Contraception

Read this article to learn more about the different contraception methods that are available to you and how they work.

Please note that Rahma Health is not a Religious organisation. Some Religions may have further recommendations around contraception types. If this is important to you, please consider consulting your trusted religious scholars for further information and support.

Key Points:

There are many different contraception options available to you. The most commonly used options include condoms and the oral contraceptive pill (sometimes called the OCP or COCP)
Condoms also help to protect you against sexually transmitted infections (STIs)
Some contraceptive options are short-term and must be used every time you have sex with each sexual contact (such as condoms), and some are longer-term and you only need to think about them once every few months (such as the Depo-Provera injection or Implanon)
It is advisable that you discuss your contraceptive options with your doctor to see which options are best for you

Sex and Contraception

Sex can be a wonderful part of life and can be a great part of a relationship that brings partners closer together. Sex has many proven benefits for our physical and mental health.

Reliable contraception knowledge can help you regularly enjoy sex without worrying about unplanned pregnancy.

Contraception (also called ‘birth control’) helps you to avoid pregnancy if you have sex. There are several methods of contraception that are safe, effective and easy-to-use before you have sex. To avoid pregnancy, you should use contraception every time you have sex, even if it is the first time you have sex or if you have your period, as you can still get pregnant. To avoid STIs, you should use condoms every time you have any sexual contact.

Any form of contraception may have side-effects and may not be safe for all people, and you should see your doctor to decide which is best for you. Your healthcare provider may discuss your goals, previous contraceptives trialled, period experiences and cost.

Contraceptive Options

Contraceptive options include:

Condoms
The Oral Contraceptive Pill (OCP/COP)
Intrauterine devices (IUDs e.g. Mirena, Copper IUD)
Hormonal implants (e.g. Implanon, Nexplanon)
Hormonal injections (e.g. Depo Provera)
Vaginal rings (e.g. NuvaRing)
Diaphragms and cervical caps
Permanent contraception (vasectomy, hysterectomy or tubal ligation)
Natural methods: Lactational Amenorrhea Method (LAM), withdrawal method, fertility awareness method
Emergency Contraception – an oral tablet or copper IUD

You can also use Emergency Contraception up to 5 days after you have unprotected sex depending on the type of Emergency Contraception you take. However, Emergency Contraception is most effective if you take it immediately following sex.

Some people can’t use certain contraceptives because of health conditions or side effects so you should speak to your health care provider to find the right one for you.

Information for this page was sourced from the Royal Women’s Hospital, Sexual Health Victoria, Planned Parenthood and Better Health Channel.

Condoms

Male (external) condoms

A male condom is a physical barrier, usually made of latex, that covers the penis when it is erect or stiff. It is placed on the penis before sex and taken off after. It collects the sperm to prevent the sperm from entering the partner’s body. Condoms are a single-use item and should be used every time you have sexual contact. Condoms made from latex alternatives are available if you have a latex allergy. Condoms can prevent pregnancy and act as a barrier to protect both partners from sexually transmitted infections, including HIV. Male condoms are 98% effective in preventing pregnancy when used correctly.

Water based lubricants are recommended to be used with condoms to prevent breakage. Oil-based lubricants such as petroleum jelly (for example, vaseline) and massage oil should not be used with condoms since these increase the risk of condom breakage. Only one condom should be worn at a time. Condoms should be stored in a cool, dry place, and should not be used if expired.

If the condom breaks, it does not protect against pregnancy and you should consider getting emergency contraception.

Learn more at: Male condom

Condom Use

Female condoms

Female condoms are thin pieces of flexible material that are inserted into the vagina before having sex. As with male condoms, you should not remove it until after sex has finished. It is a soft pouch made of synthetic rubber and has two flexible rings on each end.

Internal condoms are 95% effective when used correctly. You should position the penis inside the condom and ensure it doesn’t slip. If it slips, you might need more lubricant.

The female condom is stronger than the male latex condom. You need to place it in the vagina using the flexible ring. More information on insertertion can be found here.

Advantages	Disadvantages
* Can be used with any type of lubricant * Can be inserted a few hours before sex * Provides protection against STIs	* Not easily available – need to be ordered online, from specialised health clinics or from Family Planning services and is more expensive * Higher failure rate than other methods of contraception * More difficult to insert and remove than the male condom

Image: Sexual Health Vic

The Pill

Overview

Contraceptive pills prevent pregnancy by releasing hormones into a woman’s body. These hormones change a woman’s normal ovulation and menstrual cycle, and may stop egg release, thus preventing pregnancy.

Different types of contraceptive pills have different levels of hormones, so it is important you and your doctor decide which pill is right for you.

Some people experience different side effects more often than others. You can experiment with different pills to see which one works better for you. It can take a few months or a few menstrual cycles before you get used to the pill.

Smoking increases the risks of side effects with the pill.

The pill is 99% effective when taken regularly.

Advantages

Disadvantages

* Reduced acne for some women

* Some women report improvement in premenstrual syndrome pain and mood changes in the few days before a period

* Regulates periods

* Results in less heavy periods

* Some women experience side effects, such as sore breasts, acne, nausea, bleeding or spotting, weight gain, mood changes, reduced desire for sex or reduced libido

* Some women experience rare health complications such as blood clots

* The pill is not suitable for women who: have certain types of migraines, have a history of blood clotting or breast cancer, stroke, heart attack, liver problems or who smoke and are over 35, or take certain medications

* The Pill does NOT protect you from sexually transmissible infections such as HIV.

If you miss a pill

If you miss a pill or take a medication which interacts with the oral contraceptive pill, you will become unprotected for 7 days. If you have diarrhoea or vomiting symptoms, you will also become unprotected for the duration of those symptoms as well as 7 days after the last episode of those symptoms. During that time, you should use another method of contraception, such as condoms. You will only be protected from pregnancy after taking 7 hormone pills in a row. Some newer pills are effective from the first day of the medication. Ask your pharmacist about what type you are taking and follow the instructions on the packet.

Mini Pill

The Mini Pill has only the progesterone hormone and is safe for breastfeeding mothers.

How to use it

You should take the Pill at the same time every day.

Where to find it

You need to visit your GP and get a prescription which you can then take to your local pharmacy to have filled.

Some brands are more expensive than others but you can ask your doctor for one you can afford.

Check with your chemist if they have the generic version (non-brand name) as this will make it cheaper too.

Some people can’t use certain contraceptives because of health conditions or side effects so you should speak to your health care provider to find the right one for you.

Learn more at:
The mini pill
The oral contraceptive pill

Intrauterine device (IUD)

An intrauterine device has the shape of a “T” and releases hormones into your body. Examples of IUDs include Mirenas and Copper IUDs.

It is placed inside the uterus by a trained medical professional and it makes it difficult for a sperm to reach the egg and create a pregnancy. The IUD can be removed at any time by visiting your doctor and does not affect your long-term fertility after it is removed.

The IUD works in 99.8% of cases.

You can speak to your doctor, obstetrician, midwife or maternal child health nurse about whether an IUD is right for you and how to get one.

Advantages

Disadvantages

* The most effective contraceptive

* Can stay in your body for up to 10 years depending on the type

* You can forget about it once you have it in

* Cheaper than other forms of contraception in the long term

* Progestogen IUD has the added benefit of reducing heavy periods

* Reversible – it can be removed by a trained health professional and you can try for pregnancy directly afterwards

* Doesn’t interfere with having sex

* An IUD does NOT protect you from sexually transmissible infections

* Must be inserted by a trained medical professional Must be purchased from doctor or pharmacy

* May fall from your uterus during a period. You should always check that the string is in place

* Small risk of infection in the weeks following insertion

* Copper IUD may cause heavier periods

* The progestogen IUD may cause periods to become irregular and have side effects like increased acne, headaches, vaginal dryness

Some people can’t use certain contraceptives because of health conditions or side effects so you should speak to your health care provider to find the right one for you.

IUD
Long Acting Reversible Contraception – LARC

Hormonal Implant / Implanon

The hormonal implant is a small thin rod, about 4cm long, that is placed under the skin of the upper arm of a woman.

It is similar to The Pill because it releases synthetic hormones into the body to prevent normal ovulation which will prevent pregnancy.

Many women use this method because it lasts for 3 years and it doesn’t need daily attention like The Pill does.

Advantages

Disadvantages

* 99% effective

* Lasts for up to 3 years

* You could get pregnant immediately after having the rod removed.

* Low cost

* Doesn’t interfere with having sex

* Like The Pill, the implant can have side-effects (sore breasts, mood changes, acne, headaches), so discuss these with your doctor before you decide if it is right for you

* Some women experience changes to their monthly periods e.g. irregular bleeding or spotting

* Does NOT protect you from Sexually Transmitted Infections

* A trained doctor or nurse must insert it and remove it

* Must be purchased from Pharmacy or Medical Clinic / Family Planning Clinic

It’s important that you change it just before it expires. If you don’t replace it on time, you might get pregnant if you have unprotected sex around this time.

Contraceptive Injections

The hormonal contraceptive injection (also called “Depo Provera” or “Depo”) stops ovulation. It makes the fluid or mucus at the opening to the uterus thicker so sperm cannot enter.

Each injection lasts for 12-14 weeks (3 months) at a time.

Advantages	Disadvantages
* 99% effective * Lasts for three months, so you don’t need to remember to take a pill every day * Periods become lighter than previously; sometimes, periods stop all together	* Some women experience irregular bleeding * Some women experience weight gain, bloating, headaches, abdominal discomfort and mood changes * Contraceptive injections may increase your risk of osteoporosis (weak bones)

Once you stop taking Depo you can fall pregnant. However, if you’ve been on it for a long time, it can take longer before your normal ovulation cycle to return than it would if you had been on The Pill or had an Implant. Depo is an injection that your doctor or nurse will give you every 12-14 weeks.

Vaginal Ring

The vaginal ring is a small, soft, plastic ring that is placed at the top of your vagina, where the opening of your cervix is. Sometimes, it is called the ‘NuvaRing’.

A prescription from your doctor is required before you can buy the vaginal ring.

The vaginal ring works by slowly releasing hormones into your body that prevent pregnancy.

If the ring comes out, you can rinse it with water and put it back into place.

It stays in place for three weeks. After three weeks, you should remove it and experience a bleed for 1 week. Then,you should replace it with a new ring.

Advantages

Disadvantages

* Many women prefer the ring instead of remembering to take a pill every day.

* If you use it correctly, the ring is 99.7% effective for preventing pregnancy.

* You can insert it yourself in the privacy of your own bathroom at home

* You can remove it yourself

* It can improve acne for some women

* It can make periods lighter and more regular

* It can improve the symptoms of premenstrual syndrome

* The vaginal ring does NOT protect you from sexually transmissible infections

* Cost can be around $50 per ring. You can buy it from a pharmacy with a script from your doctor. It might be cheaper at certain chemists, so we recommend you check the prices online before you decide where to buy it from

* If you don’t use it correctly, you might be unprotected for the first 7 days of use. You need to use condoms for the first 7 days after insertion

The vaginal ring is not recommended if you:

Are older than 35 years and smoke
Have had a baby in the last 6 weeks
Have a condition that increases your risk of blood clots, or have ever been diagnosed with deep vein thrombosis, a heart attack or a stroke
Have liver disease
Have other conditions including certain migraine types, breast cancer or some types of lupus (please consult your healthcare provider)

Diaphragm

The diaphragm is a soft dome that is fitted in the vagina as a barrier from the uterus.

A doctor or nurse will place the diaphragm when you are having it fitted. Your local Family Planning clinic has doctors and nurses who are trained to help you get used to fitting it yourself. You should practice inserting it and removing it before you have sex with it for the first time.

Advantages	Disadvantages
* The diaphragm is 94% effective when you use it correctly * You can be trained to put it in and take it out yourself by a healthcare professional	* The diaphragm should remain in your vagina for up to 6 hours after having sex * Does not protect against sexually transmitted infections * First fitting needs to be done with a trained healthcare professional

You can speak to your doctor or family planning clinic to organise a fitting..

Vasectomy

A vasectomy is a permanent method of contraception for men.

It is a minor procedure that cuts the tubes that carry sperm from a man’s testicles to the penis. This prevents the man from getting a woman pregnant. It can be performed in a medical clinic.

After a vasectomy, a man can still enjoy sex, have orgasms and make male sex hormones.

A vasectomy can be reversed but being able to get a woman pregnant after this reversal is not always possible.

3 months after the procedure, you need to get a test to check that you are not producing any more sperm.

A vasectomy does not protect you from sexually transmissible infections.

Advantages	Disadvantages
* Permanent – if you have completed your family and are sure you don’t want any more children, this method might be suitable for you	* Only some doctors are trained in doing vasectomies – check with your GP who can refer you to another GP or specialist who does this procedure * Cost can vary, and may be high

It is also a good idea to talk about other contraceptive options if you are not sure this is what you want.

Tubal ligation

Tubal ligation is a permanent method of contraception that you can choose if you are sure that you do not want to have children in the future. It is also called female sterilisation or ‘having your tubes tied’.

The fallopian tubes are part of your reproductive system. When you have your period, an egg passes from your ovaries along your fallopian tubes to your uterus. During a tubal ligation, an Obstetrician / Gynaecologist uses keyhole surgery to place clips on these tubes to prevent the eggs passing through.

Tubal ligation does not protect you from sexually transmissible infections.

Where to find it:

Only some doctors perform tubal ligation.
You may need to see your family doctor first to get a referral to a specialist. You should also talk to your family doctor about other contraceptive options if you are not sure this is what you want.

Advantages	Disadvantages
* Permanent – if you have completed your family and know you don’t want any more children, this method might be suitable for you	* Requires a referral to a specialist doctor * Cost can vary, and may be high

Surgery may depend on any health conditions and may have side effects so you should speak to your health care provider to find out if this is right for you.

Natural Methods

Withdrawal Method

Withdrawal is when the penis is pulled out before ejaculation.

It is not recommended as a method of contraception, but is better than no contraception. With real-world use, the withdrawal method is 80% effective, meaning that 1 in 5 people who use it become pregnant each year.

At times, there may be sperm in the pre-ejaculate which makes the withdrawal method ineffective. It is important to urinate to wash out any sperm and to wash your hands and penis.

You may consider emergency contraception if you have used the withdrawal method and are concerned about pregnancy.

Fertility Awareness Method

The fertility awareness method may be a good method that aligns with most religious and cultural beliefs.

This can be 77-99% effective depending on the knowledge of the person who is tracking.

It involves a thorough understanding of the menstrual cycle and tracking one’s vaginal mucous thickness, body temperature, and menstrual cycle to only have sex during a non-fertile period. A woman will only get pregnant if she has released an egg and if the egg has been fertilised by a sperm. Sperm can live in the body for up to six days after sex, and the egg can live in the body for 12-24 hours after ovulation. Therefore, people need to avoid having sex from 6 days before ovulation until 2 days after ovulation. People can track their bodily changes to know when ovulation is likely to occur and avoid the fertile period.

This method requires thorough training and might cause an accidental pregnancy if your period pattern changes one month. This method is also imprecise, as an egg may be released despite a lack of bodily signs, or at an unusual time in the cycle.

For more information:

Sexual Health Vic – Natural Family Planning

Lactational Amenorrhea Method (LAM)

Some women choose to use the Lactational Amenorrhoea method, which means relying on their body not producing eggs while they breastfeed.

This method carries significant risk and many people have accidental pregnancies while using it.

We recommend using another method in addition to this.

Your body offers natural contraception after you have your baby if all of the below criteria are met:

Your baby is less than 6 months old
You haven’t had a monthly period yet
Your baby feeds every 4 hours during the day and every 6 hours at night
You are exclusively breastfeeding (this means that your baby is only having breast milk, and you are not skipping breastfeeds during the night)
If you use a breastpump or use formula, this method will not work for you.

LAM does NOT protect you from sexually transmissible infections

Advantages	Disadvantages
* Natural * Free	* Requires many factors to align in order to work (e.g. baby less than 6 months, feeds every 4-6 hours, feeds to be directly from breast etc) * Many have experienced accidental pregnancies using this method, and unplanned pregnancies may be particularly difficult for parents of young babies

Emergency Contraception

Also called “the Morning After pill” or “Plan B”

Emergency contraception (EC) is also known as “the morning after pill” or “Plan B”. You can take EC to prevent pregnancy if you had unprotected sex, if the condom broke or if you were sexually assaulted (this means you did not consent to having sex).*

EC is most effective when you take it within 24 hours of having unprotected sex but you can take it up to 5 days later depending on the type you take.

EC is 85% effective in preventing pregnancy if you take it within 3 days but it can be more effective if you take it sooner.

Advantages	Disadvantages
* Don’t need to see a doctor, and you can get from the pharmacy straight away. The pharmacist will ask you questions to determine the best option for you * Can be taken within 5 days of the sexual encounter	* EC does NOT protect you from sexually transmissible infections. * Most effective if you take it as close to the sexual encounter as possible * Some women experience side effects such as nausea, vomiting or vaginal spotting

How to use it:

You may be given one to two pills to swallow.
Sometimes you can feel sick after taking EC
If you vomit, let your doctor or pharmacist know as it might not be as effective depending how soon after you had the medication you were sick
Some doctors may offer to insert a Copper IUD if you have had unprotected sex within the past 5 days. Please see the section on IUDs for more information.

Where to find it:

In Australia, you do not need to see a doctor to get EC, however not all pharmacies may stock it
The pharmacist may ask you some questions or ask you to fill out a form before selling it to you
If they don’t sell it to you or make you feel embarrassed for asking for it, find a different chemist. You have a right to access this medication. You should never be made to feel judged or ashamed for doing so

*If you are sexually assaulted you have a right to seek help and ask for Emergency Contraception.

Some people can’t use certain contraceptives because of health conditions or side effects, so you should speak to your health care provider to find the right one for you.

For more information:

The Royal Women’s Hospital: Louna’s Lowdown on Emergency Contraception

https://www.thewomens.org.au/health-information/contraception/emergency-contraception/

Contraception

Contraception

Condoms

The Pill

Intrauterine device (IUD)

Hormonal Implant / Implanon

Contraceptive Injections

Vaginal Ring

Vasectomy

Tubal ligation

Natural Methods

Emergency Contraception

Links: