Contraception

There are many types of contraception available for both men and women. They can be categorised into four main groups based on how they work.

• Barrier methods of contraception - Physically prevent sperm from entering the vagina.
• Hormonal contraceptives - They work by altering the natural levels of sex hormones in the reproductive system.
• Long-acting reversible contraception (LARC) - Contraception that lasts from months to years after insertion.
• Permanent contraception (sterilisation) - A procedure that both men and women can have that prevents them from having children.

See below for an overview of all the types of contraception available and what category they fall under.

*Also protect you from STIs (sexually transmitted infections).

There are also ways to naturally protect yourself from pregnancy, such as the pull-out or natural family planning methods.

Hormonal methods are some of the most popular methods due to their effectiveness and simplicity. You can also order hormonal methods online.

Throughout your menstrual cycle, your body undergoes natural changes to prepare for pregnancy. A woman's cycle is governed by two hormones: oestrogen and progesterone. Both hormones are responsible for different processes.

• Oestrogen is responsible for ovulation, the process in which your ovaries release an egg into your fallopian tubes.
• Progesterone is responsible for two processes. It reduces the mucus lining in the cervix so sperm can easily reach a fertilised egg. The hormone is also responsible for thickening the womb's lining so a fertilised egg can easily implant itself.

These hormones naturally rise at different points in your cycle, which triggers these processes.

Hormonal contraception contains synthetic versions of oestrogen and progesterone. This alters the levels of your natural hormones so that they don't fluctuate. Doing so prevents these processes from happening and prevents pregnancy.

Some contraceptives contain both synthetic oestrogen and progesterone, which means both oestrogen and progesterone processes are affected. Other contraceptive types just contain synthetic progesterone.

The combined pill (the pill) is one of the most popular hormonal contraceptives. They are called combined pills because they contain both oestrogen and progesterone.

You take a pill at the same time each day, and it is over 99% effective at preventing pregnancy. The only way the efficacy is reduced is if you take a pill late or you miss a pill.

There are two main types of pills:

• Monophasic pills (e.g. Microgynon & Yasmin) - Contain the same dose of hormones across the pill pack.
• Multiphasic pills (e.g. Logynon & Qlaira) - Contain two or more doses of hormones across the pill pack to replicate your natural cycle.

Both types of pills are available as 21-day and 28-day pills. The 21-day pills contain 21 hormonal tablets, whilst the 28-day pills contain an additional 7 inactive pills that contain no hormones. The combined pill Zoely is the exception as it contains 24 active pills and 4 inactive pills.

There are many different types, and the best contraceptive pill for you depends on your lifestyle and medical history.

The mini-pill or the progestogen-only pill (POP) is another oral contraceptive option. Unlike the combined pill, it only contains synthetic progesterone. This means it is suitable for women who cannot take oestrogen whilst being just as effective.

You take one tablet each day. In addition, you do not take a pill-free break with the mini-pill. You take each strip back to back with no break. You should get your period as normal throughout each pack, but it’s common for women to have irregular periods or none at all.

The contraceptive patch is a patch which you apply to the skin each week. The only brand available in the UK is the Evra patch. The patch contains oestrogen and progesterone and works similarly to the combined pill.

Each week, place a patch on your buttocks, stomach, upper arms or upper back. Then, after 7 days, change your patch. You do this for 3 weeks. On the 4th week, you don’t use a patch. This allows for a withdrawal bleed. However, you can skip the patch-free week and immediately use a new patch if you don't want a period.

The vaginal contraceptive ring is a unique method of hormonal contraception. The ring is a small flexible device that releases synthetic oestrogen and progesterone. It releases hormones gradually throughout the month and, for that reason, is considered a low-dose hormonal contraceptive. The only brand available in the UK is the NuvaRing.

You insert each ring into the vagina and leave it in for 3 weeks. Then, after 3 weeks, you take the ring out and wait 7 days before putting it in a new one. If you want to skip your period, you can keep the ring in continuously and change it every 3 - 5 weeks.

The morning-after pill is a type of emergency contraception. Unlike the other options on this list, it is not meant to be used as your main method of contraception. It is only meant for occasional incidents where your usual contraception failed.

There are two types of morning-after pills available:

• Levonelle - Contains synthetic progesterone and works by delaying ovulation. You can take it up to 3 days after unprotected sex.
• ellaOne - Contains an ingredient that alters progesterone which works by preventing ovulation. You can take it up to 5 days after unprotected sex.

Ensure you take it correctly. Otherwise, the effectiveness of the morning-after pill could be reduced. The later you take it, the less likely it will prevent pregnancy.

See the table below for an overview of all the hormonal methods available.

	Combined pill	Mini-pill	The patch	The ring	Emergency contraception
Examples	(e.g. Yasmin, Microgynon or Cilest)	(e.g. Cerazette or Noriday)	Evra patch	NuvaRing	(e.g. ellaOne or Levonelle)
Ingredients	Oestrogen & progesterone	Progesterone	Oestrogen & progesterone	Oestrogen & progesterone	Ulipristal acetate or Levonorgestrel
How to take	Once daily for 21/24 days, then take a break or inactive pills for up to 7 days*	Once daily. No pill-free breaks	Apply once a week for 3 weeks, then have a patch-free week	Wear for 21 days and then remove for one week.	Take one tablet within 3-5 days of unprotected sex.
How it works	Prevents ovulation, thickens cervical mucus and alters the womb lining	Thickens cervical mucus and alters the womb lining	Prevents ovulation, thickens cervical mucus and alters the womb lining	Prevents ovulation, thickens cervical mucus and alters the womb lining	Prevents ovulation

*The number of hormonal and non-hormonal days depends on the brand.

When all the hormonal methods are equally effective, how do you choose? There are a few factors you should consider when picking a hormonal contraceptive.

The first thing to consider is the side effects. Suppose you are at a high risk of complications or you’re worried about side effects in general. In that case, you may want to consider taking a progesterone-only contraceptive, as these have a lower risk of side effects.

The second factor is whether you’re comfortable inserting something into yourself. If you find that prospect uncomfortable, you should not use the vaginal ring.

The final factor to consider is you and your lifestyle. Will you remember to take something daily, or prefer to take something less regularly? You must pick the right method, as taking it correctly is key for it to work.

Missing a pill or putting your patch on late could affect your contraception’s efficacy.

The main benefit of hormonal contraception is that they reliably protect you from pregnancy. However, they have several additional practical and long-term benefits.

They:

• are simple to use
• can easily be stopped or changed if you want to change contraception or try for a baby
• can make your periods shorter, less painful and less heavy
• do not physically “interrupt” sex
• can reduce symptoms of PMS (premenstrual syndrome)
• may also reduce the symptoms of certain disorders like PCOS or endometriosis

However, hormonal contraceptives do not protect against STIs or STDs. You will need to use a condom as well to fully protect yourself.

Hormonal contraception can cause some side effects. This is especially true within the first few months of using it. Thankfully, the most common side effects are mild and easily treatable.

Common side effects include:

• headaches
• sore breasts
• acne
• changes in sex drive
• weight gain
• mood changes
• feeling sick
• irregular bleeding or spotting

If any of these side effects become worrisome or persist, you may need to change contraceptives. Speak to your doctor if you are concerned.

Who has a higher risk of experiencing side effects?

Several risk factors can slightly increase your risk of side effects. Risk factors include:

• smoking
• drinking alcohol
• a history of blood clots
• a history of breast cancer
• being overweight
• having high blood pressure or cholesterol
• being 35 or older

Your doctor may prescribe you a low-risk contraceptive such as the mini-pill or the IUD to mitigate the risk. If you are at a particularly high risk, hormonal contraception may not be your best option.

Is hormonal contraception safe?

The subject of safety in hormonal contraception is a big discussion.

One of the conditions that hormonal contraception can increase the risk of is blood clots. However, the risk is still low. There is a 0.05% - 0.12% risk of a blood clot in women using a combined hormonal contraceptive. This is compared to a 0.02% risk in women who have never used a hormonal contraceptive and are not pregnant.

Another complication of hormonal contraception is cancer. It specifically increases the risk of breast and cervical cancer. Like blood clots, the risk increase is still low at around 7-10% for less than 5 years of use. The risk also reduces again once you finish using it. Hormonal contraceptives can also reduce the risk of some cancers, including ovarian and endometrial cancer.

Living a healthy lifestyle is the best way of reducing your risk of experiencing any complications. You should always consult your doctor if you are unsure about the risks.

If you already use a contraceptive, you can reorder it online from euroClinix. Simply pick the contraception you use and fill out the quick online medical questionnaire. Your answers will be reviewed by one of our online doctors to ensure it’s safe for you to take. Then, once approved your order will be sent with free next-day delivery in discreet packaging.