Contraception

It is important that you use a method of contraception if you do not wish to become pregnant. Our team can help guide you to choose the most effective method of contraception for you. If you want to learn more about contraception please talk with a member of staff or visit the Sexwise website.

What’s On the Page

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Introduction

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Getting Help

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Emergency Contraception

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STIs

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Types of contraception

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Testimonials

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Professionals

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More

Introduction to Contraception

Not all methods of contraception are available from every clinic, if you would like a specific method please advise us of this when booking your appointment.

When you attend for contraception the clinician will ask several questions about your general health and sex life. This is to ensure we are able to provide the best possible care to you and offer appropriate screening for relevant STIs.

If you didn’t use contraception and you are worried you may be at risk of pregnancy you may need emergency contraception.

If you would like a coil please open this document and read the information carefully: Essential Coil Information.

 

If you would like easy read information on contraception please click here.

Here is a list of all the methods we offer:

  • Combined pill (the pill)
  • Progestogen only pill
  • Copper Coil (IUD)
  • Progestogen Coil (IUS)
  • Contraceptive implant
  • Contraceptive injection
  • Contraceptive patch
  • Diaphragm/Caps
  • Natural Family Planning
  • Male and female condoms – condoms are available free from any of our sexual health clinics.

Getting Help

We are happy to discuss contraceptive options and help you to decide the right method for you. We offer long-term contraception, including oral contraception (known as ‘the pill’), implants, patches, coils and injectables to all women under the age of 25 years. If you are over the age of 25 we will speak to you initially first to find out your needs and may ask you to visit your GP for ongoing contraception instead.

We will of course provide emergency contraception, including emergency oral contraception (known as the ‘morning after pill’) and coils to all women, regardless of their age or even where they live. If you are worried that you might be at risk of pregnancy and require emergency contraception, please contact our triage line straightaway!

Emergency contraception (pills or coils) given last year

Contact US

Contact our dedicated team via our triage phone number 0300 421 6500 or book an appointment.

 

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male condoms when used correctly are 98% effective

Find Your nearest clinic

Our main clinics are based in Gloucester and Cheltenham, but we do have a number of other clinics throughout the county providing Sexual Health and Contraception clinics.

Please note that Pregnancy Advisory Services are based in Gloucester only.

 

Emergency Contraception

If you have had unprotected sex and you have forgotten your pill, the condom has split or you are not using any contraception, you may need emergency contraception. It is really important that you get emergency contraception as soon as possible as it works best to stop pregnancy the sooner it is taken.

There are two types of emergency contraception:

The health professional you see will be able to advise on the best option for you.

Free help is available from:

  • GPs who provide contraceptive services
  • Any sexual health clinic
  • Accident and Emergency Departments
  • Minor Injuries units
  • Your local pharmacy
  • Out of Hours service
  • School and college nurses

For information on how to access the sexual health service call 0300 421 6500 or view booking information and more on our clinics.

Click here for more information on emergency contraception

If you have found you are pregnant and not sure what you want to do you can attend our pregnancy advisory service and discuss your options.

STIs

It’s really important to remember that if you have had unprotected sex, you may also have a sexually transmitted infection (STI).

This can sound alarming but they are very common and often have no signs (symptoms).

You can visit your GP or local pharmacy for emergency hormonal contraception (EHC). Most of them will also offer postal chlamydia testing which is free of charge for under 25s.

You can also visit us for a chat about your sexual health, advice on contraception and whether you might need a test for STIs.

Combined pill (the pill)

The combined oral contraceptive pill is often just called ‘the pill’. It contains artificial versions of female hormones oestrogen and progesterone, which are produced naturally in the ovaries.

How does the pill work?

The pill prevents the ovaries from releasing an egg each month (ovulation). It also:

  • thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
  • thins the lining of the womb, so there is less chance of a fertilised egg implanting into the womb and being able to grow.
Brands

There are many different brands of pill, made up of 3 main types:

  • Monophasic 21-day pills
    This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. Microgynon, Marvelon and Yasmin are examples of this type of pill.
  • Phasic 21-day pills
    Phasic pills contain 2 or 3 sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. Phasic pills need to be taken in the right order. Logynon is an example of this type of pill.
  • Every day (ED) pills
    There are 21 active pills and 7 inactive (dummy) pills in a pack. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED is an example of this type of pill.

Follow the instructions that come with your packet. If you have any questions, ask a doctor, nurse or pharmacist.

It’s important to take the pills as instructed, because missing pills or taking them at the same time as certain medicines may make them less effective.

How effective is the combined pill?

When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than 1 in 100 who use the combined pill as contraception will get pregnant in one year.

Who can take the combined pill?

If there are no medical reasons why you cannot take the pill, and you do not smoke, you can take the pill until your menopause. However, the pill is not suitable for everyone. To find out whether the pill is right for you, talk to a GP, nurse or pharmacist.

The pill may not be right for you if you:

  • are pregnant
  • smoke and are 35 or older
  • stopped smoking less than a year ago and are 35 or older
  • are very overweight
  • take certain medicines

The pill may also not be right for you if you have (or have had):

  • blood clots in a vein, for example in your leg or lungs
  • stroke or any other disease that narrows the arteries
  • anyone in your close family having a blood clot under the age of 45
  • a heart abnormality or heart disease, including high blood pressure
  • severe migraines, especially with aura (warning symptoms)
  • breast cancer
  • disease of the gallbladder or liver
  • diabetes with complications, or diabetes for the past 20 years.
What are the risks of taking the combined pill?

There are some risks associated with using the combined contraceptive pill. However, these risks are small.

Blood clots

The oestrogen in the pill may cause your blood to clot more readily. If a blood clot develops, it could cause:

  • deep vein thrombosis (clot in your leg)
  • pulmonary embolus (clot in your lung)
  • stroke
  • heart attack

The risk of getting a blood clot is very small, but your doctor will check if you have certain risk factors before prescribing the pill.

Cancer

The pill can slightly increase the risk of developing breast cancer and cervical cancer. It can also decrease the risk of developing womb (uterus) cancer, ovarian cancer and bowel cancer.

However, 10 years after you stop taking the pill, your risk of breast cancer and cervical cancer goes back to normal.

Where can I get it?

Contraception is free to everyone through the NHS. Places where you can get contraception include:

  • sexual health clinics – they also offer contraceptive and STI testing services
  • community contraception clinics
  • GP surgeries – talk to a GP or nurse
  • some young people’s services (call the Sexual Health Line on 0300 123 7123 for more information)
Starting the combined pill

You can normally start taking the pill at any point in your menstrual cycle. There is special guidance if you have just had a baby, abortion or miscarriage. The guidance may also be different if you have a short menstrual cycle. Get advice from a doctor or nurse if you need it. You may need to use additional contraception during your first days on the pill – this depends on when in your menstrual cycle you start taking it.

  • Starting on the first day of your period
    If you start the combined pill on the first day of your period (day 1 of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.
  • Starting on the 5th day of your cycle or before
    If you start the pill on the 5th day of your period or before, you will still be protected from pregnancy straight away.
  • Starting after the 5th day of your cycle
    You will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for 7 days.
    If you start the pill after the 5th day of your cycle, make sure you have not put yourself at risk of pregnancy since your last period. If you’re worried you’re pregnant when you start the pill, take a pregnancy test 3 weeks after the last time you had unprotected sex.
What to do if you miss a pill

If you miss a pill or pills, or you start a pack late, this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:

  • when the pills are missed
  • how many pills are missed

Find out what to do if you miss a combined pill.

Vomiting and diarrhoea

If you vomit within 3 hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception until you’ve taken the pill again for 7 days without vomiting.

Very severe diarrhoea (6 to 8 watery poos in 24 hours) may also mean that the pill does not work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for 2 days after recovering.

Speak to a GP or nurse or call NHS 111 for more information, if your sickness or diarrhoea continues.

Pros and Cons

Pros

  • it does not interrupt sex
  • it usually makes your bleeds regular, lighter and less painful
  • it reduces your risk of cancer of the ovaries, womb and colon
  • it can reduce symptoms of PMS (premenstrual syndrome)
  • it can sometimes reduce acne
  • it may protect against pelvic inflammatory disease
  • it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Cons

  • it can cause temporary side effects at first, such as headaches, nausea, breast tenderness and mood swings – if these do not go after a few months, it may help to change to a different pill
  • it can increase your blood pressure
  • it does not protect you against sexually transmitted infections
  • breakthrough bleeding and spotting is common in the first few months of using the pill
  • it has been linked to an increased risk of some serious health conditions, such as blood clots and breast cancer
The combined pill with other medicines

Some medicines interact with the combined pill and it does not work properly. Some interactions are listed here, but it is not a complete list. If you want to check your medicines are safe to take with the combined pill, you can:

  • ask a GP, practice nurse or pharmacist
  • read the patient information leaflet that comes with your medicine.

Antibiotics

The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the combined pill. Other antibiotics do not have this effect.

If you are prescribed rifampicin or rifabutin, you may be advised to change to an alternative contraceptive. If not, you will need to use additional contraception (such as condoms) while taking the antibiotic and for a short time after. Speak to a doctor or nurse for advice.

Epilepsy and HIV medicines, and St John’s wort

The combined pill can interact with medicines called enzyme inducers. These speed up the breakdown of hormones by your liver, reducing the effectiveness of the pill.

Examples of enzyme inducers are:

  • the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
  • St John’s wort (a herbal remedy)
  • antiretroviral medicines used to treat HIV (research suggests that interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both)

A GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

FAQs

Visit the Sexwise website for further information.

Condoms (male and female)

External (male) and internal (female) condoms are a barrier method of contraception – they stop sperm meeting an egg.

You can get free condoms from any of our clinics!

 

What are they?

Condoms protect against STIs if used correctly during vaginal, anal and oral sex. It is really important that a condom is in place before any contact of the penis in these types of sex.

  • An external condom fits over an erect penis and is made of very thin latex (rubber), polyurethane (plastic) or polyisoprene. 
  • An internal condom is made of polyurethane (soft plastic) or nitrile polymer (synthetic rubber). It’s put in the vagina and loosely lines it.
How effective are they?

How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions.

If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year.

  • External condom
    Perfect use:
    If external condoms are always used according to instructions they’re 98% effective. This means that 2 women in 100 will get pregnant in 1 year.
    Typical use: If external condoms are not always used according to instructions, about 18 in 100 women will get pregnant in 1 year.
  • Internal condom
    Perfect use:
    If internal condoms are always used according to instructions they’re 95% effective. This means that 5 women in 100 will get pregnant in 1 year.
    Typical use: If internal condoms are not always used according to instructions, about 21 in 100 women will get pregnant in 1 year.

Sperm can get into the vagina during sex, even if you use a condom. This may happen if:

  • the penis touches the area around the vagina before a condom is put on (pre-ejaculation fluid, which leaks out of the penis before ejaculation, may contain sperm)
  • the condom splits
  • you use the wrong type or size of condom
  • you don’t use the condom correctly
  • the condom slips off (external)
  • the condom gets pushed into the vagina (internal)
  • the penis enters the vagina outside the internal condom by mistake
  • the condom gets damaged, for example by sharp fingernails or jewellery
  • you use too much or too little lubricant
  • you use oil-based products (such as body lotions) with latex or polyisoprene condoms. These damage the condom.

If any of these happen, or if you’ve had sex without using contraception, you can get advice about emergency contraception.

Who can use them?

Most people can use condoms. Occasionally some men and women might be allergic to latex condoms. If this is a problem, polyurethane or polyisoprene condoms are also available.

Some men may find that they have trouble maintaining an erection when wearing a condom or that the condom slips off when they are having sex. Getting the right condom for you can make a massive difference, so it’s worth trying out a range of condoms or coming into one of our clinics for advice. We’ll even give you some free condoms to try out.

There has been lots of innovation in the development of condoms over the past few years and they are now available in a huge variety of sizes, shapes, colours and flavours. Just make sure that it has a BSI kite mark and the European CE mark on the packet. This means they have been tested to the required safety standards.

Internal condoms are suitable for most people, but may not be suitable if you don’t feel comfortable touching the genital area to insert them.

Are there any side effects?

Many condoms are made from rubber latex. Some people – 1 or 2 people out of every 100 – experience an allergic response to the protein in the rubber. Symptoms can vary in presentation and severity, ranging from sneezing, runny nose, hives, itching or flushing, to more severe signs and symptoms, such as:

  • wheezing
  • swelling
  • dizziness,
  • light-headedness

If you or your partner are allergic to latex, polyurethane or polyisoprene condoms are also available.

Where can I get them?

External condoms are free from contraception and sexual health clinics, young people’s services and some GP practices. They may also be available for free at some pharmacies and other locations as part of local schemes.

You can buy them from a pharmacy, by mail order or online, as well as from vending machines, supermarkets, garages and other shops.

Internal condoms aren’t as widely available as external condoms. They’re also free from some contraception and sexual health clinics, young people’s services and GP surgeries, or you can buy them online and from some pharmacies.

How to use condoms

Read the Sexwise guide to using external and internal condoms here: https://www.sexwise.org.uk/stis/how-use-condoms

Pros and Cons

Pros

  • You only need to use them when you have sex
  • They help to protect both partners from some sexually transmitted infections, including HIV
  • There are no serious side-effects or health impacts (unless you or your partner are allergic to latex)
  • An internal condom can be put in any time before sex
  • Condoms are widely available (external condoms more so)
  • External condoms come in a variety of sizes, colours, flavours, textures and shapes. It can be fun to experiment.

 

Cons

  • An external condom can sometimes slip off or split
  • Some people are sensitive to latex condoms, though this is rare
  • It’s important to pull out after ejaculation, before the penis goes soft, holding the external condom firmly in place at the base of the penis
  • When using an internal condom, you need to make sure the penis is in the condom and not between the condom and vagina and that the open end of the condom stays outside the vagina
  • Internal condoms can slip out or get pushed into the vagina
  • There are also external novelty condoms available. These condoms may not protect you from pregnancy and don’t help protect you from sexually transmitted infections.
FAQs

Visit the Sexwise website for further information on external and internal condoms..

Contraceptive implant

A contraceptive implant is a small, flexible rod that’s placed just under the skin of your upper arm. An implant works for three years.

An implant is a method of long-acting reversible contraception (LARC), which includes the contraceptive implant, contraceptive injection and coils (IUD and IUS).

How does it work?

The main way the contraceptive implant works is to stop your ovaries releasing an egg each month (ovulation). It also:

  • thickens the mucus from your cervix (entrance to the womb), making it difficult for sperm to move through it and reach an egg

  • makes the lining of your uterus (womb) thinner to stop a fertilised egg implanting.

How effective is it?

The contraceptive implant is over 99% effective at preventing pregnancy and is the most effective method of contraception. Fewer than 1 in 100 implant users will get pregnant in the first year of use.

Who can have the contraceptive implant?

The implant is suitable for most people. The healthcare professional fitting your implant will need to ask you about your own and your family’s medical history to make sure the implant is suitable for you. You should tell them about any illnesses or operations you’ve had.

An implant may not be suitable for you if:

  • you think you might already be pregnant

  • you don’t want your periods to change

  • you take certain medicines

It may not be suitable if you have, or had in the past:

  • breast cancer

  • unexplained vaginal bleeding (for example bleeding between periods or after sex)

  • heart disease or stroke

  • serious liver disease

Can anything make an implant less effective?

Some medicines may make an implant less effective. These include some of the medicines used to treat HIV, epilepsy and tuberculosis (TB), and the complementary medicine St John’s Wort. These are called enzyme-inducing drugs. If you take these medicines, it’ll be recommended that you use additional contraception, such as condoms, or that you change to a different method of contraception.

Always tell your healthcare professional that you’re using an implant if you’re prescribed any medicines.

How will an implant affect my periods?

Your bleeding will probably change. It’s common for it to be unpredictable and it may change at any time over the 3 years the implant lasts.

  • Most implant users will have irregular and unpredictable bleeding

  • Sometimes bleeding stops completely

  • A few implant users will have bleeding that’s more frequent or lasts longer

These changes may be a nuisance but they’re not harmful.

If you have bleeding that’s a problem for you in the first few months after starting the implant, there’s about a 1 in 2 (50%) chance that this will improve over time.

If you have bleeding that’s a problem for you at any time, talk to your healthcare professional. They may be able to give you some additional hormone or medicine that can help control the bleeding. They may also check that the bleeding isn’t due to other causes, such as an infection.

When can I start using an implant?

You can have an implant fitted at any time in your menstrual cycle if it’s certain that you’re not pregnant.

If the implant is put in during the first 5 days of your period, you’ll be protected from pregnancy immediately.

If the implant is put in on any other day, you won’t be protected from pregnancy for the first 7 days after it’s been inserted. You’ll need to avoid sex or use additional contraception, such as condoms, during this time.

How's an implant inserted?

The implant is the size of a matchstick. It’s placed just under your skin on the inside of your upper arm.

A trained healthcare professional will give you a local anaesthetic to numb the part of your arm where the implant will go, so it won’t hurt.

It only takes a few minutes to insert and feels like having an injection. You won’t need stitches.

After it’s been inserted, the healthcare professional will check your arm to make sure the implant’s in place. You’ll be shown how to feel the implant with your fingers, so you can check it’s in place.

The area may be tender for a day or two and may be bruised and slightly swollen. The healthcare professional will put a dressing on it to keep it clean and dry and to help reduce the bruising. Keep this dressing on for a few days and try not to knock the area.

Don’t worry about knocking the implant once the area has healed. It shouldn’t break or move around your arm. You’ll be able to do normal activities and you won’t be able to see it.

You don’t need a vaginal examination or cervical screening (smear) test to have an implant inserted.

How's an implant removed?

An implant can be left in place for 3 years. It can be removed sooner if you want to stop using it.

A specially trained healthcare professional must take it out. They’ll feel your arm to locate the implant. They’ll give you a local anaesthetic injection in the area where the implant is. They’ll make a small cut in your skin and gently pull the implant out.

They’ll put a dressing on the arm to keep it clean and dry and to help reduce any bruising. Keep this dressing on for a few days.

It usually only takes a few minutes to remove an implant. If the implant’s been inserted correctly, it shouldn’t be difficult to remove.

Occasionally, an implant is difficult to feel under the skin and it may not be so easy to remove. If this happens, you may be referred to a specialist centre to have it removed with the help of an ultrasound scan.

If you want to carry on using an implant, you can get a new one inserted at the same time. You’ll then continue to be protected from pregnancy.

Pros and Cons

Pros

  • Fit and forget: You don’t have to remember to take it every day like the contraceptive pill
  • The most effective method of contraception and effective for 3 years
  • It may reduce painful or heavy periods
  • Your fertility will return as soon as it’s removed
  • It may improve acne for some people

Cons

  • Your periods may change in a way that isn’t acceptable to you
  • It doesn’t work if you take certain medication
  • It takes a small procedure to both insert and remove it
  • It does not protect you from sexually transmitted infections (STIs)

Contraceptive injection

The contraceptive injection is a method of long acting reversible contraception (LARC), which includes the contraceptive implant, contraceptive injection and coils (IUD and IUS).

It is an injection which is given intramuscular (IM – into the muscle) or subcutaneously (SC – under the skin). The injection contains a progestogen hormone which is similar to the naturally produced progesterone by the ovaries.

How does the contraceptive injection work?

The main way it works is to stop your ovaries releasing an egg each month (ovulation). It also:

  • thickens the mucus from your cervix (entrance to the womb), making it difficult for sperm to move through it and reach an egg

  • makes the lining of your uterus (womb) thinner to stop a fertilised egg implanting

How effective is the contraceptive injection?

The contraceptive injection is over 99% effective at preventing pregnancy if it is had at the right time. If your injection is late or it is missed, you may not be protected from pregnancy.

Types of contraceptive injection
  • Depo-Provera: an intramuscular injection

  • Sayana Press: a subcutaneous injection

Who can have the contraceptive injection?

The injection is suitable for most people. The healthcare professional will need to ask you about your own and your family’s medical history to make sure the injection is suitable for you. You should tell them about any illnesses or operations you’ve had.

The injection may not be suitable for you if:

  • you think you might already be pregnant

  • you don’t want your periods to change

  • you take certain medicines

  • you want a baby in the next year

 

It may not be suitable if you have, or had in the past:

  • breast cancer

  • unexplained vaginal bleeding (for example bleeding between periods or after sex)

  • heart disease or stroke

  • serious liver disease

  • risk factors for osteoporosis (thinning of the bones)

Can anything make the injection less effective?

Some medicines may make the injection less effective. These include some of the medicines used to treat HIV, epilepsy and tuberculosis (TB), and the complementary medicine St John’s Wort. These are called enzyme-inducing drugs. If you take these medicines, it’ll be recommended that you use additional contraception, such as condoms, or that you change to a different method of contraception.

Always tell your healthcare professional that you’re using the contraceptive injection if you’re prescribed any medicines.

How can the contraceptive injection affect my periods?

Your bleeding will probably change. Most often, periods will stop completely. Some injection users will have irregular bleeding or spotting (bleeding between your usual bleeds). Some injection users will have bleeding that lasts longer and is heavier.

If you have bleeding that’s a problem for you at any time, talk to your healthcare professional. They may be able to give you some additional hormone or medicine that can help control the bleeding. They may also check that the bleeding isn’t due to other causes, such as an infection.

When can I start using the contraceptive injection?

You can start having the contraceptive injection at any time in your menstrual cycle if it’s certain that you’re not pregnant.

If you start having the contraceptive injection during the first 5 days of your period, you’ll be protected from pregnancy immediately.

If you start having the contraceptive injection on any other day, you won’t be protected from pregnancy for the first 7 days. You’ll need to avoid sex or use additional contraception, such as condoms, during this time.

Contraceptive injection and my bones

The contraceptive injection affects your natural estrogen levels, and may cause thinning of the bones. This isn’t usually a problem for most injection users as the bone replaces itself when you stop the injection and it doesn’t appear to cause any long-term problems.

Thinning of the bones may be more of a problem if you already have risk factors for osteoporosis (being underweight, smoking, heavy drinking).

If you are under 18 years of age the contraceptive injection may not be the doctor or nurse’s first choice of contraception for you as your bones are still growing.

Pros and Cons

Pros

  • You don’t have to think about contraception for as long as the injection lasts (13 weeks)

  • It may reduce heavy painful periods and help with premenstrual symptoms for some people

  • You can use it if you’re breastfeeding

  • It’s a good method if you can’t use estrogens, like those in the combined contraceptive pill, patch or vaginal ring

Cons

  • Your periods may change in a way that isn’t acceptable to you

  • Irregular bleeding may continue for some months after stopping the injections

  • There can be a delay of up to one year before the return of your periods and fertility after stopping the injection

  • Some people may put on weight

  • It does not protect you from sexually transmitted infections (STIs)

Copper coil IUD

There are two types of contraceptive coil, one that uses hormones (hormonal IUS) and one that doesn’t (copper coil IUD).

What is it?

A copper coil is a small plastic and copper contraceptive device that is fitted into your uterus (womb). It has two threads that hang down to enable you to check that it is in place and to allow your doctor to remove it at a later date.

The coil stops you from getting pregnant by slowly releasing copper, which prevents sperm from surviving in your cervix, uterus or fallopian tubes. It may also stop fertilised eggs from implanting in the womb.

If being used as a method of emergency contraception it must be fitted within 5 days of having unprotected sex.

How effective is it?

A copper coil IUD is 99% effective at preventing pregnancy and can last for 5 or 10 years, depending on the type. It can also be fitted as a form of emergency contraception up to 5 days after unprotected sex. It starts working as soon as it is fitted and your fertility will return to normal as soon as it is removed. Occasionally, the IUD can be pushed out by your uterus, or it can move, which would stop it from working. This doesn’t happen very often and staff at your sexual health clinic will show you how to check so you know it’s in the right place.

Who can use it?

Most women can use the copper coil IUD, including those who are HIV positive. It is especially popular with young women. When you come in and see us, we will ask about your medical history and whether you have had any illnesses or complications just to check if the IUD is suitable for you. If you are already pregnant, have problems with your uterus or cervix or have an untreated STI then we may advise you about other methods of contraception. Everyone’s different so please come in and have a chat.

Are there any side effects?

Some women may experience some spotting or cramps for a number of days following insertion of an IUD. Heavier, longer or more painful periods when an IUD is fitted, especially in the first few months, can also be quite common. There is also a small chance of infection, especially during the first 20 days, so if you notice any unusual vaginal discharge or pain then please come back and see us as soon as possible.

The copper coil IUD is an extremely effective form of contraception and it’s very unlikely that you will get pregnant. If you do, there is a slightly increased chance that it will result in an ectopic pregnancy.

It’s also important to remember that an IUD cannot prevent you from getting a sexually transmitted infection. If you have a new partner or are unsure of your partner’s sexual history, you should still come in for a check-up.

Where can I get a copper coil IUD?

You can get an IUD fitted at any of our sexual health clinics. An IUD can only be fitted by a specially-trained doctor or nurse.

What happens when you get an IUD fitted?

You need to book an appointment to see a contraceptive nurse or doctor. They will ask you some questions about your health and then give you a quick examination to check the size and position of your uterus. Sometimes they will also check for any sexually transmitted infections (STIs).

Inserting the IUD takes around 5 minutes and can be a little uncomfortable. Don’t worry, the doctor or nurse will talk you through this beforehand and may offer you a local anaesthetic if needed. They may be able to fit the IUD at this consultation, or they will bring you back for the fitting at a later date, whichever is most appropriate. The appointment will last for approximately 30 minutes.

If you decide to have it removed, you need to visit one of our clinics. A specially-trained doctor or nurse will remove it and will give you advice about other forms of contraception you could use instead. Your fertility will return as soon as the IUD is removed. You need to make sure that you have used additional contraception or avoided sex for 7 days before you have the IUD removed, otherwise you could still get pregnant.

Pros and Cons

Pros

  • It works immediately
  • You can’t forget to take it
  • It lasts for 5 – 10 years
  • It can be used as emergency contraception
  • It is 99% effective
  • It does not contain hormones

 

Cons

  • It doesn’t protect you from STIs
  • You have to book an appointment to have one fitted (although this only takes 30 mins)
  • It can lead to heavier, more painful periods in some women.
FAQs

Visit the Sexwise website for further information.

Diaphragm/cap

Contraceptive caps and diaphragms are barrier methods of birth control. This means they help prevent you getting pregnant by stopping sperm from meeting an egg.

What is a diaphragm/cap?

A diaphragm or cap fits inside your vagina and covers your cervix (entrance to the uterus – womb). Diaphragms and caps come in different shapes and sizes.

  • Vaginal diaphragms are circular domes made of silicone with a flexible rim
  • Cervical caps are smaller and made of silicone

To be effective, diaphragms and caps should be used with a spermicide. Spermicide is a substance that kills sperm. It’s available in different forms, such as cream or gel.

How effective is the diaphragm/cap?

If fitted correctly and used perfectly every time you have sex, diaphragms and caps are 92–96% effective at preventing pregnancy when they’re used with spermicide (a substance that kills sperm). This means that 4-8 users out of 100 will get pregnant in one year.

If you don’t use your diaphragm or cap perfectly every time, they’re around 71-88% effective. This means that around 12-29 users out of 100 will get pregnant in one year.

If 100 sexually active women don’t use any contraception, 80 to 90 will get pregnant in a year.

A diaphragm or cap will be less effective if:

  • it’s damaged
  • it doesn’t cover your cervix completely
  • it isn’t the right size
  • you use it without spermicide
  • you have sex three hours or more after you put it in and don’t use extra spermicide
  • you don’t use extra spermicide with your diaphragm or cap every time you have sex
  • you remove it too soon (less than six hours after the last time you had sex).

If any of these happen, or if you’ve had sex without using contraception, you can get advice about emergency contraception from one of our clinics.

Who can use a diaphragm/cap?

Most women can use a diaphragm however, because they work by covering the cervix, anything that prevents them from fitting properly will make them less effective.

A diaphragm may not be suitable for you if:

  • you have an unusual shaped cervix
  • you can’t reach your cervix (this feels like a hard bump inside your vagina)
  • you have weak vaginal muscles (perhaps from giving birth)
  • you are allergic to latex or spermicide
  • you have a vaginal infection
  • you have multiple sexual partners
Are there any side effects?

There are not usually any side effects associated with the diaphragm as a form of contraception. Occasionally some people may be allergic to latex or spermicide and occasionally they can cause cystitis (a bladder infection).

It is really important to remember that the diaphragm cannot prevent sexually transmitted infections (STIs).

Where can I get one?

You can get a diaphragm or cap from one of our sexual health clinics, young people’s services or your GP. It’s also possible to buy a diaphragm or cap online, or from a pharmacy.

They come with instructions to help you learn to fit them, but it’s recommended that you also get advice on using them from a doctor or nurse.

What will happen?

A specially-trained doctor or nurse will have a chat with you about your sexual history, your health and what will work best for you and your lifestyle. If a diaphragm is a good option for you, they will give you a quick examination to see what size you will need. They will then show you how to apply spermicide and how to fit it, so that it is in the right place and working effectively.

We will probably ask you to come back, with your diaphragm fitted, for a check-up.

Pros and Cons

Pros

  • You only have to use it when you have sex
  • It has no serious health risks or side effects
  • You’re in control of your contraception
  • You can put it in before you have sex. (Add extra spermicide if sex takes place more than three hours after putting it in.)

Cons

  • It’s not as effective as other forms of contraception
  • You need to learn how to use it properly
  • You need to remember / stop and fit it before having sex
  • It does not protect against STIs
  • You may find spermicide messy
  • You may be sensitive to spermicide – this may cause irritation in you or a partner
FAQs

Visit the Sexwise website for further information.

Morning after pill (Emergency Hormonal Contraception)

An emergency contraceptive pill needs to be taken as soon as possible after sex to have the best chance of working.

There are two types of morning after pill (EHC) – the Levonelle and UPA (EllaOne).

Levonelle

Levonelle contains levonorgestrel, a synthetic (man-made) version of the natural hormone progesterone produced by the ovaries. Taking it’s thought to stop or delay the release of an egg (ovulation).

Levonelle is only licensed within 72 hours (3 days) of having unprotected sex, although it may work up to 96 hours. Be careful though, it gets less effective as time passes. It doesn’t interfere with your regular method of contraception.

Levonelle won’t continue to protect you against pregnancy – if you have unprotected sex at any time after taking the emergency pill, you can become pregnant.

It isn’t intended to be used as a regular form of contraception. But you can use emergency contraception more than once in a menstrual cycle if you need to.

ellaOne

EllaOne contains ulipristal acetate (or UPA for short), which stops progesterone working normally. This also works by stopping or delaying the release of an egg.EllaOne is licensed up to 120 hours (5 days) after having unprotected sex. However, it is also most likely to work if taken as soon as possible.

ellaOne won’t continue to protect you against pregnancy – if you have unprotected sex at any time after taking the emergency pill, you can become pregnant.

It isn’t intended to be used as a regular form of contraception. But you can use emergency contraception more than once in a menstrual cycle if you need to.

If you’re already using regular contraception

You may need to take the emergency pill if you:

  • forgot to take some of your regular contraceptive pills
  • didn’t use your contraceptive patch or vaginal ring correctly
  • were late having your contraceptive implant or contraceptive injection

If you have taken Levonelle, you should:

  • take your next contraceptive pill, apply a new patch or insert a new ring within 12 hours of taking the emergency pill
  • continue taking your regular contraceptive pill as normal
  • use additional contraception, such as condoms, for:
    • 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
    • 9 days for the combined pill Qlaira
    • 2 days if you use the progestogen-only pill

If you have taken ellaOne, you should:

  • wait at least 5 days before taking your next contraceptive pill, applying a new patch or inserting a new ring
  • use additional contraception, such as condoms, until you restart your contraception and for an additional:
    • 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
    • 9 days for the combined pill Qlaira
    • 2 days if you use the progestogen-only pill

A GP or nurse can advise further on when you can start taking regular contraception and how long you should use additional contraception.

How effective is the morning after pill?

Both Levonelle and ellaOne are effective only if taken before the release of an egg from the ovary (ovulation). The sooner you take Levonelle or ellaOne, the more effective it will be.

Ovulation is triggered by rising levels of a hormone called luteinising hormone (LH).

Levonelle appears not to be effective after levels of LH start to rise. EllaOne continues to be effective a little later in the cycle.

A 2017 review of the evidence estimated that around 1 to 2% of women who take ellaOne after unprotected sex will become pregnant. In comparison, it’s estimated that 0.6 to 2.6% of women who take Levonelle after unprotected sex will become pregnant.

The effectiveness of both Levonelle or ellaOne may be reduced if a woman has a high body mass index (BMI). This makes it harder to provide a more precise estimate for either pill.

Get medical advice if you vomit within 2 hours of taking Levonelle or 3 hours of taking ellaOne. You’ll need to take another dose or have an IUD/IUS fitted.

Who can use it?

Most women can use the emergency contraceptive pill. This includes women who can’t use hormonal contraception, such as the combined pill and contraceptive patch. Girls under 16 years old can also use it.

But you may not be able to take the emergency contraceptive pill if you’re allergic to anything in it, have severe asthma or take any medicines that may interact with it, such as:

  • the herbal medicine St John’s Wort
  • some medicines used to treat epilepsy, HIV or tuberculosis (TB)
  • medicine to make your stomach less acidic, such as omeprazole
  • some less commonly used antibiotics (rifampicin and rifabutin)

EllaOne can’t be used if you’re already taking one of these medicines, as it may not work. Levonelle may still be used, but the dose may need to be increased.

Tell a GP, nurse or pharmacist what medicines you’re taking, and they can advise you if they’re safe to take with the emergency contraceptive pill.

You can also read the patient information leaflet that comes with your medicine for more information.

Are there any side effects?

There are no serious or long-term side effects from taking the emergency contraceptive pill.

But it can cause:

  • headaches
  • tummy pain
  • changes to your next period – it can be earlier, later or more painful than usual
  • feeling or being sick – get medical attention if you’re sick within 2 hours of taking Levonelle or 3 hours of taking EllaOne, as you’ll need to take another dose or have an IUD fitted.

See a GP or nurse if your symptoms don’t go away after a few days or if:

  • you think you might be pregnant
  • your next period is more than 7 days late
  • your period is shorter or lighter than usual
  • you have sudden pain in your lower tummy – in rare cases, a fertilised egg may have implanted outside the womb (ectopic pregnancy)
Where can I get the morning after pill?

You can get the morning after pill (EHC) for free, even if you’re under 16, from:

  • sexual health clinic
  • some GP surgeries
  • some young people’s clinics
  • most NHS walk-in centres and minor injuries units
  • most pharmacies
  • some accident and emergency (A&E) departments (phone first to check)
Pros and Cons

Pros

  • Reliable contraception – If you take ellaOne within 5 days of contraceptive failure or unprotected sex, it is 95% effective for preventing pregnancies, while Levonelle’s effectiveness drops over time, and after 3 days it is only about 58% successful.
  • Convenient – You can buy the morning after pill in advance, so that you always have it on hand if you need it. You might want to buy some emergency contraception if you are going on holiday, or if you don’t have easy access to it.
  • No serious side effects – While there are some morning after pill side effects that you may experience, none of them are considered “severe” by the NHS.
  • Single dose – Taking the morning after pill is as simple as it sounds: you take one pill and you’re done, and many women won’t even experience any emergency contraception side effects.
  • Not harmful to foetuses – If the emergency pill doesn’t work and you become pregnant, there is no evidence that it will affect your baby.

Cons

  • Morning after pill side effects – The morning after pill does sometimes have unwanted side effects, but none of these are considered severe.
  • Effective for a limited time – If it’s been more than 5 days since you had unprotected sex or your contraception failed, there is no reason for you to take the morning after pill.
  • Only protects against pregnancy – It’s not really a negative point, but there are certainly some misconceptions about this. To be clear, the morning after pill doesn’t protect you from STIs, so if you have had unprotected sex you should still have an STI check-up even if you take emergency contraception.
  • Vomiting – If you vomit within 3 hours of taking the morning after pill, you will need to take another dose.
  • Not all women are suitable – The morning after pill is not suitable for some women. If you are not sure whether you should take the emergency contraception, speak to your doctor. People who are not suitable for the morning after pill include:
    • Women with liver problems or gut absorption problems
    • Women who take medicines to treat epilepsy
    • Women with severe uncontrolled asthma should seek medical advice before using ellaOne.
FAQs

Visit the Sexwise website for further information.

Natural Family Planning (Fertility Awareness Methods)

Natural family planning involves identifying the signs and symptoms of fertility during your or your partner’s menstrual cycle, so you can plan or avoid pregnancy.

What is it?

Natural Family Planning, also known as Fertility Awareness, involves being able to identify the signs and symptoms of fertility during the menstrual cycle so you can plan or avoid pregnancy.

In order to become pregnant, a sperm must fertilise an egg within 24 hours of ovulation (when the egg is released from the ovary).

Sperm can survive in the woman and still fertilise an egg up to 7 days after sex. This means the fertile time can be anything from 7 days prior to ovulation and for one day afterwards.

Pregnancy can be prevented by avoiding having sex or using alternative forms of contraception during this fertile time.

Who can use it?

If you are healthy, don’t have any medical conditions and have consistently regular periods, then you may be able to use natural family planning as a method of preventing pregnancy. It can be used at all stages of your reproductive life, whatever age you are.

Natural family planning may not be a suitable method if you don’t have periods. It may take longer to recognise your fertility indicators and to start natural family planning if you have irregular cycles, after stopping hormonal contraception, after having a baby, during breastfeeding, after an abortion or miscarriage, or when approaching the menopause.

There are many natural family planning apps that are designed to support observing the menstrual cycle and body changes. However, these tend to focus on monitoring only basic indicators of fertility, so they are not always reliable, especially in women with irregular menstrual cycles.

Are there any side effects?

There are no side effects to natural family planning, although it is important to remember that it will not prevent the transmission of sexually transmitted infections (STIs).

Where can I get advice about natural family planning?

We would strongly recommend that you come and visit us before trying this as a method of contraception. We can help you select the best form of contraception for you based on your sexual history and lifestyle.

If it is hormonal methods of contraception you are concerned about using, please be aware that the copper IUD is a very reliable method of contraception which is hormone free and is freely available at all our clinics.

The menstrual cycle

The menstrual cycle is the time from the first day of your period to the day before your next period starts.

The average length of the menstrual cycle is around 28 days, although many women have longer or shorter cycles and this is normal.

Regardless of how long or short the cycle is, ovulation (when the ovaries release an egg) will usually happen around 10–16 days before the start of the next period.

During your menstrual cycle:

  • eggs develop in your ovaries and usually one is released
  • the mucus in the cervix (entrance to the uterus – womb) changes to allow sperm to pass more easily through the cervix to reach the egg
  • the lining of the uterus thickens to prepare for a pregnancy
  • if the egg isn’t fertilised by sperm and you don’t get pregnant the uterus sheds its lining as your period, which signals the beginning of a new menstrual cycle.

The menstrual cycle is controlled by your body’s natural hormones – oestrogen and progesterone.

Pros and Cons

Pros

  • It doesn’t involve any chemicals or hormones
  • Using fertility awareness makes you more aware of your fertility and can help to plan a pregnancy or avoid a pregnancy
  • There are no physical side effects
  • It can help you recognise normal and abnormal vaginal secretions
  • It can help you to communicate about your fertility and sexuality
  • It’s acceptable to all faiths and cultures

Cons

  • It doesn’t protect you against STIs
  • It takes 3–6 menstrual cycles to learn effectively
  • It is not an easy method of contraception to use
  • You have to keep daily records
  • Some events, such as illness, lifestyle, stress or travel, can disrupt your usual cycle and may make fertility indicators harder to interpret
  • You need to use an alternative form of contraception when your risk of pregnancy is highest
  • It needs commitment and practice in order to be effective
FAQs

Visit the Sexwise website for further information.

Progestogen Coil (Hormonal IUS)

An IUS is a small plastic device that’s put into your uterus (womb) and releases a progestogen hormone. This is similar to the natural progestogen produced by the ovaries.

What is it?

A progestogen coil (Hormonal Intrauterine System, or IUS for short) is a small plastic t-shaped device with a sleeve that releases a low dose of a progestogen hormone into your uterus (womb). It has two threads that hang down to enable you to check that it is in place and to allow your doctor to remove it at a later date.

It stops you from getting pregnant by thickening your cervical discharge, by thinning the lining of your womb and occasionally by preventing an egg from being released (ovulation).

There are are 4 different types which release a different dose of hormone:

  • Jaydess which lasts 3 years and is the lowest dose
  • Kyleena which has a slightly higher dose of hormone but lasts 5 years
  • Levosert which has a slightly higher dose again and is licensed for 6 years; and
  • Mirena which has the same dose, but is licensed for 5 years.
How effective is the Progestogen Coil?

A hormonal IUS is 99% effective at preventing pregnancy and can last for 3 to 5 years depending on the type.

If it is fitted at the age of 45 years it can last up to 10 years for contraception purposes (but only for 5 years if being used as part of an HRT regimen). It starts working 7 days after it is fitted and your fertility will return to normal as soon as it is removed.

Occasionally, the IUS can be pushed out by your uterus, or it can move, which could affect how it works. This doesn’t happen very often and staff at your sexual health clinic will show you how to check so you know it’s in the right place.

Are there any side effects?

Some women may experience some spotting or cramps for a number of days following insertion of an IUS. Your periods may initially be quite erratic as the lining of the womb gets thinner, and you may also experience spotting and bleeding for a few weeks or possibly longer. This nearly always settles and you will eventually have very light bleeding or no bleeds at all. There is also a small chance of infection, especially during the first 20 days, so if you notice any unusual vaginal discharge or pain then please come back and see us as soon as possible.

The IUS does release a small amount of hormone. This is released into the womb and only a very small amount, if any, is absorbed into the bloodstream. You may notice some breast tenderness after it is first inserted or before a period and some acne or mood changes initially. However, these should settle and many women say it “evens out” their moods. There does not seem to be any difference in the hormonal side effects of the different types of IUS.

The hormonal IUS is an extremely effective form of contraception and it’s very unlikely that you will get pregnant. If you do, there is a slightly increased chance that it will result in an ectopic pregnancy.

It’s also important to remember that an IUS cannot prevent you from getting a sexually transmitted infection. If you have a new partner or are unsure of your partner’s sexual history, you should still come in for a check-up

Progestogen Coil for HRT use

The Mirena IUS is the only hormonal coil that is licensed for use as HRT. It can be used in conjunction with oestrogen gel, patches or tablets, as the progesterone component of combined HRT regimens. If using the Mirena for this purpose it can only be used up to 5 years maximum, no matter how old you are. In this situation therefore, the Mirena must be refitted by 5 years. If the Mirena is removed and not refitted the oestrogen-only HRT must be changed to a combined regimen. You should inform us if you are using your Mirena for this purpose.

Who can use a Progestogen Coil?

Most women can use the Progestogen Coil, including those who are HIV positive. It is especially popular with women who have heavy periods as it can make them lighter or stop them altogether. When you come in and see us, we will ask about your medical history and whether you have had any illnesses or complications just to check if the IUS is suitable for you. If you are already pregnant, have problems with your uterus or cervix or have an untreated STI then we may advise you about other methods of contraception. Everyone’s different so please come in and have a chat.

Where can I get a Progestogen Coil?

You can get an IUS fitted at any of our sexual health clinics. Some GP practices also offer coil fitting. An IUS can only be fitted by a specially-trained doctor or nurse.

What happens when you get an IUS fitted?

You need to book an appointment to see a contraceptive nurse or doctor. They will ask you some questions about your health and then will give you a quick examination to check the size and position of your uterus. Sometimes they will also check for any STIs.

Inserting the IUS takes around 5 minutes and can be a little uncomfortable. Don’t worry, the doctor or nurse will talk you through this beforehand and may offer you a local anaesthetic if needed. They may be able to fit the IUS at this consultation or they will bring you back for the fitting at a later date. The appointment will last for approximately 30 minutes.

If you decide to have it removed, you need to visit one of our clinics. A specially-trained doctor or nurse will remove it and will give you advice about other forms of contraception you could use instead. Your fertility will return as soon as the IUS is removed. You need to make sure that you have used additional contraception or avoided sex for 7 days before you have the IUS removed, otherwise you could still get pregnant.

Pros and Cons

Pros

  • It lasts for 3-5 years and will lighten or stop your periods
  • It is over 99% effective
  • You can’t forget to take it and it does not interfere with sex


Cons

  • It can cause erratic bleeding
  • It doesn’t protect you from STIs
  • You have to book an appointment to have one fitted (although this only takes 30 minutes)
FAQs

Visit the Sexwise website for further information.

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