Women's Wellness

Contraception Issues

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What is Contraception?

The aim of contraception, also known as birth control, is to prevent pregnancy.

Different contraceptives work in different ways. Some prevent ovulation while others keep the sperm and egg apart or prevent a fertilised egg from attaching to the uterine lining.

There are 15 methods of contraception currently available in the UK, including pills, condoms, diaphragms, intrauterine devices (the coil), implants and injections.

Some contraceptives, including the implant, IUD and injection, can be up to 99 percent effective, meaning fewer than one in one hundred women will get pregnant in a year. This is assuming the contraception is being used correctly.

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What are the most important risks and complications with Contraception?

Although most contraceptives have a high success rate if used as instructed, they still come with risks and complications attached.

Often simply referred to as ‘the pill’, this contraceptive contains artificial oestrogen and progesterone, the female sex hormones produced by the ovaries. It works by either keeping the egg and sperm apart or preventing ovulation. Depending on the type of pill, you may take tablets every day, or you may have a break for seven days to allow for a bleed. It is over 99% effective.

However, there are risks attached to the pill. It can cause temporary side effects such as mood swings, headaches and nausea, which may last for several months. It is common to experience breakthrough bleeding and spotting in the first few months of taking the pill.

The pill can increase your blood pressure and it has been linked to a heightened risk of serious health conditions, including breast cancer and blood clots.

Not all women can use the pill. If you smoke, or quit less than a year ago, and are over the age of 35, are very overweight, taking certain medications or have certain medical conditions, then your doctor will recommend an alternative to the pill.

An IUD is a small T-shaped plastic and copper device that's put into the uterus by a specially trained medical professional. Once in place, it can be left alone and you do not have to do anything else. If inserted correctly, it is more than 99% effective and can last for between five and ten years, depending on the type of IUD.

There are some risks associated with the IUD. There is a risk of pelvic infection within the first 20 days of the coil being put into place. There is also some evidence which suggests that an IUD makes you more prone to recurring thrush.

In some cases, your body may reject the IUD, expelling it or it may move out of place. If this happens, then there is a chance you may get pregnant. In very rare cases, it may cause damage to the uterus.

You may not be suitable for an IUD if you have an untreated STI or a pelvic infection, have unexplained bleeding between periods or after sex or have previously experienced any problems with your uterus or cervix.

Similar to an IUD, an IUS releases the hormone progesterone to prevent pregnancy. Depending on the brand, an IUS can stay in place for three to five years.

The risks are also similar to an IUD and include the possibility of pelvic infection, rejection  or damage to the uterus. Because of the presence of progesterone, some women can experience headaches, acne, mood changes and breast tenderness after having the IUS fitted. These usually settle with time. An uncommon side effect is the appearance of small cysts on the ovaries. These usually disappear without treatment, although in rare cases they may lead to complications such as ovarian torsion.

This small flexible plastic rod is placed under the skin in your upper arm by a doctor or nurse. It releases the progestogen into the bloodstream to prevent pregnancy and lasts for three years. There is a risk of infection when the implant is put in place and there may be temporary side effects during the first few months, such as nausea, mood swings, breast tenderness and acne. It may also cause your periods to become irregular or even stop completely.

Some medicines can make the implant less effective, for example medications used to treat epilepsy, HIV and some antibiotics.

The contraceptive injection releases progestogen into your bloodstream to prevent pregnancy. It can last eight or 13 weeks, depending on the type used.

You may experience side effects such as acne, decreased sex drive, mood swings, headaches and hair loss and the duration and flow of your periods may change. Sometimes they may stop altogether. This change in menstruation may last for months after the injections are stopped.

If you choose to stop the injections, it can take up to a year for your periods to go back to normal. You may find it difficult to get pregnant during this time.


How are issues with contraceptives diagnosed?

Keep a note of any side effects and how long they last for. Contraceptives that use hormones, such as the pill, injection, IUS and implant, can cause side effects in the first few months, such as mood swings, acne, breast tenderness, nausea, headaches, hair loss and decreased sex drive. These are unpleasant, but should settle down in a few months. Some contraceptives, such as the injection, can cause your periods to change, making them longer, shorter, heavier, lighter, more irregular or even stopping them completely. If after a few months the side effects have not settled down or if your menstrual cycle is causing problems, then you should go to the doctor. Be open and honest about your symptoms so your doctor can help you find a contraceptive that is right for you. If the doctor suspects any type of infection or thrush, then they will carry out tests, such as a blood test, urine test or swab test.

If the doctor suspects that your IUD or IUS has moved, then they will use a small brush in your cervix to try and locate the strings of the IUD/IUS. If they can’t find them, this means it has moved and an ultrasound will be carried out in a bid to find the device.


What treatment options are available?

If your contraceptive is causing ongoing symptoms that are affecting your day-to-day life, such as mood swings, headaches, nausea and acne, or if it is making your period heavy, painful, irregular or difficult to manage, you don’t have to put up with it. There are plenty of different contraceptives out there, and your doctor can change you to a different brand or a different type that is better suited to you.

If you have a displaced IUD/IUS, this can be retrieved via a minimally-invasive procedure called a laparoscopy (keyhole surgery) where fine surgical instruments are passed through a tiny incision in the abdomen. If an IUD/IUS has been displaced, you may need emergency contraception and a back-up method of birth control as pregnancy with an IUD/IUS can be dangerous. If an IUD/IUS has been displaced or fallen out, it can be replaced straightaway.

If you experience multiple cysts on your ovaries as a result of your IUS, these usually go away on their own, but they can be aspirated if they are particularly large.

If you are suffering from an infection as a result of your contraceptive, then you will be prescribed a course of antibiotics. Thrush will require treatment with antifungal medication.


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Frequently Asked Questions

This can vary from person to person. Certain health conditions, taking certain medications, smoking, obesity and other lifestyle factors may mean that not all contraceptive options are available to you. The combined oral contraceptive pill carries a heightened risk of serious health conditions, including breast cancer and blood clots, compared to IUD/IUS, injections and implants.

Only barrier methods, such as condoms can also protect against sexually transmitted infections (STIs) and HIV/AIDS.

Studies have shown that oral contraceptives can be less effective for women aged over 40. There are also additional risks of taking the pill at this age, including the risk of bone fractures and cardiovascular complications, such as blood clots.

The ideal contraceptive for women over 40 would be an IUD/IUS or a similar long-acting, reversible contraception.

Smokers aged over 35  should avoid certain contraceptives, such as the combined pill. This is because smoking increases the risk of serious cardiovascular side effects. However you can use an IUD, IUS, implant, injection and progesterone-only pill safely.

Contraceptive implants, IUD, IUS, injection, combined contraceptive pill and progesterone-only pill are some of the most effective forms of contraceptives and are more than 99% effective if used correctly. Female sterilisation is also more than 99% effective, but this is permanent and cannot be reversed.

The least effective methods of birth control is fertility awareness, which involves tracking your menstrual cycle and then avoiding having sex around the time of ovulation in order to prevent pregnancy. If you have irregular periods, or if the length of your cycle varies each month, this makes this method even more unreliable. It is only around 76% effective.

Another method involves pulling the penis out of the vagina before ejaculation. This is only 78% effective.


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