Contraceptive choices are very personal, there is no one right answer for everybody. There are a range of options to consider in order to safely meet your own personal, sexual and medical needs at the current stage in your life. Do you want to prevent pregnancy? Do you need STI protection? Do you want non contraceptive benefits, like control over your menstrual cycle or acne control?
So how do you know what the right contraceptive is for you?
What is Contraception?
Contraception is a way of preventing pregnancy, it may come in the form of a barrier method, a medication, a device or surgery.
Why might I need contraception?
You may choose to commence contraception to prevent pregnancy. If you are having penis in vagina sex, and do not want to become pregnant, then contraception can prevent an unplanned pregnancy.
However, depending on the type of contraception they can serve many other non-contraceptive hormonal benefits, these might include:
– Menstrual management – heavy or painful periods can be controlled with certain forms of contraception.
– Avoiding/reducing menstrual cycles– there are many people who may feel more comfortable in their bodies with reduced or no menstrual cycles. Including cis, trans and gender diverse people. You may use contraception as part of gender affirming care.
– Certain medical conditions may be treated with contraceptives, such as PCOS (polycystic ovarian syndrome), iron deficiency or acne.
– Prevention of Sexually Transmitted Infections (STIs)- condoms are the only contraception that can prevent STIs.
Which option is the most likely to prevent me from getting pregnant?
The short answer is that the contraceptive implant or intrauterine device (IUD) are the most effective methods at preventing pregnancy. However it is really important to remember that no contraception is 100% effective. There is risk with all methods, however that risk level varies.
There have been lots of studies looking at different contraceptive options and how good they are at preventing unplanned pregnancies. The results vary between what is considered “perfect use” and “typical use”. That is for example condoms or the pill require action on the part of the person responsible to complete a task (ie remembering to take the pill everyday) in order for “perfect use”. The contraception with consistent results above 99% effectiveness include those options which require no regular tasks. These include the Long-Acting Reversible Contraceptives- the contraceptive implant or Intrauterine Device (IUD). These methods are inserted between every 3 and 10 years. There is no need to remember to take a pill every day or insert a barrier method every time you have sex.
What are the different types of contraception?
Barrier Methods
– Condoms – provide a barrier which prevents STIs and also helps to prevent pregnancy by preventing sperm from reaching the cervix. It is not as effective of a method at preventing pregnancy so you may choose to use condoms together with another form of contraception. You can purchase both external or internal types of condoms.
– Diaphragm – is a silicone cup-shaped device inserted over the cervix to prevent sperm entering the cervix. It does not prevent STIs or manage periods.
Hormonal Contraception
– Combined Oral Contraceptive Pill – “The Pill” as it is commonly known, is a tablet taken daily which combines hormones- oestrogen and progesterone. It is a popular option in Australians to prevent pregnancy and also to manage menstrual cycles. This is an easy method to take a pill, but you need to be sure to remember it every single day.
– Vaginal Ring – The vaginal ring is a flexible plastic ring which contains hormones just like The Pill. Instead of a tablet though, the vaginal ring is inserted high in the vagina. You need to be able to insert the ring in the correct position for it to be effective.
– Progesterone Only Pill – This pill is also taken daily, however it only contains one hormone as in it’s name, it contains progesterone only.
– Contraceptive injection – Some may know this one as “Depo”. It is an injection which must be given every 3 months. It also contains progesterone only.
Long Acting Reversible Contraception
– Contraceptive Implant – The “Rod” as you may have heard of it, is inserted under the arm and can stay there for 3 years releasing the hormone progesterone. It is the most effective method of contraception – more than 99.95% effective at preventing pregnancy. The Rod will impact menstrual cycles often with reduced flow and frequency, although it is likely to be irregular. Some people have no menstrual bleeding at all with the Rod in place. Many GPs are trained to inserted the Implant, check with your GP clinic or you can see Dr Amy Sinclair-Thomson at Maven Centre.
– Intrauterine Device (IUD) – An IUD is inserted into the uterus (womb) by a gynaecologist or women’s health GP. There are two hormonal IUD’s available in Australia – Mirena and Kyleena, both release progesterone locally. There is also a Copper IUD which has no hormones but rather uses copper to prevent pregnancy. This is also an incredibly effective method – 99.5% effective at preventing pregnancy. An IUD requires a procedure to be inserted, this can usually be done while you are awake but may on occasion require general anaesthetic. It can be inserted by a gynaecologist or some GPs are also trained to insert IUDs. We have a number of providers at Maven Centre available for this procedure.
Fertility Awareness Methods
– This is when you learn to track your cycle and use this as a guide to know when it is safer or not safe to have sex. You need to monitor your cycle closely and it can be hard to use if you don’t have a regular cycle or have any changes to your cycle, eg breastfeeding, menopause, illness.
Permanent Methods
– Tubal Ligation – during an operation a clip is put on the fallopian tube (the pathway for the egg to get to the uterus) to prevent pregnancy
– Vasectomy – the tubes that carry sperm are cut during a procedure which can be performed under local or general anaesthetic.
Emergency Contraception
– Emergency contraceptive pill or “The morning after pill” is a tablet that can be taken after unprotected sex to prevent pregnancy, it must be within four-five days. It can be accessed from a pharmacy.
– Copper IUD (details as above)– this is also an effective emergency contraception but must be inserted within five days
What factors might impact my choice?
This may be an individual choice you make for your own body without another person involved or it may be something you decide to discuss with a sexual partner. Your doctor will also help you work through these considerations.
Some factors you may consider include:
– How easy is it to use? Do I want to take something every day (eg the pill) or every sexual encounter (eg condoms) or something I can “set and forget” (eg implant or IUD)?
– Does it protect against STIs? (Condoms only)
– What level of pregnancy risk will I accept? If it is the absolute minimum (contraceptive implant or IUD)
– Do I want to become pregnant in the near future? Is it easy to stop (eg the pill)? Or should you avoid it because it has an undefined time of action- meaning you won’t know when you will be fertile again (eg depot)
– Are there benefits other than contraception?
– Are the possible side effects tolerable to me?
– Do I have medical conditions that may increase my risks with certain contraceptives?
