By Emma Brazier and Harvey Davies Contraception By Emma Brazier and Harvey Davies

Outline Types of contraception How each type works The advantages and disadvantages to each type

Why do people want contraception? Reproductive choice – when or if to have a child Can prevent STIs Population control

Types of Contraception Natural Barrier Hormonal Other Surgical IUD

Natural Rhythm Coitus interruptus Lactation Avoid intercourse in the fertility window – 4-5 days prior and 1-2 days after ovulation (can be predicted with watery spinnbarkeit mucus, raise in morning temperature etc.) Pros: cheap, no side effects, nothing extra needed, Pope approved Cons: 9% failure rate per year, no protection against STIs Coitus interruptus Penile withdrawal before ejaculation Pros: cheap, no side effects, nothing extra needed Cons: significant failure rate, no protection against STIs Lactation Requires REGULAR breast feeding (every 4-6 hours). Prolactin suppresses HPO axis, thus no ovulation, and works for up to 6 months)

Barrier All act to prevent living sperm entering the uterus Condom Pros: cheap, easily available, STI protection Cons: some sensation loss, latex allergies Diaphragm and Cervical Cap Pros: don’t alter sensation, reusability Cons: requires professional fitting first time (needs uterus orientation checking), needs to be washed and cleaned between uses Spermicide Good at aiding other forms of contraception Shouldn’t really be used in isolation

Hormonal Combined Oral Contraceptive Pill Contains oestrogen → stops ovulation and thins uterus, and progesterone → thickens cervical mucus Pros: makes periods lighter, regular, and less painful; >99% effectiveness; lowers ovarian, uterine, and colon cancer risk Cons: hormonal side effects (acne, breast tenderness, mood changes, weight gain etc.), not suitable for overweight or smokers, increased clotting risk Progesterone-Only Pill (Mini Pill) Progesterone thickens the cervical mucus, and in 20% HPO inhibition (stopping ovulation) Pros: >99% effectiveness; can use while breast feeding, overweight, smokers, or when CI to oestrogen; reduces PMS Cons: hormonal side effects (acne, breast tenderness, weight change and headaches), increased risk of ovarian cysts, taken same time every day

Hormonal Injections Implant Depot of slow releasing progesterone injected Pros: >99% effectiveness, no worry about compliance, lasts 12 weeks, breastfeeding friendly, may relieve some symptoms of PID/PMS Cons: hormonal side effects Implant Implanted rod containing slow release progesterone Pros: >99% effectiveness, reduces dysmenorrhoea, can cause amenorrhoea, lasts up to 3 years Cons: hormonal side effects, minor invasive procedure, irregular bleeding

Hormonal Patches Rings Adhesive patch contain oestrogen and progesterone (same as COC Pill) Pros: >99% effectiveness, lowers menstrual symptoms, can improve acne, not affected by D&V Cons: requires weekly change, skin irritation, not suitable for overweight people or smokers, clotting risk Rings Vaginal ring containing oestrogen and progesterone (same as COC Pill) >99% effectiveness, lowers menstrual symptoms, can improve acne, not affected by D&V, can be left in for 21 days Cons: need to be comfortable inserting them, not suitable for overweight people or smokers, clotting risk

Other IUCD (Intrauterine Contraceptive Device) Sterilisation Two main types: copper coil, Mirena (progesterone coated coil) Act to prevent implantation via irritation of the uterus, ± progesterone effects Pros: long lasting (1-10 years), no compliance problems, best form of emergency contraception Cons: can cause bleeding or more cramping, requires checking for string, no protection against STIs Sterilisation Tubal ligation or vasectomy Pros: ‘irreversible’ contraception Cons: Can fail, invasive, very costly

Emergency May be needed in times of contraceptive failure, human failure, rape etc. Main mechanism is to prevent implantation: High dose progesterone IUCD

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