The Latest & Complete Guide to Birth Control Methods

Oral Contraceptives - "The Pill"

The Pill is a tablet containing synthetic hormones and taken on a daily basis. When absorbed into a woman’s bloodstream it prevents the release of the egg from the ovary, thickens cervical mucous, which hinders the passage of sperm, and thins the lining of the uterus which minimizes the chances of fertilization. The freedom the Pill gives has been of enormous psychological benefit to women since the 1960's. The pill is available in most countries throughout the world, if you live in the US or surrounding Islands it can also be purchased online. More information.

The combined Pill contains synthetic forms of the hormones estrogen and progestogen which interfere with the woman's regular 28 day menstrual cycle. When the Pill keeps the hormone level artificially constant, the signal to ovulate is canceled out. Between them, the two hormones stop you from getting pregnant. The main way in which they do this is by stopping your ovaries from releasing an egg (ovulating) each month.

Oral contraceptives should be taken each day at approximately the same time for maximum effectiveness.

if the pill is forgotten one day it should be taken as soon as remembered and the normal routine resumed;
for two days in a row take two the day remembered and two the next;
if the pill is taken more than 12 hours late at any point during the cycle another form of contraception must be used or intercourse avoided for the remainder of the cycle;
if three or more consecutive pills are missed the packet for that cycle should be thrown away and a new packet started after the next menstrual period.

It is important to use another form of contraception during the first two weeks of the next prescription.

The Pill's effectiveness can be affected by the following:

certain antibiotics
diarrhoea
forgetting pills
vomiting

Before the Pill is prescribed a thorough medical examination should be carried out by your health professional to check blood pressure, breasts and pelvis. This form of contraception is not recommended for women who have a history of:

angina pectoris
blood clots in the legs or lungs (thrombosis)
diabetes and heart disease
high blood pressure
obesity
smoking
tumors in the breast or sex organs
unusual, undiagnosed vaginal bleeding
varicose veins

as the following serious side effects can occur:

heart attacks (coronary thrombosis)
strokes
thrombosis (clotting) in the leg veins, possibly leading to a clot in the lung

Advantages	Disadvantages
no interruption between foreplay and intercourse	Side effects*
may decrease menstrual cramps and pain	changes in body chemistry
highly effective	reduction in blood levels of folic acid, Vitamins B6, B12, and C***
regular menstrual cycle
decreased menstrual flow
predictable menstrual cycles
provides some protection against tubal infection called PID (pelvic inflammatory disease)
reduced risks of certain diseases**

*side effects include:

abnormal blood-clotting
bloating
breast tenderness or enlargement
chance of circulatory problems is greater in women who smoke or are over 35
danger to a developing fetus if oral contraceptives used immediately before pregnancy
formation of tumors
gall bladder disease
headaches
heart diseases
improvement or worsening of acne
increased or decreased sex drive slightly increased risk of breast cancer, cancer of the cervix and a very rare type of liver cancer that has been linked to the Pill
light or missed periods
moodiness or depression
nausea
spotting between periods
stroke
vomiting
weight gain or loss
yeast infections

Symptoms may often be alleviated by switching to a different type of pill.

** Reduces risk of:

benign breast diseases
developing bowel cancer
cancer of the endometrium
iron-deficiency anemia
cancer of the womb
fibrocystic breasts
iron deficiency anemia
ovarian cancer
ovarian cysts
Pelvic Inflammatory Disease

*** Pill users should eat more foods containing these vitamins or take dietary supplements.

Call your medical practitioner immediately should the following occur:

abdominal pain (severe)
bad headaches
chest pain
coughing up blood
eye problems (vision loss, blurring, or flashing lights)
numbness or weakness in arms and legs
severe leg pain in calf or thigh
shortness of breath
shortness of breath

Leading Brands Available:

Alesse
Microtte
Ortho Evra
Ortho Tricyclen
Ortho Tricyclen LO
Yasmin

The mini-pill, the progestogen only Pill (POP) is not a low dose Pill, but one containing a single hormone, progestogen which thickens the secretions in the cervix making it difficult for sperm to pass. The combined Pill is far more popular than the mini-Pill. Progestogen is an artificially manufactured hormone very like progesterone, one of the female hormones the body produces. The mini-Pill does not contains any estrogen which is responsible for many of the combined Pill's side effects.

The Mini-Pill should be taken at the same time of day every day, even when you are menstruating. You may easily get pregnant if you do not take it every day. Even if you are more than three hours late in taking it you could fall pregnant. Set yourself a fixed time of day to take the mini-Pill, maybe suppertime or bedtime. The mini-Pill would probably not be suitable for you if:

you are unreliable at taking tablets regularly
you work shift work or in a job such as on an an airline where hours are irregular and disrupted

The Mini-Pill is suitable for women:

who are at special risk of heart disease or strokes (DO NOT TAKE the mini-Pill without consulting a specialist)
who are breast-feeding mums
who are over 40 who have been medically advised not to take the Pill
who are heavy smokers
who cannot take estrogen

Doctors may refuse to prescribe the mini-Pill if you:

are too obese as the mini-Pill may not provide a big enough dose
have an abnormally high cholesterol or other blood fats
have breast cancer
have ever had an ectopic pregnancy
have unexplained vaginal bleeding

Some brands of the mini-Pill include:

Femulen
Micronor
Microval
Neogest
Norgeston
Noriday

Advantages	Disadvantages
no interruption between foreplay and intercourse	Side effects*
can be used when breast feeding as it does not suppress lactation like the combined Pill.	has to be taken every single day of the year with no breaks at all, even during your period.
less side effects than Combined Pill	not quite as effective as the ordinary Pill (about as effective as an IUD)
	if you become pregnant while taking the mini-Pill the pregnancy might be ectopic (that is outside the womb)

*The side effects are:

headaches
irregular periods
nausea
ovarian cysts
periods may stop
skin spots
tender breasts

As mentioned above, if you would like to use the contraceptive pill please visit your local health care provider. The pill is available in most countries throughout the world.

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Implant (Norplant)

Norplant is a relatively new contraceptive method which involves six matchstick-size implants being inserted in the skin of a woman’s inner arm in a fan-like pattern under a local anesthetic in a simple, almost pain free procedure. These sticks release a continuous low dosage of a synthetic hormone into the bloodstream inhibiting ovulation and thickening the cervical mucous. It causes changes in the lining of the uterus that interfere with the ability of fertilized eggs to implant in the uterus. Norplant is one of the most effective methods of birth control available to women today and is effective for five years, but may be removed earlier if desired. "Contraceptive Research, Introduction, and Use: Lessons from Norplant" by Polly F. Harrison is a book that can be useful for any woman with, or considering Norplant or other hormonal implants.More Information

Advantages	Disadvantages
no interruption between foreplay and intercourse	Side effects*
no inconvenience of a pill	implants may be slightly visible
implant site is comfortable and barely visible
effective within 24 hours after insertion
effectiveness rates high
can use while breast-feeding starting six weeks after delivery

* Side effects include:

acne
breast tenderness
change in appetite
depression
dermatitis
enlargement of the ovaries and/or fallopian tubes
hair growth or loss
headaches
infection at insertion site (rare)
irregular bleeding
nausea
nervousness
pregnancies, which rarely occur, are more likely to be ectopic (in the fallopian tubes)
prolonged menstrual bleeding
scarring and/or discoloration of the skin at insertion site
skipped periods
spotting between periods
small amount of bleeding each day while using Norplant
weight gain or loss

Seek immediate medical attention should the following occur:

arm pain
blurred vision
delayed periods after a long interval of regular periods
expulsion of an implant
heavy vaginal bleeding
migraine headaches
pus or bleeding at the insertion site
repeated very painful headaches
severe lower abdominal pain

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Implant (Implanon)

This is new on the market and can only be administered by doctors and nurses who have been trained to insert it. Effectiveness rates are difficult to asses because of its newness. To date, however, no women taking part in the research trials has become pregnant. A check up 3 months after the insertion of the implant should be undertaken and the implant should not be left in place for longer than 3 years.

Implanon's active ingredient is Etonogestrel Organon, which is a synthetic form of the naturally occurring female sex hormone, progesterone. In a woman's normal menstrual cycle, an egg matures and is released from the ovaries (ovulation), which then produces progesterone, preventing the release of further eggs and priming the lining of the womb for a possible pregnancy. If pregnancy occurs, progesterone levels in the body remain high, maintaining the womb lining. If pregnancy does not occur, progesterone levels in the body fall, resulting in a menstrual period.

The etonogestrel implant is injected under the skin of the arm to slowly release the hormone into the body, maintaining a high level of the hormone in the blood. It provides contraception for 3 years but can removed at any time by your doctor or family planning nurse.

Etonogestrel works by tricking the body into thinking that ovulation has already occurred, by maintaining high levels of the synthetic progesterone which prevents the release of eggs from the ovaries. It also increases the thickness of this mucus by affecting the natural mucus at the neck of the womb (cervix) making it more difficult for sperm to cross from the vagina into the womb.

This medicine will not protect you or your partner from sexually transmitted diseases, so you should use a condom to provide this protection. In women who are heavier than normal, the contraceptive effect of this implant may not last for 3 years. Also consult your doctor if you are to be immobilized for a long time due to surgery or illness.

Implanon should be used with caution in people with a history of:

blood clots in the blood vessels (thromboembolism)
breast cancer
decreased liver function
diabetes
high blood pressure (hypertension)
a tendency to suffer from irregular yellowish-brown skin patches on the face and other areas often due to pregnancy or the use of oral contraceptives (chloasma) - avoid exposure to the sun or ultraviolet radiation whilst using this implant

Implanon should not be used in:

a type of cancer affected by progestogens
blood clots in the blood vessel (thrombosis) that may travel through the vessels (thromboembolism)
current or previous severe liver disease
pregnancy or suspected pregnancy (may be present in breast milk)
vaginal bleeding of unknown cause
allergy to one or any of its ingredients (stop using this medicine and inform your doctor or pharmacist immediately if you feel you have experienced an allergic reaction)

Advantages	Disadvantages
no interruption between foreplay and intercourse	Side effects*
no inconvenience of a pill	implants may be slightly visible
implant site is comfortable and barely visible
effective within 24 hours after insertion
effectiveness rates high

*Side effects include:

abdominal pain
abnormal or irregular menstrual bleeding
acne
breast tenderness or pain
bruising at site of implant
changes in sex drive
depression
difficult and painful menstruation (dysmenorrhea)
hair loss (alopecia)
headache
increased risk of breast cancer
irritation, pain or itching at site of implant
rise in blood pressure
weight gain

The etonogestrel implant's contraceptive effectiveness may be reduced if taking the following medicines:

Rifamycins such as Rifabutin and Rifampicin
antiepileptic medicines such as Carbamazepine, Phenytoin, Phenobarbital and Primidone
Griseofulvin

Inform your doctor if you are taking any of these medicines as a barrier method of contraception such as condoms may be required. "Hormonal Contraception: Pills, Implants & Injections" by Joseph W. Goldzieher is a useful and informative book for any woman considering or using hormonal contraceptive methods.

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Injection

Depo-Provera

Depro-Provera is a highly effective form of contraception. An injection of a progestogen hormone which is slowly released into the body is given once every three months. This prevents ovulation and interferes with eggs leaving the ovaries, as well as causing a thickening of the cervical mucus and changes in the lining of the uterus which prevents sperm from entering the uterus.

Before commencing Depro-Provera a medical examination is required to check blood pressure, breasts and pelvis The injection is given in the buttocks or upper arm. Depro-Provera begins to give protection against pregnancy within 24 hours of the first injection, which must be given within five days of the beginning of a period unless the woman has been using the Pill or an IUD. As the effect slowly wears off over time protection from pregnancy after the 3 month mark is not assured.

Noristerat is a similar injection which gives contraceptive protection for eight weeks.

At the present time Depo-Provera is far more widely used than Noristerat.

You should not have injections if you:

have any type of heart disease
have breast or womb cancer
have liver disease or jaundice
have sickle cell anemia
have suffered from bad depression
might be pregnant

Advantages	Disadvantages
no interruption between foreplay and intercourse	Side effects*
no inconvenience of a pill	Side effects cannot be neutralized or reversed should side until the effects wear off after 3 months
highly effective	it takes an average of 9-10 months to fall pregnant after ceasing injections
elimination of monthly periods after extended use	some prescribed medicines adversely affect the contraception injection's effectiveness
may give some protection against cancer of the womb	not effective against sexually transmitted infection
protects against cancer of the lining of the uterus and iron deficiency anemia	return of regular periods and fertility may be delayed for up to a year after the last injection
can be used while breast-feeding immediately after delivery	side effects not reversed until medication wears off (up to 12 weeks)
	may cause delay in getting pregnant after shots are stopped

*Side effects include:

abdominal pain
acne
depression
dizziness
fluid retention
headache
increased appetite
increased or decreased sex drive
increased risk of blood clots or stroke
irregular periods
menstrual changes
mental depression
mild hair loss
pregnancy symptoms
pregnancies, which rarely occur, are more likely to be ectopic (in the fallopian tubes)
prolonged menstrual bleeding
small increased risk of breast cancer
spotting between periods
stomach aches
tender breast
very little bleeding or no bleeding at all
weakness
weight changes

Seek immediate medical advice should you have:

bad headaches
blurred vision
chest or abdominal pain
excessive bleeding
numbness
pain, pus or bleeding at injection site
severe leg pain

"Hormonal Contraception: Pills, Implants & Injections" by Joseph W. Goldzieher is a useful and informative book for any woman considering or using hormonal contraceptive methods.

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IUD (Intrauterine Device)

IUD's are a highly effective form of contraception although not as effective as the Pill (combined oral contraceptive). The IUD appears to work:

by thickening the mucus round the neck of your womb (cervix) making it difficult for sperm to fertilize an egg
by interfering with the passage and implantation of an egg into the womb which helps stop conception
disrupting the normal structure of the uterine lining with infection fighting white blood cells which gather in the lining of the uterus

Modern IUD's mostly look like a matchstick with a bar across the top, in a letter 'T' shape, whereas the early models were coil or loop shaped. The IUD must be inserted by a doctor trained in family planning and a medical examination is needed before insertion of the IUD (intrauterine device) to check the uterus. The IUD, is a small device, about 11/2 inches/4cm long, made of metal (usually copper) and plastic and placed inside the uterus to prevent pregnancy.

How To Use

The doctor examines the vagina and then inserts a speculum to hold the vagina open
The IUD comes compressed in a thin tube, which is slid through the cervical canal at the top of the vagina into the uterus and then withdrawn, leaving the IUD to spring into shape
Thin threads hang from the IUD about 3cm/1 inch into the vagina, and these can be felt with the fingers to make sure that the device is still in place
The IUD string should be checked monthly to make sure it is still in in place
To remove an IUD the doctor pulls the string of the IUD with a specially designed instrument

Insertion can be slightly painful and unpleasant. The amount of pain you feel generally depends on:

if you are relaxed
the skill of the doctor
the shape of your womb
whether you have had children as insertion is usually easy if you have had a baby or abortion
size of IUS or IUD as insertion of an IUS and larger IUDs can be more painful than smaller devices

Painkillers can be taken before insertion if recommended by your doctor.

After insertion of IUD:

rest for at least half an hour
do not drive just in case you feel faint
have aspirin or paracetamol on hand for cramps or pain over the next few hours
you may lose a little blood during the next few days
you will be protected against pregnancy immediately so sex can be resumed as soon as you like

An IUD coil should NOT be inserted in any woman who:

has had an ectopic pregnancy (in which the fetus starts to develop in the tubes)
has had cancer of the ovary or the womb
has unexplained bleeding or pelvic pain
has multiple sexual partners because of the danger of infection
has a pelvic infection or sexually transmitted disease
has major structural problems of the womb
has had surgery on the Fallopian Tubes
has had serious artery disease (Mirena IUS only)
has an artificial heart valve (Mirena IUS only)
has a liver condition called Wilson’s disease
is allergic to copper (should not have IUDs that contain copper)
may be pregnant

Some side effects include:

Pelvic Inflammatory Disease. The risk of pelvic infection is increased with an IUD, especially if you have more than one sexual partner. Symptoms include:

discharge occurring soon after insertion
fever
pelvic pain

IUD's are usually fitted during the last few days of a period or just after and insertion usually takes only about 10 minutes. An IUD can be fitted immediately after a termination (abortion) but after having a baby an IUD is not usually put in until about six weeks after childbirth. Very occasionally doctors are unable to fit the IUD and have to suggest other methods of contraception.

If you fall pregnant on an IUD (about 2 in 100), the pregnancy carries the risk of being an ectopic pregnancy (fetus starts to develop outside the womb usually in one of the Fallopian Tubes). Severe pain and bleeding may occur. Consult a doctor immediately as this is a very serious condition.

IUD's have a 96-99 % effectiveness rate. Depending on type, IUDs are usually replaced about every 3 to 10 years:

FLEXI-T 300 - 5 years
GYNEFIX - 5 years
MULTILOAD Cu 375 - 5 years
MULTILOAD Cu 250 and Cu 250 Short - 3 years.
NOVA-T380 - 5 years
MIRENA IUS - 5 years
PROGESTASERT - replaced yearly

Advantages	Disadvantages
in women who have had children or an abortion the uterus is enlarged allowing more room for the IUD to fit better	may cause pelvic inflammatory disease or worsen existing infection
effective immediately	1.5 times greater risk of getting a pelvic infection than on another method of birth control
sex is not interrupted	sterility due to scarring of the fallopian tubes by pelvic infection
easily reversed	more bleeding or cramping with periods
	discomfort and bleeding for a few hours or days after the IUD is inserted can occur
	one in four women have it removed because of acute pain and heavy bleeding.
	sometimes an IUD may fall out and this is more likely to happen during a period
	medical risks sometimes include infection or puncture of uterus, increased difficulty in getting pregnant and problems with pregnancy

Call your medical practitioner immediately should the following occur:

abdominal or pelvic pain
bleeding between periods
chills
fever
IUD felt at cervical opening
lost string
perforation (occasionally, an IUD may perforate (go through) the womb usually at insertion) is a serious matter because if the IUD gets inside inside your abdomen it could cause you severe pain and an operation might be needed to remove it
severe cramping
very heavy periods

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Intrauterine System (IUS)

Some of the latest coils slowly release hormones into the womb over a period of anything up to 5 years. This type of device is called an intrauterine system and is inserted in a similar way to a standard IUD. The IUS has a higher effectiveness rate than the standard IUD because of the hormone it releases. It thins the lining of your womb so that there is less bleeding and the womb is less likely to be fertilized by an egg. It may also prevent ovulation (egg release) in some women.

One hormone used in IUS's is Levonorgestrel which is a progestogen (a synthetic version of the natural hormone progesterone) and is called commercially Mirena IUS. Progestasert is another effective IUS available but must be replaced yearly. Less than 1 in 100 will fall pregnant on this IUS (about the same effectiveness rate as the Pill).

Advantages	Disadvantages
Progestasert IUS and Mirena IUS release progesterone into the uterus	may cause pelvic inflammatory disease or worsen existing infection
periods become much shorter and lighter.	1.5 times greater risk of getting a pelvic infection than on another method of birth control
effective immediately	sterility due to scarring of the fallopian tubes by pelvic infection
sex is not interrupted	more bleeding or cramping with periods
easily reversed	discomfort and bleeding for a few hours or days after the IUD is inserted can occur
Mirena has lower failure rate than the Combined Pill because levonorgestrel adds to the contraceptive effect	sometimes an IUS may fall out and this is more likely to happen during a period
useful form of contraception if you suffer from painful periods or heavy or prolonged blood loss, which leads to anemia	medical risks sometimes include infection or puncture of uterus or problems with pregnancy

It is possible that:

period pain may be reduced
you may get irregular bleeding during the first few months
your periods might stop altogether
Mirena has a low risk of ectopic pregnancy

Side effects include:

backache
lower abdominal pain
those listed for standard IUD

Possible side effects of the hormone include:

acne
breast tenderness
headaches
ovarian cysts (no connection with polycystic ovary syndrome)
spots
weight gain

As Levonorgesterel, the hormone in Mirena, has been in widespread use for only a short period of time, long term effects of the hormone are as yet unknown.

A good source for more information is the detailed book "Mirena: The Levonorgestrel Intrauterine System: The New Contraceptive Option for Parous Women" by E. D. B. Johansson.

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