The pill, patch or ring? What are my contraceptive options?

What are my contraceptive options?

Most people are familiar with the contraceptive pill or ‘the pill’ as it is better known however there are many other forms of contraception available and more and more people are now availing of these options. There are five types of contraception: hormonal, barrier, intrauterine (inserted inside the uterus/womb), sterilisation and natural. The choice is very much patient driven and the decision should be made after appropriate counselling with an adequately trained healthcare professional.

Happy to think more often about your contraception?

The following methods require consistent use to work effectively (user dependent);

Combined oral contraceptive pills (COCs): These contains 2 different types of hormones (oestrogen & progesterone) and the typical dose is one tablet daily for 21 days and then a ‘pill free week’ where you have a withdrawal bleed/period. There are different choices of oestrogen and progesterone and there are also different strengths of each. The decision of which option to go for depends of a person’s cycle, period flow (heavy/light), age, if there are skin complaints (e.g. acne), mood issues (low mood or PMT (pre-menstrual tension), bleeding issues with other pill options and many other factors.

Mode of action

• The synthetic oestrogen stops your body from producing two hormones that are involved in the menstrual cycle: Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). This prevents your ovaries from producing an egg because it stops your eggs from ripening and ovulating.
• The synthetic progesterone thickens the mucus at the entrance of your womb so that sperm can’t get through to fertilise your eggs and also thins the lining of the uterus, making it difficult for a fertilised egg to implant itself.

Advantages

• Typical effectiveness* (i.e. prevent pregnancy), perfect effectiveness* 99%.
• Useful for women who do not want a long term contraceptive method and  are able to comply with the daily medicine schedule.
• Often reduced bleeding and period pain, and may help with premenstrual symptoms.

Drawbacks

• Oestrogen component may not be suitable for some women depending on medical history.
• May not be suitable for women who could forget to take the pill.
• Effectiveness can be affected by vomiting or diarrhoea (if severe/persistent) or other medication you are taking.

Progesterone only pill/POP/’mini pill’: This contains only progesterone of which there are different types available. This pill is taken every day of the cycle/month and there is ‘-no pill free week’.

Mode of action

• The majority of mini pills work by thickening the cervical mucus, making it difficult for sperm to get through to fertilise an egg and thinning the lining of the uterus, making it less likely that a fertilised egg will implant itself.
• Cerazette (desogestrel), the most commonly used mini pill, also works by preventing ovulation.

Advantages

• Typical effectiveness 91%*, perfect use effectiveness 99%*.
• May be suitable for women who do not want to or who cannot take oestrogen e.g. due to medical history.
• May be used safely in breastfeeding women

Disadvantages

• Woman may have changes in menstrual pattern (periods), can cause irregular bleeding/heavier bleeding.
• Effectiveness can be altered by vomiting/diarrhoea/other medication taken.
• May not consistently prevent egg release.

Combined contraceptive patch (CCP): Contains both oestrogen & progesterone and mode of action is same as COC pill.

Advantages

• Typical effectiveness 91%, perfect use effectiveness 99%*.
• Patient should apply one patch per week for 3 weeks and then have a patch free week in week 4.
• Not affected by vomiting or diarrhoea

Drawbacks

• May be seen on the skin
• Oestrogen component may not be suitable for some women depending on medical history.

Vaginal ring: Flexible ring which is placed inside the vagina and contains both oestrogen and progesterone. Similar mode of action as COC and CCP.

Advantages

• Typical effectiveness 91%, perfect use effectiveness 99%*.
• Only needs to be replaced once per month (one week following removal (ring free week)).
• Not affected by vomiting or diarrhoea

Drawbacks

• Need to learn how to insert (via trained individual)
• Oestrogen component may not be suitable for some women depending on medical history.

Condoms: Male & female, acts as barrier, does not contain any hormones and use is not restricted due to medical history.

Advantages

• Typical effectiveness for male is ~82%; perfect use effectiveness is ~98%*.
• Typical effectiveness for female is ~79%; perfect use effectiveness is ~95%.
• May be useful for those who wish to avoid hormones, or as additional protection.
• The only contraception that offers protection against sexually transmitted infections.

Drawbacks

• Putting them on can involve interruption of sexual intercourse.
• The male condom can split or rupture.
• The female condom can be accidentally dislodged.

Diaphragm & caps: Barrier method that fits inside the vagina, does not contain hormones and use is not restricted to your medical history.

Advantages

• Typical effectiveness 71-88%*; perfect use effectiveness (when used with       spermicide) ~92-96%*.
• For women who do not want a long term contraception method but who wish to avoid taking hormones.

Drawbacks

• Can take time to learn how to use
• Involves forward planning or interruption of intercourse.
• Can be messy as you need to use spermicide as well.

Natural methods: Recognising the fertile and infertile times of your cycle to plan when you should avoid intercourse.

Advantages

• Efficacy will vary depending on the type of NFP method used, if/how many methods used concurrently and how reliably it is adhered to; typical effectiveness ~76%*, perfect effectiveness can be between 91-99%*.
• May be useful for those who wish to avoid hormones or devices.
• Can be used at all stages of reproductive life.

Drawbacks

• There are different types of NFP methods and it can take up to 6 months to learn effectivity
• Stress or illness can make the method unreliable.
• Need to avoid intercourse at certain times of the month and be highly motivated.
• Does not protect against sexually transmitted infection

For further information:
https://patient.info/health/contraception-methods/natural-family-planning-methods

Don’t want to think about contraception everyday/every time you have sex?

Then why don’t you consider Long Acing Reversible Contraceptive methods (LARC).

IUD/intrauterine device: Copper containing coil inserted into the womb and can remain in place for 5-10 years (depending on type used), does not contain hormones so does not interact with other medications.

Mode of action

The copper released makes the uterus an in-hospitable environment for sperm.

Advantages

• Typical & perfect use effectiveness is over 99%*->user independent.
• For women who want longer-term contraception but do not want hormones.
• Fertility should return to levels expected for you after removal.
• May be used safely in breastfeeding women

Drawbacks

• Women may have changes in menstrual patterns (periods).
• Insertion and removal must be performed by trained healthcare professional

IUS/intrauterine system/better known as Mirena coil: Progesterone containing coil/device fitted into womb and can last 3 or 5 years depending on type used.

Mode of action

• Progesterone is released daily and essentially works by preventing fertilization.

Advantages

• Typical & perfect use effectiveness is over 99%*-> user independent.
• Fertility should return to levels expected for you after removal.
• Can greatly help with patients with heavy periods.
• May be used safely in breastfeeding women

Drawbacks

• Some women may have issues with bleeding.
• Insertion and removal must be performed by trained healthcare professionals.

Contraceptive implant: Progesterone containing implant inserted under the skin of the upper arm which lasts for up to 3 years.

Advantages

• Typical & perfect use effectiveness is over 99%*-> user independent.
• Fertility should return to levels expected for you after removal.
• May be used safely in breastfeeding women

Drawbacks

• Women may have changes in menstrual pattern
• Insertion and removal must be performed by trained healthcare professionals.

Contraceptive injection: Progesterone containing injection given every 8-13 weeks, depending on the type used.

Advantages

• Typical effectiveness ~94%, perfect use effectiveness ~99%*.
• Short-term LARC for women and couples awaiting sterilisation or vasectomy.
• May be used safely in breastfeeding women

Drawbacks

• Women may have changes in menstrual patterns
• Can take time for fertility to return to normal.
• Can affect bone density

Want long-term contraception?

Sterilisation (male & female): Fallopian tubes that carry the egg in women or the vas deferens that carry sperm in the male are cut or clipped.

Advantages

• Failure rate is ~1 in 200 or 1 in 500 for females (depending on method) and   1 in 20,000 in males.
• May be suitable for those who want a permanent method of contraception that involves no hormones.

Disadvantages

• Cannot be easily reversed.
• Involves an operation/procedure.
• Sterilisation is not effective immediately.

*’These are ‘typical’ effectiveness rates which is how effective the method is with an average person. Typical rates tend to reflect real life usage (including inconsistent and incorrect use). ‘Perfect’ effectiveness rates is how effective the method is when used perfectly. Refer to the patient information leaflet for ‘perfect use’.

In conclusion, there is a large variety of contraceptive options available, so please enquire when you are next in with your local GP to see what would best suit you.

Dr Vanessa Ni Churrain
Private GP, Fulham