Understanding Contraception – Choosing A Contraceptive

make the right choice for your body, by reviewing the evidence and understanding the impact, pros and cons

Dr Jess says: If you have already read the hormone toolkit, you will understand that hormones are very complex things. There are many different hormonal systems in our body that all need to work together. Our frequent use of synthetic (drug-based) hormones can affect multiple bodily functions and increase our long-term risk of health issues. Therefore it’s important to be aware of the side effects of the use of hormonal contraceptives.  

Whilst synthetic hormones from contraception can be necessary and the right choice for you, I would encourage you to regularly consider their impact and weigh it against the risks and benefits of an unwanted pregnancy or the severity of your period symptoms. 

Where possible, I encourage both women and men to explore and understand all the available non-hormonal contraception options, to help you to make the best choices for you, your partner and your body. (There is a section on male contraception at the end of the article). 

I found that the contraceptive pill had an extremely negative impact on my mood leading to mood swings, irritability, difficulty dealing with stress and finally unrelenting migraines, with fits of rage (I wasn’t an easy girlfriend!). These all stopped when my university relationship broke down (unsurprisingly!) and I came off the pill. Without the synthetic hormones, I felt like a different person. 

When I recently looked at my genetics in more detail, I have problems with a process called methylation and breaking down oestrogen, so this makes some sense to me. And I am not alone in my experiences. Whilst some women may tolerate synthetic hormones better, and others may find they seem to suit them, I would encourage you to look at allowing the natural cycles and rhythms of the body to continue unchanged, wherever possible, for healthy hormone balance. 

If you are taking a hormonal contraceptive or medication to prevent pain, acne, excessive bleeding or hormonal issues, it may be worth working through our hormone toolkit and seeing a good Chinese herbalist or functional medicine doctor to work on the root causes. This way, you may be able to correct any underlying problems and reduce your need for medication. 

There are several good non-hormonal methods of contraception that do not interfere with our hormonal balance. Many of my patients have found the copper (non-hormonal) coil is an easy and very effective form of long-term contraception with few side effects, as are condoms, which are very effective when used correctly. 

Any contraception decisions should always be made, not only with your partner, but also on the advice of your medical provider. 

Understanding the basics of fertility and contraception 

If an egg has been released from the ovary (ovulation) it is picked up by the fallopian tube (a mobile arm-like appendage at the top of the womb) and it begins to travel along the fallopian tube into the womb. Natural pregnancy occurs when semen containing sperm (mainly ejaculated during male orgasm, but a small amount is released before) is ejaculated inside (or introduced to the vaginal canal). The sperm then makes its way up the vagina to the cervix (the entrance of the womb), penetrating a layer of mucus to make it inside. 

The sperm can meet and fertilise the egg at any point during the egg’s journey along the tube, or be waiting there, ready for when the ovulated egg arrives. Once the egg is fertilised, it then travels to, and implants itself into the wall of the womb. There, it begins to release a pregnancy hormone at increasing amounts (which can only be picked up on a pregnancy test after implantation). The ovulated egg can only survive unfertilised for a maximum of 24 hours after its release. Sperm can survive for an average of three days inside the female body (but can even survive for as long as a week). 

Contraception works in a variety of ways: 

Non-hormonal: These forms of contraception may work through timing, by making sure that penetrative, vaginal sex does not happen around the time of ovulation. Other non-hormonal contraception may employ a barrier that blocks the ability of the sperm to either enter into the vaginal canal or the womb, or prevents the egg from implanting. Spermicides work by immobilising any sperm that manage to get through that barrier and preventing it from moving.

Hormonal: These work by preventing the release of the egg, thickening the cervical mucus (making it harder for the sperm to enter the womb), or by thinning the lining of the womb to prevent implantation. Some forms of hormonal contraception work in a few of these ways simultaneously. 

This is a long article. If you want to read about a specific form of contraception click on the quick links below:

Hormonal contraceptives:

Non-hormonal contraceptives:

hormonal contraceptives containing artificial oestrogen and progesterone

combined oral contraceptive pill (COC)

Brand names include: Microgynon, Rigevidon, Ovranette, Cilique, Yasmin, Loestrin 30, Ovranette, Lucette, Dyanette. Lower dose of estradiol (20mcg): Gedarel 20, Eloine, Loestrin 20, Femodene, Femodette, Logynon, Millinette, Mercilon.

How does the combined pill work?

The combined pill (a combination of artificial oestrogen and progesterone) is 99% effective when used correctly. It works by preventing egg release, thickening the mucus at the neck of the womb to prevent sperm from entering and thinning the lining of the womb, so that a fertilised egg is less likely to implant.  

How do you use the combined pill?

Oral contraception may be taken in one of several ways. The most common way is to take one pill a day, for 21 days, then taking a break of seven days before restarting. This cycle is repeated every month. During the seven days of not taking the pill, you have a withdrawal bleed, where bleeding occurs. This is not a period. The bleeding occurs as a result of the drop in hormone levels when you take that seven-day break.  

Some patients may be advised by their doctor to take the pill without a break, or to take a shorter break of around four days. Some brands of combined pills contain seven dummy pills, so that you take a pill every day. This can be useful for people who prefer the routine of taking a pill daily. Other brands of combined pill give different dosages or hormones throughout the month. Logynon is an example of one of those brands. 

You can start taking the combined pill at any time during your menstrual cycle (assuming that you are not pregnant). If you start on day 1-5 of your cycle (day 1 is the first day of your period), then you are fully protected immediately. If you are starting the pill after day 5, you should use additional contraception (like condoms) for the first seven days, as you are not protected for the first week. 

If you miss a pill or start a pack a day late, take the pill that you missed as soon as you realise (even if it means taking two in one day) and you should still be protected. If you miss two or more pills, or you start a pack more than two days late, take one of the missed pills on the day that you realise (even if it means taking two in one day) and use additional contraception for seven days. You need to go straight onto a new pack of pills (without a break) if there are less than seven left when you missed a pill and you may need emergency contraception. Take a pregnancy test after three and four weeks to ensure you are not pregnant. 

Who shouldn’t take the combined pill? 

Do not start taking the combined pill if you are 35 or older. Avoid taking it if you are a smoker. If you have smoked within the last 12 months, it should be used with extreme caution. The combined pill should not be taken if you have migraines, are overweight, have diabetes with complications, gallbladder or liver disease, systemic lupus erythematosus (SLE), a clotting disorder or history of blood clots, a history of arterial disease, high blood pressure, heart disease or stroke or if you have a history of breast cancer. 

Do not take the pill if any of your close blood relatives have had a blood clot when under 45 years old. If you have a family history of breast cancer, the combined pill should be discussed with your medical provider to evaluate the benefits and risks. Do not take the pill when breastfeeding, for the first in weeks after giving birth. There is an increased risk of blood clots in the first six months after birth, and it may reduce your milk supply.

The pill should not be taken past 50 years of age, as safer alternatives exist. The benefits and risks of taking the pill should be discussed if you have high cholesterol, regular headaches, idiopathic intracranial hypertension or rheumatoid arthritis.

Most contraceptive pills contain lactose so aren’t suitable for use if you are lactose intolerant. Instead, consider using the vaginal ring or patch as an alternative method of contraception.

What might stop the combined pill from working?

The combined pill should be taken daily, at around the same time, to space the treatment 24 hours apart. Not taking it consistently may cause it to fail and not be an effective form of contraception. 

If you vomit within three hours of taking the pill, have severe diarrhoea (six or more watery stools in 24 hours) or suffer from malabsorption (a digestive problem) the pill may not be effective. If you have vomiting or diarrhoea, you must use additional contraception for the duration of your illness and for two days after you have recovered. 

The combined pill interacts with the below medications, so you must use alternative contraception whilst you take any of these and for four weeks afterwards: 

  • Carbamazepine 
  • Eslicarbazepine acetate
  • Nevirapine
  • Oxcarbazepine
  • Phenytoin
  • Phenobarbital
  • Primidone 
  • Ritonavir 
  • St John’s Wort (Hypericum perforatum)
  • Topiramate
  • Rifabutin
  • Rifampicin
  • Griseofulvin

Combined pill side effects, risks and disadvantages

The combined pill does not protect against STIs. Side effects may include mood swings, nausea, breast tenderness and headaches. It may increase your blood pressure and cause breakthrough bleeding and spotting. Many patients report weight gain, although this is not currently supported by any evidence. 

There is a small risk of blood clots including DVT, PE, heart attack and stroke and this risk is higher if you smoke. Pills that contain a greater amount of oestrogen, like Yasmin, have a higher risk of blood clots.1

Your blood pressure and weight should be checked annually. 

The combined contraceptive pill has been linked to an increased risk of breast and cervical cancer2,3,4. As breast cancer is the leading cause of death in women under 50 years old, we would encourage you to strongly consider the additional risk factors. 

There is evidence that the combined oral contraceptive pill can worsen autoimmune diseases such as lupus (SLE), multiple sclerosis and inflammatory bowel disease.5 

The oral contraceptive pill has been shown to affect the permeability of the gut wall, leading to digestive issues and an increased risk of inflammation. It can also alter the gut microbiome, negatively increasing inflammation.6 

Early research shows that when taking the combined contraceptive pill, you may select different sexual partners as it influences your response to pheromones. When women aren’t on the contraceptive pill, receptors in their nose help them instinctively select males with scents that have a very different genetic code than their own (helping to ensure genetic diversity). Early research shows that when women are taking the contraceptive pill they make different choices, picking males with closer genetics to their own. While this may sound like a good thing, but to ensure we have healthy children, we ideally want a varied genetic pool.7

There is evidence that hormonal contraceptive use can alter your hormone balance in the long term. It may inhibit oxytocin (the cuddle hormone) which is important for maintaining relationships, act on the nerves to reduce erotic sensations, change women’s relationship behaviour and increase sexual jealousy.8  

Combined contraceptive pills can alter the vaginal microbiome (the beneficial bacteria in the vagina), reducing bacterial diversity and potentially increasing the risk of infections, like HIV.9 Dr Jess notes that she has regularly seen an increased incidence of thrush and urinary tract infections in patients taking the contraceptive pill, which settles when they stop taking it. 

Depression can also be a side effect of the contraceptive pill, which may be worse in adolescents. Please consult your medical provider and consider changing contraceptives if you are experiencing new low mood symptoms whilst on the pill.10

You may struggle to remember to take a daily pill and this may lead to pregnancy. Many women using this method set phone reminders to prompt them to take it.  

Due to the large number of conditions that can increase the risk of using the pill, we would strongly recommend that you have a routine set of blood tests taken, to check your full blood count, kidney function, liver function, cholesterol and blood sugar, to rule out any unknown health conditions before you start taking it.

You may also wish to dig a little deeper, to see how your genetics affect your ability to process hormones. You can do this by taking a home mouth swab DNA test. We like DNAoestrogen, with DNA life, which provides a relatively easy to understand report which can show if you struggle to process oestrogen and therefore should consider using a non-hormonal form of contraception.

Advantages of taking the combined pill

It doesn’t interrupt sex. If you have heavy or painful periods, PMS, acne or endometriosis the combined contraceptive pill may reduce or eliminate symptoms, as it ‘blocks’ your natural rhythm and cycle. (When you take the pill, you aren’t ovulating. The bleeding is just a result of withdrawal from the hormone). 

How do I get it?

The combined contraceptive pill is free and available from sexual health clinics, contraception clinics and all GP surgeries. Your weight and blood pressure should be recorded and your medical history taken when attending a consultation. 

vaginal ring

Brand names include: NuvaRing

How does the vaginal ring work?

The vaginal ring works in the same way as the combined pill, it just uses a different method of delivery. The plastic ring releases a continuous dose of oestrogen and progesterone that is absorbed vaginally into the bloodstream for 21 days of each month. It is removed after 21 days, then a new ring is inserted after a seven-day break.  

How do you use the vaginal ring?

The ring is inserted into the vagina and is replaced each month. It is inserted by washing your hands, squeezing the ring between your finger and thumb and inserting the ring into your vagina, as high as you can, to a point where you can no longer feel it. Unlike the contraceptive cap, It doesn’t have to cover the cervix to work. It is removed three weeks later by hooking a finger around the edge of the ring and pulling it out. Many women find this easier in a squatting position. After a seven-day break, a new ring is inserted. 

If you leave the ring in for more than four weeks or forget to put a new ring in, remove the old ring, insert a new one and use additional contraception for 7 days.  You may need emergency contraception. Do a pregnancy test at both three and four weeks afterwards, regardless of whether you forgot to insert a new ring, or had left an old one in. 

Some patients may be advised by their doctor to use the contraceptive ring without a break, or to take a shorter break of around four days. 

You can insert a ring any time during your menstrual cycle (assuming that you are not pregnant). Protection rates are the same as for the combined contraceptive pill. 

Who shouldn’t use the vaginal ring? 

Do not start using the vaginal ring if you are 35 or older. Avoid use if you are a smoker. If you have smoked within the last 12 months, it should be used with extreme caution. The contraceptive ring should not be used if you have migraines, are overweight, have diabetes with complications, gallbladder or liver disease, systemic lupus erythematosus (SLE), a clotting disorder or history of blood clots, a history of arterial disease, high blood pressure, heart disease or stroke or if you have a history of breast cancer. 

Do not use the vaginal ring if any of your close blood relatives have had a blood clot when under 45 years old. If you have a family history of breast cancer, the contraceptive ring should be discussed with your medical provider to evaluate the benefits and risks. Do not use the vaginal ring when breastfeeding, for the first six weeks after giving birth. There is an increased risk of blood clots in the first six months after birth, and it may reduce your milk supply.

The vaginal ring should not be used past 50 years of age, as safer alternatives exist. The benefits and risks of using the ring should be discussed if you have high cholesterol, regular headaches, idiopathic intracranial hypertension or rheumatoid arthritis.

What might stop the vaginal ring from working?

Not replacing it each month can stop the vaginal ring from working. It can occasionally fall out (if this happens, rinse it in warm water and reinsert it).

Unlike the pill, the vaginal ring still works if you experience vomiting, diarrhoea or malabsorption. 

The vaginal ring interacts with the below medications, so you must use alternative contraception whilst you take any of these and for four weeks afterwards: 

  • Carbamazepine 
  • Eslicarbazepine acetate
  • Nevirapine
  • Oxcarbazepine
  • Phenytoin
  • Phenobarbital
  • Primidone 
  • Ritonavir 
  • St John’s Wort (Hypericum perforatum)
  • Topiramate
  • Rifabutin
  • Rifampicin
  • Griseofulvin

Side effects, risks and disadvantages of the vaginal ring

The vaginal ring does not protect against STIs. The side effects and risks are the same as for the combined contraceptive pill. 

Contraceptive vaginal rings can also change the vaginal environment, creating a significantly increased risk of cervical and vaginal inflammation.9 

Inserting and removing the ring can feel uncomfortable. 

Advantages of the vaginal ring

The vaginal ring and the combined contraceptive pill offer the same advantages, but there is the added benefit of not having to remember to take a daily pill. 

How do I get it?

The vaginal ring is free and available from NHS sexual health clinics, contraception clinics and some GP surgeries (but if this is a contraceptive option that you may be interested in, check first to make sure your medical provider offers this service). 

contraceptive patch 

Brand names include: Evra

How does the contraceptive patch work?

The contraceptive patch works in the same way as the combined pill, just using a different method of delivery. The patch releases a continuous dose of oestrogen and progesterone that is absorbed through the skin into the bloodstream, throughout 21 days of the month. 

How do you use the contraceptive patch?

The contraceptive patch is about 2” in size. It is worn on clean, dry and hairless skin in an area where the skin is unbroken and the patch won’t be rubbed by clothing or excess movement.  Each patch is worn for a week. After three weeks of wearing the patch, a seven-day break is taken, before a new patch is used. 

Some patients may be advised by their doctor to use the contraceptive patch without a break, in a nine-week cycle, or to take a shorter break of around four days. 

You can start using the contraceptive patch at any time during your menstrual cycle (assuming that you are not pregnant). Protection rates are the same as for the combined contraceptive pill. 

The patch can be worn whilst showering, bathing, swimming and in the sauna. 

If the patch comes off and you notice within 48 hours, replace it and make that the new day of the week that you change your patch. If you don’t know when the patch came off, or it has been longer than 24 hours, or longer than your seven-day break, put on a new patch and use additional contraception for seven days. You may need to use emergency contraception. Take a pregnancy test at two and three weeks after the patch came off, and also at four weeks, if you went longer than a seven-day break. 

Who shouldn’t use the contraceptive patch? 

Do not start using the contraceptive patch if you are 35 or older. Avoid use if you are a smoker. If you have smoked within the last 12 months, it should be used with extreme caution. The contraceptive patch should not be used if you have migraines, are overweight, have diabetes with complications, gallbladder or liver disease, systemic lupus erythematosus (SLE), a clotting disorder or history of blood clots, a history of arterial disease, high blood pressure, heart disease or stroke or if you have a history of breast cancer. 

Do not use the contraceptive patch if any of your close blood relatives have had a blood clot when under 45 years old. If you have a family history of breast cancer, the contraceptive patch should be discussed with your medical provider to evaluate the benefits and risks. Do not use the contraceptive patch when breastfeeding, for the first six weeks after giving birth. There is an increased risk of blood clots in the first six months after birth, and it may reduce your milk supply.

The contraceptive patch should not be used if you are over 50 years of age, as safer alternatives exist. The benefits and risks of using the ring should be discussed if you have high cholesterol, regular headaches, idiopathic intracranial hypertension or rheumatoid arthritis.

What might stop the contraceptive patch from working?

Not replacing it each week. It can occasionally lose contact or fall off without you noticing. 

Unlike the pill, the contraceptive patch still works if you experience vomiting, diarrhoea or malabsorption. 

The contraceptive patch interacts with the below medications, so you must use alternative contraception whilst you take any of these and for four weeks afterwards: 

  • Carbamazepine 
  • Eslicarbazepine acetate
  • Nevirapine
  • Oxcarbazepine
  • Phenytoin
  • Phenobarbital
  • Primidone 
  • Ritonavir 
  • St John’s Wort (Hypericum perforatum)
  • Topiramate
  • Rifabutin
  • Rifampicin
  • Griseofulvin

Side effects, risks and disadvantages of the contraceptive patch

The contraceptive patch does not protect against STIs. Side effects and risks are the same as they are for the combined contraceptive pill, with the additional risk of skin irritation. This can be minimised by placing the patch on a different part of the skin each time one is used. 

Advantages of the contraceptive patch

The contraceptive patch and the combined contraceptive pill offer the same advantages, but there is the added benefit of not having to remember to take a daily pill. 

How do I get it?

The contraceptive patch is free and available from NHS sexual health clinics, contraception clinics and some GP surgeries (but if this is a contraceptive option that you may be interested in, check first to make sure your medical provider offers this service). 

The clinic will advise you on the best way to apply the patch to ensure good adhesion. 

contraceptives only containing artificial progesterone


progestogen-only pills

Brand names include: Noriday and Norgestron (3-hour window, often called mini-pills), Cerelle and Cerazette (12-hour window)

How does the progestogen-only pill work?

The progestogen-only pill is 99% effective when used correctly, but due to human error, it is likely only 91% effective in the real world. It contains artificial progesterone and works by thickening the mucus at the neck of the womb to prevent sperm from entering. The desogestrel progesterone-only pill may also prevent egg release.  

How do you use the progestogen-only pill?

There are two types of progestogen-only pill. One is a 3-hour window pill (i.e. must be taken within 3 hours of the same time each day) and the other is a 12-hour window pill (i.e. must be taken within 12 hours of the same time each day). It is taken as one pill daily, every day of the month with no breaks, following the timing (either within a three or 12-hour window each day) that is on your pill packet instructions. 

You can start taking this pill any time during your menstrual cycle (assuming you are not pregnant). If you start on days 1-5 of your cycle (day one is the first day of your period) then you are fully protected immediately. If you are starting the pill after day five, you should use additional contraception (like condoms) for the first two days, as you are not protected. 

If you miss a pill or are outside your three or 12-hour time window (check your packet instructions), take the pill that you missed as soon as you realise (even if it means taking two in one day) and take the next pill at the usual time. Use additional contraception for 48 hours. You may need emergency contraception and to take a pregnancy test three and four weeks. 

Who shouldn’t use the progestogen-only pill? 

It should not be started if you think you are pregnant. Avoid if you have liver disease, systemic lupus erythematosus (SLE), undiagnosed vaginal bleeding in between periods or after sex, a history of arterial disease, heart disease or stroke or if you have a history of breast cancer. If you have a family history of breast cancer it should be discussed with your medical provider to determine the benefits and risks. 

What might stop the progestogen-only pill from working?

Not taking it consistently, it must be taken daily at around the same time. 

Vomiting within three hours of taking a pill, severe diarrhoea (six or more watery stools in 24 hours) or malabsorption (digestive problem). If you have vomiting or diarrhoea use additional contraception, during illness and for two days after. 

For interactions with other medications, see the list we have compiled for the combined oral contraceptive pill. If using a medication with interactions, use alternative contraception both whilst taking the medication and for four weeks afterwards.

Side effects, risks and disadvantages of the progestogen-only pill

The progestogen-only pill does not protect against STIs. 

Side effects include: 

  • acne
  • mood changes including depression 
  • a change to your sex drive (usually lower)
  • irregular bleeding
  • nausea or vomiting
  • skin reactions 
  • weight gain 
  • ovarian cysts
  • breast tenderness and changes 
  • Headaches
  • hair loss
  • fatigue (tiredness)
  • vulval or vaginal infections. 

It may also cause breakthrough bleeding and spotting. Many women find on the 12-hour progestogen-only pill that their periods become much lighter, less frequent or stop. 

There is some evidence of an increased risk of breast cancer with progestogen-only pills.11 Although natural progesterone can be protective against breast cancer and breaks down quickly in the body to be eliminated, synthetic progestins (also known as progestogen) are shown to be more difficult to eliminate and have a different effect upon breast tissue that is more likely to promote cancer cell growth.12  Breast cancer is the leading cause of death in women under 50 years in the UK, so everyone should strongly consider any factor that increases that risk. 

A disadvantage of the 3-hour progestogen-only pill is the difficulty of remembering to take it regularly.  

It should also be noted that recent research has shown that the artificial hormones (from taking progestogen-only and other pills) that humans are excreting are having an extremely negative effect upon aquatic wildlife and can stop fish from being able to reproduce. Where possible, it is important to consider the wider impact of the choices we make on the environment around us.13

Due to the multiple number of conditions that can increase the risk of the progestogen-only pill, we would strongly recommend that if you haven’t had a recent blood test you have a routine set of blood tests to check your full blood count, kidney function, liver function, cholesterol and blood sugar to rule out any unknown health conditions before you start taking the pill. 

You may also wish to see how your genetics affect your ability to process hormones. You can do a home mouth swab DNA test, we like DNAoestrogen with DNA life which provides a relatively easy to understand report which will show you if you struggle to process hormones and therefore should consider a different and non-hormonal form of contraception. 

Advantages of the progestogen-only pill

It doesn’t interrupt sex. It is an alternative to the combined pill if that is not suitable for you. If you have heavy periods, or severe periods, taking the 12-hour pill may lighten or stop periods, as it prevents your natural rhythm and cycle. 

How do I get the progestogen-only pill?

The progestogen-only pill is free and available from NHS sexual health clinics, contraception clinics and all GP surgeries as well as online doctor services. 

contraceptive implant (progestogen-only)

Brand names include: Nexplanon, Implanon (etonogestrel)

How does the contraceptive implant work?

The progestogen-only implant is 99% effective. It works by releasing a continuous dose of artificial progesterone that is absorbed into the bloodstream. It works by preventing egg release, thickening the mucus at the neck of the womb to prevent sperm from entering and thinning the lining of the womb, so that a fertilised egg is less likely to implant.  

How do you use the contraceptive implant?

After numbing the area with a local anaesthetic, a small plastic rod is inserted under the skin of your upper arm by a doctor or nurse. The process takes just a few minutes. Once fitted, the contraceptive implant can stay in place for up to three years when it needs to be removed (a doctor or nurse applies a local anaesthetic and makes a small cut and removes it). Contraceptive protection is lost as soon as it is removed.

You can have an implant fitted at any time during your menstrual cycle (assuming you are not pregnant). If you have it put in between days 1-5 of your cycle (day one is the first day of your period) then you are fully protected immediately. If you have the implant inserted after day five, you should use additional contraception (like condoms) for the first seven days as you are not protected. It can be inserted straight after giving birth, or whilst breastfeeding.

Training to insert Nexplanon is a two-hour training course. Check that your medical provider has the appropriate training and has experience in inserting them (ask them how many they have put in)! If it is not inserted correctly, they can damage nerves and blood vessels in your arm, and on rare occasions, implants have travelled along blood vessels, and migrated into the chest, causing serious issues.14 The risk of this is significantly reduced if the person putting in your implants is experienced. Your medical provider should show you how to feel the implant and you should check for it regularly. If at any time you can’t feel it you should seek medical advice. 

Who shouldn’t use the contraceptive implant? 

It should not be used if you think you are pregnant. Avoid if you have liver disease, systemic lupus erythematosus (SLE), undiagnosed vaginal bleeding in between periods or after sex, a history of arterial disease, heart disease or stroke or if you have a history of breast cancer. If you have a family history of breast cancer it should be discussed with your medical provider to determine the benefits and risks. 

What might stop the contraceptive implant from working?

For interactions with other medications, see the list we have compiled for the combined oral contraceptive pill. If using a medication with interactions, use alternative contraception both whilst taking the medication and for four weeks afterwards.

Side effects, risks and disadvantages of the contraceptive implant

The contraceptive implant does not protect against STIs. 

Side effects include: 

  • acne
  • mood changes including depression 
  • a change to your sex drive (usually lower)
  • irregular bleeding
  • nausea or vomiting
  • skin reactions 
  • weight gain 
  • ovarian cysts
  • breast tenderness and changes 
  • Headaches
  • hair loss
  • fatigue (tiredness)
  • vulval or vaginal infections. 

It may also cause breakthrough bleeding and spotting. Many women find on the contraceptive implant that their periods become much lighter, less frequent or stop. 

There is some evidence of an increased risk of breast cancer with progestogen-only implants.11Although natural progesterone can be protective against breast cancer and breaks down quickly in the body to be eliminated, synthetic progestins (also known as progestogen) are shown to be more difficult to eliminate and have a different effect upon breast tissue that is more likely to promote cancer cell growth.12  Breast cancer is the leading cause of death in women under 50 years in the UK, so everyone should strongly consider any factor that increases that risk. 

Additional risks include bleeding and swelling at the site of insertion, infection, pain, migration of the implant into the chest or blood vessels.15 

If the implant cannot be felt anymore, it will need to be located and may be more difficult to remove, requiring surgery. Seek medical advice if you cannot locate your implant. 

The implant may affect breast milk supply and/or baby’s weight gain if put in after birth.16

The implant may be more likely than the pill to cause a side effect of abnormal bleeding requiring further medical advice.15

Case studies have been documented where the implant caused reversible loss of female orgasm.17

Advantages of the contraceptive implant

It doesn’t interrupt sex. It is an alternative to the pill, if it is not suitable for you. It does not require you to remember to take a daily tablet. If you have heavy periods, endometriosis or severe period pain, the implant may improve your symptoms, as it prevents your natural rhythm and cycle. 

How do I get it?

The contraceptive implant is free and available from NHS sexual health clinics, contraception clinics and many but not all GP surgeries (check with yours). 

contraceptive injection (progestogen-only)

Brand names include: Depo-Provera, Sayana Press or Noristerat

How does the progestogen injection work?

The progestogen injection is 99% effective. An injection of a high dose of artificial progesterone is absorbed into the bloodstream. It works by preventing egg release, thickening the mucus at the neck of the womb to prevent sperm from entering and thinning the lining of the womb so that a fertilised egg is less likely to implant.  

How is the progestogen injection given?

The injection is given into your bottom or upper arm by a doctor or nurse, or with the Sayana Press into your tummy or thigh (and you can be taught how to do this yourself). It only takes a few seconds, with minimal discomfort. Once given, depending on the injection given, it lasts either 13 or 8 weeks (Noristerat). Contraceptive protection is lost 8 or 12 weeks after your last dose. 

You can have an injection at any time during your menstrual cycle (assuming you are not pregnant). If you have it between days 1-5 of your cycle (day 1 is the first day of your period) then you are fully protected immediately. If you have the injection after day five, you should use additional contraception (like condoms) for the first seven days, as you are not protected. It can be given six weeks after birth and whilst breastfeeding.

Who shouldn’t use the progestogen injection? 

It should not be used if you think you are pregnant. Avoid if you have liver disease, systemic lupus erythematosus (SLE), undiagnosed vaginal bleeding in between periods or after sex, a history of arterial disease, heart disease or stroke or if you have a history of breast cancer. If you have a family history of breast cancer it should be discussed with your medical provider to determine the benefits and risks. 

Additionally, it affects your fertility for up to a year after the last injection, so it should not be used by those wishing to get pregnant in the near future. 

There is also evidence of bone thinning with the contraceptive injection, which reduces oestrogen levels, so caution is advised if you are at risk of osteoporosis or have a strong family history. The injection should also be strongly cautioned in adolescent girls, as their skeletons are still growing and it is advised against by the National Osteoporosis Foundation, as it may prevent them from reaching peak bone mass, increasing their risk of osteoporosis later in life.18

What might stop the progestogen injection from working?

It is not affected by other medicines.

Side effects, risks and disadvantages of the progestogen injection

The contraceptive injection does not protect against STIs. 

Side effects include: 

  • acne
  • mood changes including depression 
  • a change to your sex drive (usually lower)
  • irregular bleeding
  • nausea or vomiting
  • skin reactions 
  • weight gain 
  • ovarian cysts
  • breast tenderness and changes 
  • Headaches
  • hair loss
  • fatigue (tiredness)
  • vulval or vaginal infections. 

It may also cause breakthrough bleeding and spotting. Many women find on the contraceptive injection that their periods become much lighter, less frequent or stop. 

Although natural progesterone can be protective against breast cancer and breaks down quickly in the body to be eliminated, synthetic progestins (also known as progestogen) are shown to be more difficult to eliminate and have a different effect upon breast tissue that is more likely to promote cancer cell growth.12  Breast cancer is the leading cause of death in women under 50 years in the UK, so everyone should strongly consider any factor that increases that risk. 

As the contraceptive injection reduces oestrogen levels, it can thin bone and may increase the risk of osteoporosis, especially in teenagers.18

There is evidence that the contraceptive injection can alter the vaginal microbiome (balance of beneficial bacteria in the vaginal canal) and this may affect susceptibility to infections like HIV.19,20

It requires you to keep track of when you need your next injection, to ensure ongoing contraceptive cover. 

Advantages of the progestogen injection

It doesn’t interrupt sex. It is an alternative to the pill if it is not suitable for you. It does not require you to remember to take a daily tablet. If you have heavy periods, endometriosis or severe period pain, the contraceptive injection may improve your symptoms, as it prevents your natural rhythm and cycle. 

How do I get it?

The progestogen injection is free and available from NHS sexual health clinics, contraception clinics and most GP surgeries. 

intrauterine system (IUS)/ hormonal coil (progestogen-only)

Brand names include: Mirena, Jaydess (lower dose), Levosert, Kyleena

How does the IUS work?

The IUS is more than 99% effective. It is a small, T-shaped piece of plastic that is placed into your womb by a doctor or nurse (in a process similar to having a smear test). It releases artificial progestogen to thicken the mucus at the neck of the womb to prevent sperm from entering and thinning the lining of the womb, so that a fertilised egg is less likely to implant. In some people, it prevents ovulation (an egg being released). Once fitted, it lasts for 3-5 years, depending on the brand. The Jaydess IUS needs changing every three years, but is a lower dose of hormone. 

How do you use the IUS?

The IUS is inserted into your womb by a doctor or nurse who will often see you for an initial check-up, where they will test you for STIs and infections and check the size and position of your womb. You are awake during the process, which should only take about 10 minutes. A speculum is inserted into the vagina to keep it open (as for a smear test). A local anaesthetic gel is usually applied to the cervix to reduce any discomfort, then a thin rod (containing the coil) is inserted through the cervix into the womb. The coil is released from this rod and opens into a T shape once in place. The rod device is removed by leaving small threads in the cervix (to help locate the coil). Some people may experience some cramping during insertion and for a few hours afterwards. This is usually easily controlled by painkillers. You may have spotting for a few days afterwards. 

The coil should be checked (to see it is in the correct place) after 3 – 6 weeks and you should be taught how to feel for the threads (to check that the coil is still there) regularly, especially after a period. 

You can have an IUS fitted any time in the menstrual cycle (assuming you are not pregnant). If you have it put in on days 1-7 of your cycle (day one is the first day of your period) then you are fully protected immediately. If the IUS is fitted after day seven, you should use additional contraception (like condoms) for the first seven days, as you are not protected. It can be fitted four weeks after birth and whilst breastfeeding. 

Your partner cannot feel the coil or threads during intercourse, however, you may experience mild discomfort from the coil in sexual positions which allow deeper penetration. If your partner can feel the coil during intercourse, seek medical advice. 

Who shouldn’t use the IUS? 

It should not be used if you think you are pregnant. Avoid if you have liver disease, systemic lupus erythematosus (SLE), undiagnosed vaginal bleeding in between periods or after sex, a history of arterial disease, heart disease or stroke or if you have a history of breast cancer. If you have a family history of breast cancer it should be discussed with your medical provider to determine the benefits and risks. 

It also may not be suitable if you have any abnormalities in the anatomy of your womb or cervix. It can be more difficult to insert before you have had children. 

What might stop the IUS from working?

It is not affected by other medicines. It is unlikely to come out, but if you feel like the coil has moved or cannot feel the threads, then you need to be checked and should use alternative contraception until you know it is still in place. It is most likely to move within the first few weeks and you should check the threads regularly during this time. 

Side effects, risks and disadvantages of the IUS

The IUS does not protect against STIs. 

Side effects include: 

  • acne
  • mood changes including depression 
  • a change to your sex drive (usually lower)
  • irregular bleeding
  • nausea or vomiting
  • skin reactions 
  • weight gain 
  • ovarian cysts
  • breast tenderness and changes 
  • Headaches
  • hair loss
  • fatigue (tiredness)
  • vulval or vaginal infections. 

It may also cause breakthrough bleeding and spotting. Many women find that the IUS makes their periods become much lighter, less frequent or stop. 

Although natural progesterone can be protective against breast cancer and breaks down quickly in the body to be eliminated, synthetic progestins (also known as progestogen) are shown to be more difficult to eliminate and have a different effect upon breast tissue that is more likely to promote cancer cell growth.12  Breast cancer is the leading cause of death in women under 50 years in the UK, so everyone should strongly consider any factor that increases that risk. 

The Jaydess IUS releases a lower dose of progestogen (13.5mg vs. Mirena at 52mg), potentially reducing risks and making it less likely to stop periods.21

Additional risks of both the IUS and IUD include the risk of perforation of the womb during insertion (very rare with experienced practitioners). In a large European study, the risk was approximately 1 in 3,000, increasing to 1 in 1000 if breastfeeding, with no long-term ill effects.222 Other side effects include pain and extremely rarely, infection of the womb (see a doctor immediately if you experience ongoing pain, smelly discharge or a fever after insertion).

If you cannot feel your threads anymore (by feeling inside the vaginal canal) your coil will need to be checked. Seek medical advice if you cannot locate your threads. 

There is evidence that the IUS can increase the risk of ectopic pregnancy (a pregnancy growing outside the womb that can be life-threatening, if you do get pregnant). 

The IUS can increase the risk of pelvic inflammatory disease and increase the risk of fertility issues if you were to contract an STI (sexually transmitted infection) whilst the coil is in.

The progestogen intrauterine device also carries an increased risk of breast cancer.2,23 It may increase the risk of a more invasive (aggressive) type of breast cancer in women in their 40s.24  It may also carry an increased risk of cervical cancer.25  The IUS, when compared to the copper IUD (see below), carried an increased risk of needing treatment for anxiety in a large French study.26

Advantages of the IUS

It doesn’t interrupt sex. It is an alternative to the combined pill (if it is not suitable for you). It does not require you to remember to take a daily tablet. If you have heavy periods, endometriosis or severe period pain, the implant may improve your symptoms, as it prevents your natural rhythm and cycle. You can get pregnant as soon as the coil is removed.

How do I get it?

The IUS is free and available from NHS sexual health clinics, contraception clinics and many but not all GP surgeries (check with yours). 

If you are using hormonal contraceptives because you are struggling with hormonal symptoms, consider whether it may be the right time to work on the underlying root causes of those symptoms, rather than using synthetic, artificial hormones with potential health risks to reduce your symptoms. Visit our female hormone toolkit for more information.

female non-hormonal contraceptives

intrauterine device (IUD)/ copper coil (non-hormonal)

Brand names include: Mirena, Jaydess, Levosert, Kyleena

How does the IUD work

The IUD is more than 99% effective. It is usually a small T-shaped piece of plastic (although other shapes and types exist) that is placed into your womb by a doctor or nurse (in a process similar to having a smear test). Instead of releasing artificial hormones (like the IUS) the copper in the coil alters the mucus at the neck of the womb to prevent sperm from getting in, or surviving, and it also makes a fertilised egg less likely to implant. Once fitted, it lasts for 5-10 years depending on the brand. 

How do you use the IUD?

The copper coil is inserted into your womb by a doctor or nurse who will often see you for an initial check-up in which they will test you for STIs and infections and check the size and position of your womb. A speculum is inserted into the vagina to keep it open (as for a smear test). A local anaesthetic gel is usually applied to the cervix to reduce discomfort and then a thin rod (containing the coil) is inserted through the cervix into the womb. The coil is released from this rod and opens into a T shape (other shapes exist, but this is the most common).  The rod is removed, leaving threads in the cervix (to help locate the coil). You may experience some cramping during insertion and for a few hours afterwards. This is usually easily controlled by painkillers. You may have spotting or bleeding for a few days afterwards. Periods can be heavier or more painful for the first 3-6 months after insertion. 

The coil should be checked (to see it is in the correct place) after 3-6 weeks and you should be taught how to feel for the threads (to check the coil is still there) regularly, especially after your period. 

You can have an IUD fitted at any time in your menstrual cycle and are fully protected. It can be fitted as soon as four weeks after giving birth and whilst breastfeeding. 

Your partner cannot feel the coil or threads during intercourse, however, you may experience mild discomfort from the coil in sexual positions which allow deeper penetration. If your partner can feel the coil during intercourse seek medical advice. 

Who shouldn’t use the IUD? 

As the copper coil can increase pain and bleeding, it may not be suitable for those with painful or heavy periods (see the Gynefix note below, for alternative types). If you are struggling with period problems consult our hormone toolkit for support. The IUD may not be suitable if you have any abnormalities in the anatomy of your womb or cervix. It can be more difficult to insert before you have had children. 

What might stop the IUD from working?

It is not affected by other medicines or hormones. It is unlikely to come out, but if you feel that the coil has moved or cannot feel the threads, then you need to be checked and should use alternative contraception until you know it is still in place. It is most likely to move within the first few weeks and you should check the threads regularly during this time. 

Side effects, risks and disadvantages of the IUD

It does not protect against STIs. There is a risk of perforation of the womb during insertion although this is very rare with experienced practitioners. In a large European study, the risk was approximately 1 in 3,000, increasing to 1 in 1000 breastfeeding women, with no long term ill effects.21 Other side effects include pain and rarely, infection of the womb (see a doctor immediately if you experience ongoing pain, smelly discharge and/or a fever).

If you cannot feel your threads anymore (by feeling inside the vaginal canal) your coil will need to be checked. Seek medical advice if you cannot locate your threads. 

There is evidence that the IUD can increase the risk of ectopic pregnancy (a pregnancy growing outside the womb that can be life-threatening), if you do get pregnant. Although this risk is very small, it is important to do a pregnancy test if you miss your period, to be assessed early, lowering your risk of complications. 

The copper IUD can increase the risk of pelvic inflammatory disease, increasing the risk of fertility issues if you contract an STI (sexually transmitted infection) whilst the coil is in.

You may experience heavier or more painful periods and/or mid-cycle spotting. Working on your hormonal balance, using our hormonal toolkit can improve hormonal symptoms. You could consider herbal supports like Shepherd’s purse tincture (traditionally used for spotting or to lessen bleeding during the period) or Yarrow tea, drunk during your period (for pain). Dr Jess has seen this help many of her clients. 

There is a smaller, frameless type of copper coil called a Gynefix which is a thin thread with attached copper, or the newer Copperball coil (a thread with small copper balls on)  which have been shown to have fewer side effects and be better suited for those who have heavy or painful periods. Many women prefer this coil, but it can be more difficult to find a doctor who can fit it. 

Advantages of the IUD

It doesn’t interrupt sex. There are no hormonal side effects. It does not require you to remember to take a daily tablet. It does not interrupt your natural, monthly cycle. You can get pregnant as soon as the coil is removed.

How do I get it?

The IUD is free and available from NHS sexual health clinics, contraception clinics and many but not all GP surgeries (check with yours). 

As the coil should be fitted by an experienced practitioner to lower the risk of perforation, we would recommend from experience that you attend your local sexual health or family planning clinic, who are usually extremely experienced.  

To find someone who can fit a Gynefix coil ask your sexual health clinic if they offer it – The Contraception and Reproductive Health Service in Liverpool (NHS) was the first to adopt the Gynefix. For a list of trained doctors in the UK, you can send an e-mail to info@soyinl.be. For more information about the product and the doctors who provide it, please visit www.gynefix.be or https://www.wildemeersch.com/ for the developer and trainer of Gynefix who inserts them in Belgium using ultrasound.

diaphragm or cap and spermicide (non-hormonal)

Brand names include: Caya, Omniflex (diaphragm), Femcap (cervical cap) 

How does the diaphragm work?

The cap or diaphragm is 92-96% effective when used with spermicide, and can be combined with the natural fertility method below, for an increased effectiveness of over 99%. 

A diaphragm is a circular dome made of soft latex or silicone that sits over the cervix to act as a physical barrier to prevent sperm from getting into the womb. A cap is smaller than a diaphragm, but also sits over the cervix and acts in the same way. Some caps have small tabs to help remove them. Both are used with spermicide (a gel or foam that is applied to the cap or diaphragm before insertion, that immobilises sperm) and are inserted and removed before and after intercourse. 

How do you use the diaphragm or cap?

Diaphragm:

When you choose to use a  diaphragm, a doctor or nurse at a sexual health or family planning clinic will fit you with one that is the right size for you. They will show you how to insert and remove it. Once you are happy putting your diaphragm in (it is important to practice and have it checked by the issuing doctor or nurse to make sure that you are fitting it correctly), then you are ready to use it. 

diaphragm

To insert the diaphragm, first, wash your hands with soap and dry them, then apply spermicide gel (we recommend contragel, which is a natural, non-toxic spermicide) inside the bowl of the diaphragm and around the rim. Squeeze the sides of the diaphragm together and insert it in the same way you would insert a tampon. Once it is inside your vagina, push upwards, releasing it to cover the cervix. Press into place with your middle finger and check to ensure it is in the correct position. Many women find it easier to squat or put one foot up on a bath or stool to insert their diaphragm. 

A diaphragm is fitted properly if it covers the cervix, with the back rim resting comfortably in the posterior fornix (the pocket of space between the cervix and the rear vaginal wall) and the front rim resting snugly behind the pubic bone. The cervix feels like a doughnut at the top of the vagina with a very small hole in the centre. The diaphragm should not be left in the vagina for longer than 24 hours. It can be put in up to three hours before you have sex and should be left in for six hours after sex, before removal. If you plan to have sex again or go longer than the three hours, you need to add more spermicide onto the outside of the diaphragm (without removing it).

To remove the diaphragm, hook a finger over the edge of the rim to break the suction and gently pull it down and out. 

After use, the diaphragm should be washed with soap and water (do not use disinfectant) and some can be boiled in hot water now and then, but check the instructions for your model to be sure. Check it regularly against a light for holes, cracks or thinning and fill the bowl with water to check for any leaks. 

The Caya diaphragm is a newer option available online that will fit 80% of women and does not need fitting (although it is important to feel comfortable inserting it and checking its position).

The cap:

A cap can be fitted by a doctor or nurse at a sexual health or family planning clinic. They will ensure your cap is the right size for you and they will show you how to insert it. Once you are happy putting your cap in (it is important to practice and have it checked by the issuing doctor or nurse to make sure that you are doing it correctly), then you are ready to use it. 

First, wash and dry your hands. Then apply spermicide gel (we recommend contragel which is a natural, non-toxic spermicide) inside the bowl of the cap, but not around the rim as it can prevent suction. Squeeze the sides together and insert it like a tampon. Once it is inside the vagina, push upwards to cover the cervix, pressing into place with your middle finger to ensure it is in the correct position. Many women find it easier to squat or put one foot up on a bath or stool to insert the cap. 

The cap adheres to the cervix by suction and it shouldn’t move if you try to push it.  A cap is fitted properly if it covers the cervix like a hat. The cervix feels like a doughnut at the top of the vagina with a very small hole in the centre. The cap should not be left in the vagina for longer than 48 hours. It can be put in up to three hours before you have sex and should be left in for six hours after sex, before removal. If you plan to have sex again or go longer than three hours, you need to add more spermicide onto the outside of the diaphragm (without removing it).

To remove the cap hook a finger over the edge of the rim to break the suction, or pull the tab if it has one, then gently pull it down and out. After use, the cap can be washed with soap and water (do not use disinfectant) and some can be boiled in hot water now and then, but check the instructions on your particular model. Check your cap regularly against a light for holes, cracks or thinning and fill the bowl with water to check for leaks.

The Femcap cervical cap is a newer option that is available to buy online. It comes in three sizes that are easy to self-select, based on whether or not you have been pregnant. It does not need fitting by a health professional, although it is important that you feel comfortable inserting it and checking its position. Consult a family planning clinic if you are unsure of how to use it or if you are using it correctly and use alternative contraception if you are uncertain. 

Who shouldn’t use the cap or diaphragm? 

The diaphragm or cap can increase the risk of urinary tract infections, so it should be carefully considered for those with a history of UTIs. It is important to remember not to leave it in longer than is recommended. Many caps and diaphragms contain latex, so anyone with an allergy or history of toxic shock syndrome should look for a latex-free option. 

The diaphragm or cap may not be suitable if you have an abnormally shaped cervix or have weak vaginal muscles and are unable to keep it in place (possibly after birth) or severe prolapse. Successful diaphragm and cap insertion requires practice and time to learn how to insert it. Spending time learning this process is important to ensure its effectiveness as a contraceptive. Once mastered, it can be as effective as the male condom.27 

What might stop the cap or diaphragm from working?

It is not affected by other medicines or hormones. It will be less effective if:

  • you do not apply spermicide to the diaphragm or cap
  • if the diaphragm or cap is damaged or has holes in it
  • It doesn’t fully cover the cervix or isn’t the right size (a family planning clinic can size it properly and teach you correct insertion)
  • If you lose or gain a large amount of weight (greater than 3kg) or have been pregnant, it may need refitting.  

Side effects, risks and disadvantages of the cap or diaphragm

It is slightly less effective than other forms of contraception and if it is not used correctly, its effectiveness can drop under 70%. However, it can be combined with methods like the natural fertility method for over 99% effectiveness.

It takes time to learn to put it in correctly and remember to remove it in the correct time frame.

It can increase your risk of UTIs.

Spermicides can irritate some people and those which contain nonoxynol-9 can increase the risk of STIs.28 Instead, use a spermicide without irritating chemicals or nonoxynol-9, like contragel

Advantages of the cap or diaphragm

It doesn’t interrupt sex. There are no hormonal side effects. It does not require you to remember to take a daily tablet. It does not interrupt your natural, monthly cycle and you can get pregnant as soon as you stop using it. 

How do I get it?

The diaphragm or cap and spermicide are free and available from NHS sexual health clinics, contraception clinics and many, but not all, GP surgeries (check with yours). 

The Caya diaphragm and Femcap cervical cap are both available to buy online. Consult a family planning clinic if you are unsure about their correct use.

natural fertility method and contraception monitors

Brand names include: Paper basal temperature chart, Natural Cycles app (natural fertility method with FDA approval as a form of contraception), Femometer, ClearBlue contraception monitor (urine testing).

How does it work

The natural fertility method works by using taught methods of period cycle awareness to calculate ovulation and fertile days. This is done by counting days of your regular period cycle, testing your daily temperature first thing in the morning and checking for other signs of ovulation, such as the texture and volume of cervical mucus, to calculate fertile windows of the month (when you should abstain from penetrative sex, unless using an additional barrier contraceptive method such as condoms). When used correctly, it can be up to 99% effective,29 which makes it a very valid form of contraception. It can also be used alongside barrier methods like condoms, caps or diaphragms for extra security. 

We would always encourage you to learn this method from a fertility education specialist – see the fertility UK website for providers, to make sure you are practising this method correctly.

Contraception monitors, like the ClearBlue contraception monitor, test the hormones in your urine to check your fertility. These are less effective than the natural fertility method, at 94% effective, but can be used in combination or for reassurance, when learning more about natural fertility and contraception.

How do you use natural fertility methods?

Firstly, it is important to be able to both predict (as best as possible, based on your previous cycles) and to observe ovulation. 

Temperature: With day 1 of your cycle as the first day of proper bleeding (when your period starts), you measure your temperature daily, recording it on a paper chart (or app like Natural Cycles). Your temperature should be taken using a digital thermometer (oral, do not use an ear or forehead monitor) first thing in the morning upon waking (before moving or getting out of bed, as muscle contractions warm your basal body temperature).

This temperature must be recorded each day of the month at roughly the same time, after at least three hours of rest. Your temperature between day one and your ovulation will be lower (approximately 0.2 degrees less) than it is after ovulation, when your temperature will remain slightly higher, until your next period. 

When your temperature rises by more than 0.2 degrees it tells you that ovulation has taken place. Three readings of a higher temperature, then six lower temperature readings during the first half of your cycle tells you when ovulation occurred. This is usually obvious as a steep rise around the middle of your cycle, but for some people, this rise may be more gradual. It takes practice to read a basal temperature chart, which is why you may find it easier to use an app like Natural Cycles to do it for you. 

Alongside your temperature, note any cervical secretions (discharge) throughout the month. There are different types during the time up to ovulation that you can assess by rubbing/ pulling your vaginal discharge between your middle finger and thumb and seeing if it is sticky, thin or thick and noting its colour. Women should record from when they’ve stopped bleeding heavily after their period, stick a clean middle finger inside the vagina up to their middle knuckle, and record the type of discharge.

  • Type 1: Least fertile (in the time usually right after the period), little to no discharge.
  • Type 2: Low fertility (about a week after the period) discharge is thin and white or light coloured, can make underwear slightly damp. 
  • Type 3: Fertile, secretions become stickier and white or cloudy.
  • Type 4: Most fertile, when the body is preparing to ovulate, discharge becomes clearer, slippery and stretchy and can stick between fingers to form a string when fingers pull apart, like a raw egg white. You are considered to be fertile for three days after you see this most fertile change. 
  • Post ovulation: Discharge should lessen and can be creamy and slightly sticky.

A final indicator that is not always used for natural fertility awareness, is to check the cervix itself. The cervix is at the end of the vaginal canal and can change consistency from firm to soft and also alter its position during your cycle. Accurate cervical assessment takes practice and education. 

You are fertile for up to seven days before ovulation and for two days afterwards (a total of nine days each cycle), where you need to use barrier contraception or avoid penetrative sex. Ovulation can be predicted accurately in most women who have a regular cycle

It is recommended that you spend at least three cycles learning how to chart your temperature and checking cervical secretions before using this as your only contraception method. Your cycle needs to be relatively regular (a variation of no more than four days of cycle length), with a cycle that lasts between 22 and 36 days. Fertility UK has an excellent explanatory article on avoiding pregnancy using this method and downloadable paper charts.

Contraception monitors are used with daily urine testing (using testing sticks, which you hold in the stream of your first morning urine). The stick is placed into the monitor, which will then give you an indication of whether you are fertile or not. This method is less reliable, but can give you additional reassurance with the natural fertility method.

Who shouldn’t use natural fertility or contraception monitors? 

Natural fertility methods should not be used if you have erratic or irregular periods (a variation in your cycle length over the last six months of over five days). Also do not use it if it would be dangerous for you or the baby, were you to become pregnant. 

Discuss with your doctor if you are on a medication that affects your body temperature (examples include isoniazid, procainamide, quinidine, phenytoin, carbamazepine, amphotericin B), or ones that can change your cervical secretions (hormonal contraception). You may need to use another method if you change countries regularly and are living in different time zones. Secretions may be inaccurate if you have thrush or an STI. Basal temperature is less accurate if you drink above the recommended amount of alcohol (14 units per week).

What might stop it from working?

Not using the method properly, missing temperature readings and not practising charting your cycles correctly. We would always encourage learning this method with a specialist in natural fertility methods. 

If using barrier methods during fertile windows, you are subject to their effectiveness level. 

If you take the morning-after pill, you need to wait for two cycles, to be able to reliably use this method again. 

Side effects, risks and disadvantages of natural fertility or contraception monitors

It does not protect against STIs. There are no side effects. 

It requires discipline, commitment and practice to be able to accurately implement this method, although new basal temperature apps make this easier. 

Period cycles can be disrupted by stress, illness, over-exercising, weight changes or medications. This might make predictions less accurate.

Advantages of natural fertility or contraception monitors

It doesn’t interrupt sex. It doesn’t block your natural cycle and promotes awareness of your body and monthly rhythm, making you more likely to detect any gynaecological issues and seek early treatment. It doesn’t have any side effects. 

Once you have learned how to do it, you don’t need any regular prescription or contact with health professionals. It also teaches you how to find your most fertile time, if you want to get pregnant in the future.

How do I get it?

The natural fertility method is free (unless you purchase an app and thermometer like Natural Cycles). You need to find a specialist to educate you on how to use this process, contact Fertility UK for further information or to find a clinic.

female condom

Brand names include: Pasante Femidom 

How does the female condom work?

The female condom is 95% effective. It both protects against STIs and is a barrier contraceptive method. It sits inside the vaginal canal and acts as a barrier to prevent sperm from entering the womb. 

How do you use the female condom?

Female condoms are available to purchase online or can be obtained for free from a doctor or nurse at a sexual health or family planning clinic. Female condoms can be inserted before you have sex. 

Open the packet carefully, being careful not to rip the condom. You will see a tube with two rings one at each end. One ring is smaller than the other and that end of the condom is closed. Take the smaller ring and squeeze it together, inserting it into the vagina like a tampon. Let it release, then push upwards. Many women find this easier standing with one leg on a step, sitting on the toilet or squatting. Make sure the larger ring at the end of the condom covers the opening of the vagina. 

It is important that during sex, the penis goes inside the condom and not between the outside of the condom and the wall of the vagina. After sex, remove the large ring and twist the condom to prevent any semen from leaking, then gently pull it out and dispose of it in a bin (not down the toilet).

Female condoms are pre-lubricated, but you can use them with a water-based lubricant like Yes organic lubricant, for easier insertion.   

Who shouldn’t use the female condom? 

The female condom is suitable for most women and can be used straight after giving birth or after an abortion or miscarriage. (Do not have sex sooner than your doctor advises you to).

What might stop it from working?

If you accidentally tear the condom with your fingernails or jewellery, the sperm can enter the vagina and pose a risk of pregnancy. If the condom gets pushed up inside the vaginal canal during sex or the penis enters the vaginal canal, between the side of the condom and the vaginal wall (you may wish to take emergency contraception if any of these scenarios happen).  

Side effects, risks and disadvantages of the female condom

Female condoms are slightly less effective than male condoms and although they are strong, they may rip or tear. 

They are often more expensive and less available than male condoms. They are not a popular method of contraception in the UK (<1%) and so many women feel embarrassed to suggest them as a form of contraception. However they have some advantages over male condoms, protect against STIs and many couples like the lack of interruption during sex that female condoms offer.

Advantages of the female condom

It gives the woman control over barrier contraception and can prevent STIs. It has no side effects. You only need to use it when you have sex and it can be inserted by the woman before, rather than during sex, like a male condom. 

How do I get it?

The female condom is available from some GPs, sexual health and family planning clinics. You can also buy Femidom female condoms online.

sterilisation

Male and female sterilization procedures: vasectomy and tubal ligation, healthcare and birth control concept

Female sterilisation is an operation to permanently prevent pregnancy. It should only be considered by those who are certain that they either do not want any more children or that they do not and will not want children in the future. The fallopian tubes are sealed, to prevent the egg from reaching the sperm. It is more than 99% effective as a form of contraception.  

What happens in a sterilisation?

Female sterilisation is a surgical procedure that is performed under general or local anaesthetic. The surgeon makes a small incision in your abdomen near your belly button and usually employs laparoscopy (a long thin instrument containing a light and camera) to apply either clips or rings to the fallopian tubes (to block them). In some instances, they may tie the fallopian tubes, or remove a small piece of them. 

Sterilisation is a minor operation that usually allows you to return home the same day. Occasionally, your surgeon may choose to remove the fallopian tube or may need to make a bigger incision (laparotomy) to perform this surgery. Contraception should be used from the operation date up until the next period. Recovery is usually 5-7 days. 

Who shouldn’t consider sterilisation?

Sterilisation is not suitable for those who wish to become pregnant in the future or are uncertain if they want children.

What might stop it from working?

Occasionally fallopian tubes can rejoin or sterilisation fails. This can happen anytime after the surgery.

Side effects, risks and disadvantages of sterilisation

It does not protect against STIs. As with all surgery, there is a small risk of bleeding, bruising, damage to internal organs and pain. 

Sterilisation is very difficult to reverse and a reversal is not offered on the NHS. The operation may not work and occasionally fallopian tubes rejoin later. If a pregnancy does develop, it is more likely to be ectopic (a pregnancy that grows outside the womb). 

If you have not had children, your GP may suggest you have counselling to ensure that sterilisation is the right choice for you. 

Advantages of sterilisation

It does not interrupt sex and does not interfere with the hormonal cycle or periods. No more contraception is required. 

How do I get it?

Your GP would need to refer you for sterilisation if they believe that this is the correct option for you. It can be done either by the NHS or privately. 

 

male contraceptives

male condom

Brand names include: Durex, Mates, Trojan, Skyn.

How do male condoms work?

The male condom is 98% effective. It both protects against STIs and is a barrier contraceptive method.  Condoms fit over the penis and act as a barrier to prevent sperm from entering the womb. 

How do you use male condoms?

Open the condom packet carefully, being careful not to rip the condom. You will see a ring with the condom rolled up and there may be a teat visible in the centre. If the teat is in the centre gently hold it to expel the air and roll it down over the erect penis. If it will not roll down then you may be holding it the wrong way round. If this is the case, discard that condom (as it may have sperm on it) and use a new one. 

After sex, remove the condom carefully and dispose of it in a rubbish bin (not down the toilet).

Most condoms are pre-lubricated, but you can use them with a water-based lubricant like Yes organic lubricant.   

Who shouldn’t use the male condom? 

The male condom is suitable for most men, but avoid latex condoms if you or your partner have a latex allergy (latex-free condoms are available). If you have difficulty maintaining an erection, this may not be the most suitable method to use, as this can lead to semen leaking out.  

What might stop the male condom from working?

If you accidentally tear the condom with fingernails or jewellery. If you use an oil-based lubricant, including moisturiser, petroleum jelly or baby oil (although these do not affect polyurethane condoms) it can cause the condom to fail. Women should also avoid using pessaries or thrush creams. The condom can slip off or tear during sex (you may wish to take emergency contraception if this happens).  

The man needs to pull out after ejaculation, as when the penis goes soft, semen can leak from the condom into the vagina. 

Side effects, risks and disadvantages

Male condoms are strong, but they may rip or tear. Some couples feel that they interrupt sex, but they can be used as part of foreplay.

Condoms can be environmentally questionable and may contain toxic chemicals. Consider choosing ethical and sustainable eco brands like Hanx, Einhorn, French Letter, Glyde or Sustain Natural, which are made sustainably, without toxic chemicals. Some of these brands are also biodegradable. 

Advantages of using male condoms

They are the most reliable method of preventing STIs and are readily available both in shops and online. There are no side effects.  

How do I get them?

The male condom is available for free from some GPs, sexual health and family planning clinics. You can also buy male condoms easily online and in shops.

vasectomy


How does a vasectomy work?

A vasectomy is a surgical procedure that prevents pregnancy by cutting or sealing the tubes that carry a man’s sperm. It should only be considered by those who do not want any more children or feel that they do not and will not want children in the future. It is more than 99% effective.  

What happens in a vasectomy?

A vasectomy is a minor surgical procedure usually performed under a local anaesthetic (in which you are awake). In the now common no-scalpel vasectomy, a surgeon numbs the scrotum with a local anaesthetic, then makes a very small hole in the scrotal skin to access the tubes underneath. The tubes are then sealed or tied. There is usually no bleeding and no stitches needed. 

Occasionally, a different procedure requiring a small cut on each side of the scrotum is performed instead, using dissolvable stitches (these dissolve within a week). It is a minor procedure that usually only takes a few minutes and you can go home immediately afterwards. 

You may have mild swelling, bruising and pain afterwards and can take painkillers and wear supportive underwear to help. You may have blood-stained ejaculation for a few days. Avoid sport, heavy lifting and sex for one week afterwards. Use additional contraception for 12 weeks afterwards. A semen sample is taken at this time to check that the procedure was effective.

Who shouldn’t consider a vasectomy? 

A vasectomy is not suitable for those who wish to be a father in the future or are uncertain if they want children. It is considered permanent and reversals are not done on the NHS. The chance of a reversal regaining fertility within 10 years of a vasectomy is only 55%.

What might stop a vasectomy from working?

Occasionally the tubes can rejoin or a vasectomy fails. This can happen any time after the surgery.

Side effects, risks and disadvantages of a vasectomy

It does not protect against STIs. There is a small risk of bleeding, bruising (haematoma), testicular lumps (sperm granulomas caused by sperm leaking out of the tubes), infection or long-term testicular pain. 

Vasectomies can be reversed, but nearly 50% of men will not be able to father a child after reversal, so it should be considered a permanent treatment. Reversal is not offered on the NHS. The operation may not work and occasionally the tubes (vas deferens) rejoin later. 

If you have not had children, your GP may suggest that you have counselling to make sure this is the right choice for you. 

There is a possibility that a vasectomy may slightly increase the long term risk of prostate cancer, though studies are conflicting and the increase in risk is minimal.30

Advantages of a vasectomy

It does not interrupt sex and does not affect sex drive, sensation, hormones or the ability to get an erection or ejaculate. It is a simple and safe procedure that allows your female partner to avoid side effects and difficulties with contraception. 

How do I get it?

Your GP would need to refer you for a vasectomy if they believe that this is the correct option for you. It can be done by the NHS or privately. 

 

references

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