contraception
If you have sexual intercourse but don't want to get yourself or your partner pregnant, you need to use some form of contraceptive.
Most importantly remember that no matter what form of contraception you choose, none of them are 100% effective at preventing a pregnancy.
Some types are more effective than others.
The following information is on the many different types of contraception available.
When selecting a method of contraception it is important to choose one that best suits you and your partner, and to keep in mind that some methods help protect against the spread of sexually transmissible infections (STIs) while others do not.
ORAL CONTRACEPTIVE PILL("the pill")
There are several types of contraceptive pill containing slightly different hormones.
Oral contraceptives can be very effective contraceptives, but they will not protect you against STIs.
The combined pill
The combined pill contains two important female hormones : oestrogen and progesterone.
When taken, this pill stops ovulation occurring - it stops the woman's ovaries from releasing an egg each month.
Things to know about the combined pill...
It's easy to use.
Periods will usually be regular.
You must get a prescription for the pill(from a doctor or family planning clinic), and then buy it from a pharmacist. You will need to get another prescription when you start your last packet.
There are various types of combined pills.
Some have varied doses of hormones throughout the cycle, while others have the same fixed dose of oestrogen and progesterone in all the active pills.
Both types of combined pill work in the same way - by replacing your hormones, preventing ovulation, and therefore preventing pregnancy.
When you stop taking"the pill", your own hormones take over and ovulation begins once more.
The mini pill:
The mini pill (or progesterone-only pill") only contains one of the female hormones - progesterone.
It works by changing the mucus at the cervix (the opening into the uterus) so sperm cannot get through and meet with the egg.
It MUST be taken on time daily; and it can sometimes cause irregular periods.
Your doctor can give you further details about how to take it properly and discuss possible side effects.
Things to know about both pills:
Starting "the pill": You should begin your first packet of pills when you have a period, following the detailed instructions in the printed pamphlet in the pill packet. After having a baby, or a miscarriage or abortion, ask your doctor when to start taking "the pill".
It is very important to take the pills in the correct order and to take them regularly, at the same time each day.
Some women and girls cannot take "the pill" for medical reasons, perhaps because they are heavy smokers or have high blood pressure.
Other medications and drugs (such as antibiotics, anti-epilepsy drugs and vitamin C), or diarrhoea and/or vomiting may interfere with "the pill's" effectiveness. Your doctor needs to know if you are on other medication. If the drug or medication you are on does interfere with "the pill" then you must use other contraception eg condoms or not have sex until you have finished the other treatment and taken active hormone pills for seven consecutive days after you have finished taking the other drug.
If you forget to take a pill, take it as soon as you remember and then take the next pill at your usual time.
When "the pill" is not effective:
When you have diarrhoea or vomiting. As "the pill" is absorbed in the gut, anything that upsets the stomach or intestines is going to interfere with the absorption of "the pill" and make it less effective.
When you forget to take a pill. If you miss a pill completely, then the cycle can be interrupted and ovulation may still occur. If you do forget to take a pill, it is best to take it as soon as possible, and then take the next one at the normal time the next day.
When you are taking antibiotics or other medications. These can stop the absorption of "the pill" from the gut.
Health benefits and risks:
"The pill" has a number of important benefits to your health: taking it for months or years is found to reduce your risk of developing ovarian cancer, ovarian cysts, cancer of the lining of the uterus (endometrium), anaemia, serious pelvic infection and benign breast lumps.
"The pill" also makes periods lighter, more regular and less painful, and may also relieve premenstrual tension and improve acne.
A few women experience side effects such as weight gain, sore breasts, thrush (may also develop when taking antibiotics), spotting or bleeding like a period while taking active pills, nausea, decreased sex drive and mood changes, including irritability and depression.
These usually disappear after the first two or three cycles on "the pill".
Some women find these improve if they take their pill more regularly, at the same time each day, or they take it at night rather than in the morning.
Very few women have serious health problems due to taking "the pill".
If you feel you might have persisting problems, discuss these with your doctor or family planning clinic.
Often changing "the pill" may be all that is needed.
"The pill" is suitable for most women, but you should not take it if:
you have ever had a deep thrombosis (blood clot in your veins), a stroke, or heart attack.
you have hepatitis, active liver disease, or severely impaired liver function.
you have vaginal bleeding, the cause of which has not been identified.
You should arrange to have your blood pressure checked at least once a year while you are taking "the pill".
You should also have a breast check and pap smear at least every 2 years- your doctor can advise you on how frequently you need these checks.
Remember also to examine your own breasts every month after your period - breast cancer doesn't just affect old ladies.
EMERGENCY CONTRACEPTION
The "morning after" pill (MAP) and the intrauterine device (IUD) can be effective after sex without contraception, or if contraception failed.
The MAP is a high dose hormone pill and should not be used as a regular form of female contraception, because of the possible side effects.
You must visit your doctor within 72 hours of having sex.
Tablets are taken 12 hours apart, and you will need a check-up three weeks later.
The "morning after" pill will often cause nausea and even vomiting.
If vomiting does occur, you will need to revisit your doctor who will prescribe you a new dose.
The doctor can prescribe some medication to stop you vomiting.
The IUD can also sometimes be used as emergency contraception for women.
Generally, this method is not recommended for younger women because of increased risk of complications that can occur, such as problems with fertility.
Ask your doctor- they are the best informed and you can be sure they will keep all your information confidential..
DEPO PROVERA
Depo provera is an injectable synthetic hormone, a progestogen, which has been used since 1966 to treat various female health problems.
It has been only used as a contraceptive since 1994.
It works in three ways:
It stops the release of ovum (egg) every month.
It changes the lining of the uterus so a fertilised egg cannot grow.
It alters the mucus in the cervix (the entrance to the uterus) so sperm cannot get through.
Depo provera is just as effective as the oral contraceptive pill.
Less than one woman out of every 100 using this method will get pregnant over one year of use.
This means it is more than 99% effective.
Advantages of Depo Provera
It is an effective form of contraception.
The date of the next injection is the only thing that needs to be remembered.
Many women find their periods stop after 1 or 2 injections - this is often seen as convenient and as a health benefit.
It does not contain oestrogen and so can be used in women where oestrogen cannot be used.
Its efficiency is not affected by changes in body weight or by taking other medications.
Disadvantages of Depo Provera
Once the injection has been given, it cannot be removed or cancelled. The hormone is slowly released into the body and broken down over the next twelve weeks.
Some women experience a weight gain, headaches and tiredness.
Irregular bleeding may occur for the first few injections. This is usually light bleeding lasting for a few days. Rarely, prolonged heavy bleeding can occur.
Once you stop Depo Provera injections, return to fertility takes 5 to 6 months.
Studies have shown no evidence of any effect on a pregnancy or a foetus.
This drug does not affect the ability to breast feed.
Depo provera can be used by most women but is not recommended for those who :
are allergic to the drug (very rare)
are pregnant.
have undiagnosed vaginal bleeding.
have active liver disease.
have developed depression on oral contraception.
have a history of a depressive illness or post natal depression.
To date, no studies have found any long term side- effects.
Recent reports suggest that there is an association with osteoporosis and women who are at increased risk of developing osteoporosis need to be followed closely and encouraged to maintain a calcium rich diet.
IMPLANTS
Implants are some of the newest forms of contraception.
Two of the available types are Norplant and Implanon.
They consist of a small rod (or rods) that are implanted under the skin of the upper arm.
They are actuallly smaller than a matchstick.
Each rod contains one of the female sex hormones, similar to progesterone, and is slowly released.
It thickens the mucus at the cervix and stops the sperm from entering the uterus.
These implants can last for a long time.
Norplant is effective for up to 5 years, and Implanon for 3 years.
INTRA UTERINE DEVICES (IUDs)
An intra-uterine device (IUD) is a small plastic object containing copper that is placed inside woman's uterus by a doctor.
It is a very effective working by altering the lining of the uterus so fertilised eggs cannot implant and grow.
A single IUD is left in place for up to 5 years.
Important facts about IUDs:
You must visit a doctor or clinic to have it fitted. Some pain may be associated with the insertion, and in some women this pain may continue while the IUD is in place. The IUD is not suitable for many women so you will need to discuss this with your doctor.
Periods may be heavier, and you may get more premenstrual tension and cramping.
Pelvic infection can be a risk and may lead to infertility in the future.
You must check each month that the IUD is still in place. Your doctor will show you how to do this.
When it is removed, you are usually able to get pregnant immediately.
IUDs can be quite expensive.
DIAPHRAGMS
Diaphragms are soft rubber that are used as a barrier to the passage of sperm.
The diaphragm must be placed inside the vagina to cover the cervix each time you have sex.
Diaphragms come in different sizes, so you must have one fitted by a doctor or a family planning nurse and then be taught how to use it.
You must use your diaphragm every time you have sex and leave it in for at least 4 hours afterwards.
When you know what size you need, you can buy one over the counter at a pharmacy or a family planning clinic.
It is usually easy to put in once you've been taught and have practiced.
You only have to use a diaphragm when you have sex - it has no effect at other times.
You need to check the size again after a pregnancy, a vaginal operation, or if the diaphragm feels loose or is uncomfortable.
It is best to use spermicide in conjunction with the diaphragm.
SPERMICIDES:
Spermicides need to be placed inside the vagina before you have sex.
They help to kill the sperm.
Spermicide creams, foams and jellies are not effective contraceptives on their own, and should always be used with a diaphragm or condom.
Some spermicides give some protection against STIs because they can kill some viruses and bacteria as well as sperm.
HOWEVER, don't rely on this protection by itself as it is not 100% - use a condom as well and stay safe!!
Things you need to know about creams, jellies and foams...
You don't need to see a doctor. You can get them from the pharmacist.
The cream or jelly must be inserted immediately before you have sex.
Some people find spermicides irritating and/or messy.
CONDOMS
Currently, the condom is the only contraceptive device for use by men.
It is made of thin rubber and is rolled onto the man's erect penis before it is put into the woman's vagina.
It collects the man's sperm, preventing them from entering the vagina.
A new condom must be used each time you have sex, and must be on before any close physical contact takes place, because even sperm spilled outside the vagina can cause a pregnancy!
Condoms provide effective contraception if used properly, and also give good protection against STIs.
Other things you need to know about condoms:
You don't have to see a doctor to obtain condoms. Condoms can be purchased at pharmacies, shops, and from vending machines in some public toilets.
You need a new condom each time you have sex.
It is best to use a spermicide cream or jelly in the vagina as well, as this will kill any sperm that may escape. Aim not to let any sperm escape, as this can lead to unwanted pregnancy.
When removing the penis from the vagina, care must be taken to ensure that the condom does not come off or tear. Hold the condom to prevent it coming off.
Old unused condoms may not be any good. The rubber perishes and there may be holes. Check the expiry date on the packet!
Water-based lubricants will help stop the condom breaking.
Never use oil-based lubricants (eg Vaseline) as they cause the condom rubber to deteriorate.
Condoms don't cost much, they are small and easy to carry with you. But do not store condoms in your wallet for more than a week as they may become damaged.
If you have a new sex partner, or if you or your partner have sex with other people, you should always use condoms to help prevent the spread of STIs!!
Always use condoms with the other forms of contraception you use currently.
FERTILITY AWARENESS & "NATURAL" FAMILY PLANNING
The "Rhythm" Method
These methods help a woman to know her fertile times -the times in the month when she is most likely to get pregnant.
This is done either by taking her temperature daily by checking her vaginal secretions, and by recording dates on a calendar to give an idea of fertile periods.
During the fertile time, another form of barrier contraception such as a condom can be used to prevent unwanted pregnancy.
Cycle lengths do not have to be regular for this method to be effective.
Your doctor may be able to help you with this, or can refer you to the help and advice you require.
There needs to be a firm commitment from both partners for these methods to work.
They give NO protection against HIV infection and other STIs.
Things to know about natural methods:
You need to be taught how to recognise your fertile times and the "safe" time for sex. This takes time, effort and patience.
The failure rate is higher than other methods - you must be highly motivated and careful to avoid pregnancy,
There are times when it is unsafe to have sex unless other forms of contraception are used.
If your periods are irregular, these methods will be hard to use.
There are no costs, side-effects or health risks.
WITHDRAWAL
In this method the man removes his penis from the woman's vagina before he ejaculates ("comes").
The risk of pregnancy is very high, and success is dependent on the man's ability to control his ejaculation.
Even if the man "comes" just outside the vagina, sperm may still be able to swim inside.
This method does not protect against passing on HIV infection or other STIs.
Although this method works for some people, it is not recommended as a long-term method of contraception.
STERILISATION
There are operations for both men and women to make them sterile (ie unable to have children).
In women the operation is called "tubal ligation" and requires a general anaesthetic.
The tubes that carry eggs to the uterus (the fallopian tubes) are blocked off.
This requires surgery by a doctor, usually in hospital.
In men the tubes that carry the sperm (the vas deferens") are blocked off - this is called a vasectomy.
When the man "comes" during sex, semen is still ejaculated but there is no sperm in it.
Vasectomy must be performed by a doctor, but it can be done under local anaesthetic in the doctor's surgery.
People who have been sterilised should still use condoms if there is any risk of HIV/AIDS or STIS!!
If you don't want any more children, sterilisation is a good way of preventing pregnancy.
Sterilisation cannot be reliably reversed once performed.
Be very sure it is what you really want!
You have to have surgery - may be some discomfort and it may cost a lot of money.
After male sterilisation it takes some time for all the existing sperm to be ejaculated.
It is important to use other methods of contraception during this time.
THINGS THAT DON'T WORK
Standing up while having sex.
Putting other things into the vagina after having sex, for example coke or aspirins. .
Taking a hot bath.
Using plastic film instead of a condom.
Remember..
You CAN get pregnant the first time you have sex.
You don't have to have an orgasm (climax, "come") to get pregnant.
Every woman and girl who has sex should have a Pap smear every two years, to make sure her cervix, uterus and vagina are healthy. Ask your doctor !
If there is any risk of HIV or STIs, use a condom as well as your other form of contraceptive.
NEED FURTHER ADVICE?
Ultimately, it is up to you and your partner to decide on the best and most convenient contraception to use, your doctor is able to help.
He/she will respect your privacy.
Will my doctor tell my parents I'm having sex?
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