CONTRACEPTION

Choosing a method of birth control is a highly personal decision, based on individual preferences, medical history, lifestyle, and other factors. Each method carries with it a number of risks and benefits of which the user should be aware.
Each method of birth control has a failure rate – an inability to prevent pregnancy over a 1-year period. Sometimes the failure rate is due to the method and sometimes it is due to human error, such as incorrect use or not using it at all. Each method has possible side effects, some minor and some serious. Some methods require lifestyle modifications, such as remembering to use the method with each and every sexual intercourse. Some cannot be used by individuals with certain medical problems.

Intrauterine device (IUD)

An intrauterine device is a small, T-shaped contraceptive device made from plastic and/or copper that fits inside the womb (uterus). The IUD used to be called a coil or a loop. It's a long-acting and reversible method of contraception, which can stay in the womb for 5-10 years depending on the type.

Some IUDs contain hormones that are gradually released to prevent pregnancy. These IUDs can also be used to manage heavy periods. IUDs are 99% effective.

Contraceptive implants & injections

Contraceptive implant The contraceptive implant (sold as Implanon NXTTM) is a hormonal implant the size of a matchstick, which is inserted under the skin at the inner side of the upper arm. This 4 cm-long implant contains etonogestrel, a progesterone-like hormone that prevents ovulation.
This hormone also thickens the mucus in the cervix (entrance to the uterus), preventing sperm from getting through. The implant is inserted and removed under local anaesthetic by a specially trained doctor. 
Advantages of the contraceptive implant include that:

• It is close to 100 per cent effective.
• It lasts for three years.
• It costs about $100 (less a Medicare rebate) to have an implant inserted.
• At most, it takes just one week to start working (depending on when the implant is inserted).
• It is safe to use when breastfeeding.
• It can be used by most women who cannot take synthetic oestrogens.
• Women usually start ovulating again within three weeks of removing the implant.

Disadvantages of the contraceptive implant:

• Some bruising and discomfort around the implant is common and may last for up to a week.
• It can cause irregularities with periods, such as unscheduled bleeding.
• It can cause headaches, acne, breast tenderness and increased appetite.
• It can move from its original position under the skin.
• There is a slight risk of infection and bleeding around the implant.
• The contraceptive implant does not provide protection from sexually transmissible infections (STIs).
• Some medications, particularly some that are used to treat epilepsy, and the herbal remedy St John’s Wort, can make it less effective.

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Contraceptive injection The contraceptive injection, known as Depo (sold as Depo-ProveraTM/ Depo-RaloveraTM) is a long-acting, injectable contraceptive that contains only the synthetic form of progesterone, depot medroxyprogesterone acetate (DMPA). Each injection of DMPA prevents an unplanned pregnancy for 12 to 14 weeks. 
The contraceptive injection prevents ovulation and thickens the mucus in the cervix, preventing sperm from getting through. It can also be used to treat women with menstrual problems.
You will need to talk with a doctor or nurse before you start using the contraceptive injection, as this method is not suitable for all women.
Advantages of the contraceptive injection include that:

• It is very effective and convenient.
• It is safe to use when breastfeeding, especially if the baby is over six weeks old.
• About 50 per cent of women using the contraceptive injection do not have periods, which some women see as an advantage.
• There are no medications that make it less effective.

Disadvantages of the contraceptive injection include that:

• It cannot be reversed or withdrawn, which means side effects may last for 12 to 14 weeks.
• It can cause unpredictable irregularities with periods.
• There is a delay in return to fertility after the contraceptive injection is stopped.
• It can be associated with a reduction in bone density.
• Some women experience side effects such as weight gain, headaches and depression.
• The contraceptive injection does not provide protection from sexually transmissible infections (STIs).
• Male injectable contraceptives are currently being trialled.

Hormonal contraception for women is available in the form of implants or injections that release the contraceptive into the body over a sustained period of time. 
Hormonal implants and injections are very effective if used correctly, but can cause side effects. Speaking with a doctor or nurse can help you to choose the method of contraception that best suits your needs.
Other forms of hormonal contraception include oral tablets (the combined pill and the mini pill), the hormonal IUD and the vaginal ring.

Female Sterilisation

Female sterilisation is an effective and permanent form of contraception that prevents women from being able to fall pregnant. Sterilisation is a big decision and should not be taken lightly, and should be discussed in detail with your GP and your specialist.

Dr Holland performs surgical procedures at Newcastle Private Hospital. The sterilisation operation, called a tubal ligation, would involve surgically clipping, cutting and tying or sealing shut the fallopian tubes. This will prevent any eggs from travelling from your ovaries into your uterus where they can become fertilised.

Contraception After a Baby

It's possible to become pregnant again very soon after the birth of a baby, even if you're breastfeeding and even if your periods haven't returned. You ovulate (release an egg) about two weeks before your period arrives, so your fertility may have returned before you realise it.
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It's important to sort out contraception from the start. If you had your baby in hospital, you should discuss contraception with your doctor or midwife before going home. You'll also be asked about contraception at your six week postnatal check, but you can discuss it at any time with your midwife, doctor or local family planning/sexual health clinic.

You can use male and female condoms as soon as you feel ready to have sex. The combined pill, progestogen-only pill and contraceptive implants can be used from 21 days after the birth. However, the combined pill is not recommended if you are breastfeeding, as it can affect your milk supply.
You can usually have a contraceptive injection or start using a diaphragm or cap around six weeks after giving birth. If you used a diaphragm or cap before becoming pregnant, see your doctor or family planning/sexual health clinic after the birth to ensure that it still fits correctly, as childbirth and other factors such as weight loss/gain can have a significant effect. An IUD or IUS can usually be fitted 6-8 weeks after giving birth.