to be very dedicated and understand that there a range of factors that can affect its reliability and many days when sex must be avoided.
Does contraception make you gain weight?
There is only one method of contraception where an association with weight gain is well established and this is the 3-monthly contraceptive injection. There is no clear effect for the other hormonal methods including the contraceptive pill and vaginal ring, the implant and the hormonal IUD on weight – and in any group of women there will be some who gain weight, some who lose weight and many who stay the same – and we do need to remember the slightly sad truth that we all tend to gain weight as we get older! That said, if you do think your contraceptive method has caused weight gain talk to your doctor as another method may be more suitable.
How reliable is the pull-out method?
The pull-out or withdrawal method is not recommended as a reliable form of contraception – apart from the fact that it relies on the self-control of your partner, around 40% of men also have sperm in the pre-ejaculate! The effectiveness is between 96% and 78% which means that somewhere between 4 and 22 women in every 100 will become pregnant in a year.
Visit Contraceptive Match to learn more about your options and find helpful information to take to your GP.