HEALTH

Here Are All The Contraception Options That Aren't The Pill

Every woman is different, so explore all avenues first.

13/03/2017 1:12 PM AEDT | Updated 15/07/2017 5:53 PM AEST

So you've forgotten to take your pill correctly everyday this month, again. Or you've overheard your friends talking about some of the risks associated with it. Or you're brand-spanking new to the wonderfully complex world of contraception and you just want to know a little more about your options.

Whatever your reason for clicking here, it's important to know there are options. Many options. And some of those options which seemed uncommon a few years ago are becoming increasingly popular among Australian women and medical professionals too.

The most effective contraceptive methods (besides not having sex) being pushed by medical professionals are called LARCs (which stands for Long Active Reversible Contraception).

Medical Director of NSW Family Planning, Dr Deborah Bateson said they're essentially methods where you "fit and forget", such as the Implanon and IUDs (interuterine devices).

"They're highly effective because the woman doesn't need to remember to take a pill every day, which can be easily forgotten," Bateson told HuffPost Australia.

It's just important that women have all the information to make that best choice for themDr Deborah Bateson

They also don't have some of the risks associated with The Pill. Bateson said the main risk with hormonal contraception is associated with the oestrogen component (which yes, the combined oral contraceptive pill has) which can increase the risk of blood clotting.

The increased risk is still very low, but women with a family history of blood clotting should consult their doctor first -- and maybe explore other contraceptive avenues.

Every woman is different, so what works for you may not work for your best friend.

"One method will suit some women and one method another, and its just important that women have all the information to make that best choice for them," Bateson said.

So take a look (and the rest is up to you):

LARC METHODS

Implanon

How it works: The contraceptive implant, known as Implanon, is a small rod inserted under the skin of the inner arm. It releases a low dose of progestogen into the bloodstream, which prevents ovulation. The rod only needs to be replaced every three years.

What it does to the body: As Implanon prevents ovulation, it changes the bleeding patterns for women and can in some cases halt a woman's period altogether. About one in five women have irregular or persistent bleeding. However, a key advantage of Implanon is fertility instantly returns once the rod is removed.

"It's important for women to know it's not metal, it's a physical rod in the arm and women have to feel comfortable with that," Bateson said.

"Lots of women use Implanon worldwide and there's no evidence it causes a delay in the return to the woman's previous level of fertility. You can actually ovulate very, very quickly afterwards."

Rate of effectiveness: 99.9 percent. It is also on the PBS (Pharmaceutical Benefits Scheme).

Mirena (or hormonal IUD)

How it works: A small T-shaped device is fitted inside the uterus, which slowly releases a low dose of progestogen into the uterus. It needs to be replaced every five years. It doesn't stop ovulation, but thins out the lining of the uterus.

What it does to the body: This can make women's periods lighter and in some cases halt completely.

"Hormonal IUDs are sometimes used to help women with heavy bleeding, as they can sometimes end up with high blood loss and even anaemia otherwise," Bateson said.

Rate of effectiveness: 99.8 percent. It is also on the PBS.

Copper IUD

How it works: A small device made from plastic and copper, the interuterine device is fitted inside the uterus by a medical practictioner. The copper IUD works in two ways -- by stopping sperm from reaching the egg and preventing any fertilised egg from sticking to the wall of the uterus. It needs to be replaced every five to 10 years. This can also be used as a form of emergency contraception, if inserted within the first five days after sex.

What it does to the body: As the copper interuterine device doesn't use any hormones, it doesn't impact the regular period cycle. However, periods can become heavier for some women using the contraception.

Rate of effectiveness: 99.2 percent. Not on the PBS, and costs around $100.

IUDs (both hormonal and copper) used to be commonly used for older women, but Bateson said they're now effective methods for young women too.

NON-LARC METHODS

Contraceptive Injection

How it works: Like the name suggests, a woman is given an injection into a muscle every three months, which stops ovulation.

What it does to the body: The injection stops ovulation. However, one factor to consider is fertility may be delayed once stopping use of this contraceptive.

"It can take up to 12 months to return to previous fertility," Bateson said, "so women are probably using it less, but it's still an effective contraceptive."

Rate of effectiveness: 94-99.8 percent.

Vaginal Ring (Nuva Ring)

How it works: The soft plastic ring is self-inserted and remains in the vagina for three weeks. Once removed, it is replaced by another ring one week later.

What it does to the body: The vaginal ring slowly releases low doses of oestrogen and progestogen, are the hormones used in the combined oral contraceptive pill. This, in turn, prevents ovulation.

"They're not on the PBS, so they're a bit more expensive than those pills which are subsidised. Some of the newer pills and the vaginal ring are around $25 per month, compared the $5 for the cheaper pills."

Rate of effectiveness: 91-99.7 percent effective. Not on the PBS.

BARRIER METHODS

Diaphragm

How it works: The soft, silicone cap which is shaped like a dome is placed in the vagina before sex. The diaphragm should be fitted for size by a medical practitioner.

What it does to the body: Once inserted, the diaphragm covers the cervix and stops sperm entering the uterus. "It stays in for six hours after intercourse, and the sperm die off in that time," Bateson said.

Rate of effectiveness: 88-94 percent.

Condoms

How it works: Male and female condoms act as a barrier method, preventing sperm from entering the vagina. Male condoms are made of latex or polyurethane and are rolled onto the penis before sex. Female condoms are made of polyurethane, with two flexible rings to keep it in place when inserted into the vagina before sex.

"They are the only contraceptive which protects from STIs as well," Bateson said, "but they're not as effective as some of those other methods as a contraceptive."

Rate of effectiveness: Male condoms are 82-98 percent effective. Female condoms are 79-95 percent effective.

Withdrawal Method

How it works: Also known as coitus interruptus, the withdrawal method is where the man removes his penis from the woman's vagina before ejaculating.

What it does to the body: No sperm enters the vagina, preventing the woman from falling pregnant. However, medical professionals do not recommend this as a form of reliable contraception. Then there's the increased risk of contracting a sexually transmitted disease.

Rate of effectiveness: 78-97 percent

Fertility Awareness Based Methods (Calendar Method)

How it works: A woman can identify the fertile days of her menstrual cycle to avoid pregnancy, by using a menstrual calendar and/or observing symptoms. You can find more information about those methods here.

What it does to the body: This method obviously uses no external hormones, and simply monitors the natural cycle. Sperm survives in the uterus or fallopian tubes from five to seven days, but the egg only survives from 12 to 24 hours once released. A woman is most fertile the week before ovulating until a day after ovulation has occurred. You can basically do the calculations around this, but it takes diligent monitoring.

Rate of effectiveness: 75-99.6 percent.

Emergency contraception

How it works: This isn't a regular form of contraception, but used to prevent unintended pregnancies after unprotected sex. There are a range of pills available which can be taken up to three days after sex and five days after sex. All pills are most effective when taken in the first 24 hours.

What it does to the body: Emergency contraceptive pills work in two ways: they stop/delay ovulation, or prevent the egg and sperm meeting. It's important to note they don't cause an abortion.

Rate of effectiveness: Prevents 85 percent of expected pregnancies.

Steralisation

How it works: There is both male steralisation and female steralisation which are permanent procedures. Bateson said male sterilisation can be reversed sometimes, but not always.

What it does to the body: For women, the Fallopian tubes are blocked in the operation (under general anaesthetic) which stops eggs passing through. For men, the operation (under general or local anaesthetic) on the vas deferens prevents sperm forming in the testes connecting to the ejaculate fluid.

The rise of LARC methods has seen female steralisation declining in Australia, Bateson said, as women now have other long term options.

Rate of effectiveness: Permanent.

For more information consult your local GP or visit Family Planning NSW.

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