Health Information: Contraception

Definition

Contraception involves the use of a medication, device or method that prevents pregnancy from occurring.

Description

Each month, after puberty, a female produces an egg from her ovaries. Each ejaculation of semen from a male contains millions of sperm. One sperm can fertilise an egg resulting in pregnancy. Following is a list of commonly used contraceptive medications, devices and methods.

ORAL CONTRACEPTIVE PILL
There are two main types of Oral Contraceptive Pill. The combined pill contains two hormones and prevents the ovaries from releasing an egg each month. The progestogen-only pill has only one hormone and works by changing the mucus at the entrance to the uterus (womb) so that sperm cannot pass through to fertilise the egg.

The combined pill is more than 99 percent effective if taken properly. Some medications such as antibiotics can make the pill less effective. The progestogen-only pill is only slightly less effective and it is very important to take it at the same time each day. For further information see the Pill (Contraceptive) topic.

Potential Advantages
* The combined pill helps to regulate periods.
* Periods are shorter, lighter and may be less painful.
* A woman can time her period, or not have a period at all.
* Improvement of acne.
* Improvement of premenstrual symptoms.

Potential Disadvantages
* Slight bleeding (spotting) between periods.
* A change in appetite.
* Mood changes.
* Breast enlargement or soreness.

CONDOMS (MALE)
A condom is a fine rubber sheath that is worn on an erect penis. Condoms collect the semen and prevent it entering the vagina and uterus. When used correctly condoms are approximately 97 percent effective. Correct use involves using a new condom before sex, taking care to put it on and take it off correctly, and using the condom with only water-based lubricants. Oil-based lubricants such as petroleum jelly, baby oil, massage oil and some body lotions can damage a condom, increasing the risk of breakage.

CONDOMS (FEMALE)
Female condoms are polyurethane sheaths that fit inside the vagina and prevent the semen entering the vagina and uterus.

Potential Advantages
* Protection against some sexually transmissible infections.
* Readily available. No prescription required.
* Small, discrete and easy to keep private.
* No health risks associated with using this type of condom.

Potential Disadvantages
* Decrease in sensitivity during sex in certain people.
* The rubber used in condoms is perishable so condoms need to be kept in a cool place and used before the expiry date.
* Certain people may be allergic to the rubber or to the lubricant on the condom.

INTRA UTERINE DEVICE (IUD)
An IUD is a small plastic and copper object, which a Doctor places inside a woman's uterus. The IUD works in two ways. It stops the sperm reaching the egg, and in case an egg is fertilised, it prevents the egg attaching to the lining of the uterus. A Doctor must assess a woman's suitability for an IUD before it is fitted.

Potential Advantages
* An IUD is approximately 99 percent effective in preventing pregnancy.
* Ease of use - no daily dosing required. Once the IUD has been fitted no additional contraception is required before sex.
* An IUD is easily removed by a doctor and, in most cases, a woman's fertility returns immediately.
* An IUD is cost effective considering that it provides effective contraception from between five to eight years.

Potential Disadvantages
* When the IUD is first fitted, some pain may be felt that is similar to period pain.
* Problems such as heavier bleeding with more painful cramps during menstruation may occur with an IUD.
* A woman may be more likely to contract an infection in the uterus or the fallopian tubes with an IUD in place. This risk is highest in women who have more than one sexual partner, or whose partner has more than one sexual partner.
* In general, the type of woman who is more likely to experience problems with an IUD is young and without children.

DIAPHRAGMS AND CERVICAL CAPS
A Diaphragm or cervical cap is a soft rubber cap worn inside the vagina to cover the cervix, the entrance to the uterus. These devices prevent sperm from entering the uterus.

Potential Advantages
* A diaphragm is a drug-free contraceptive device that is only worn during sex and has no potential health risks or side effects.

Potential Disadvantages
* A diaphragm is only approximately 90 percent effective in preventing pregnancy.
* Correctly inserting a diaphragm requires practise.
* Some people may have an allergic reaction to the rubber in the diaphragm or the spermicide that is often used at the same time.

INJECTIONS
Depo-Provera is an injection into the buttocks of the synthetic hormone, progesterone, which provides birth control for women for three months. For further information see the Depo-Provera topic.

Potential Advantages
* Injections are more effective than the OCP.
* Ease of use - no daily dosing required.
* Effectiveness not altered by vomiting or diarrhoea, or by other medications.
* Unlike OCPs implants are particularly useful for women who cannot tolerate oestrogen.

Potential Disadvantages
* Once a Depo-Provera injection has been given it cannot be reversed, it has to wear off.
* Unpredictable bleeding may occur.
* Weight gain may be experienced.
* There may be a delay of several months between the effectiveness of Depo-Provera wearing off and a woman ovulating and becoming fertile again.

IMPLANTS
The contraceptive implant is a small, flexible tube which is inserted under the skin in the upper arm. It slowly releases a hormone called progestogen and works for 3 years. The implant must be fitted by a trained doctor or nurse. Implants are a safe and effective method of reversible, long-term contraception for most women.

Once it has been established that a woman is not pregnant the implant can be inserted on day one to day five but can be inserted at any time during a woman's menstrual cycle. The implant stops sperm reaching the egg by thickening the mucus from the cervix and stops the egg settling in the uterus. The implant may also stop the ovaries releasing an egg each month.

Potential Advantages
* Implants remain effective for approximately three years and can be removed at any time.
* Fertility returns within approximately one month of removing an implant.
* Ease of use - no daily dosing required.
* Effectiveness not altered by vomiting or diarrhoea, or by other medications.
* Unlike OCPs implants are particularly useful for women who cannot tolerate oestrogen.

Potential Disadvantages
* May cause irregular bleeding patterns, especially in the first year.
* Side effects such as headaches, weight gain, nausea, bloating, breast tenderness and depression may develop in some women and these usually pass after the first few months.
* In some rare cases, an implant can cause an infection in the arm at the site where it has been inserted and it is sometimes difficult to remove.

STERILISATION
Both men and women can have an operation to make them sterile (unable to impregnate or conceive). In women the operation, tubal ligation, surgically blocks the Fallopian tubes (leading from the ovaries to the uterus) to prevent the sperm from reaching and fertilising an egg. In men the vasectomy operation is the surgical interruption of the two tubes (vas deferens) that carry sperm from the testicles to the ejaculatory ducts (where the sperm is stored before leaving the body during orgasm). This means that a man still ejaculates, however, sperm is not released in the fluid, thus preventing pregnancy.

NOTE
* Sterilisation is more than 99 percent effective in both men and women.
* Sterilisation is permanent. If a person wants to have the procedure reversed there is no guarantee that the operation will be successful.

Pharmacist's Advice

If you have any queries regarding Contraception ask your Pharmacist for advice.
1) Condoms are readily available from your Pharmacy.
2) Your Pharmacy will stock a range of diaphragms. Ask your Pharmacist for advice about how to use a diaphragm and how to sterilise it after use.
3) Spermicidal creams, gels, foams and vaginal tablets are available from your Pharmacy. A spermicide increases the effectiveness of the diaphragm in preventing pregnancy. A prescription from your Doctor is NOT required to purchase condoms, diaphragms and spermicides.

LESS EFFECTIVE METHODS OF CONTRACEPTION

Spermicides
These are creams, foams, gels or vaginal tablets that are placed in the vagina before sex. These are available from your pharmacy and can be used with a diaphragm or cervical cap.
Withdrawal
This technique involves the male taking his penis out of the vagina before ejaculation to prevent the sperm entering the vagina. This technique will fail if the penis is not withdrawn in time. If the male ejaculates at the entrance to the vagina the sperm may still swim inside. Some men may also release fluid containing sperm from the penis before ejaculation.
Safe time methods
There are many myths around what is a "safe time of the month" to have sex. Fertility awareness methods eg rhythm, Billing's, mucus, ovulation and temperature methods, identify when a woman or girl may be fertile so that she can avoid sex at that time. All methods require good instruction and effort to be effective. These methods may not be effective due to the effort required and because periods are not always regular. A family planning clinic or doctor will provide proper counselling or refer you to an appropriate health care practitioner if you wish to learn to use these methods.

THIS IS NOT DIAGNOSTIC INFORMATION. STAY ON PRESCRIBED MEDICINES. (C) 2008 HEALTHPOINT TECHNOLOGIES.
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