Our Guide To Female Contraception

About the Author

Dr Bree Dare is an Online Doctor at Medmate

Women’s reproductive health, contraception and family planning have been pivotal in shaping societies and individual lives for decades. In Australia, access to effective and reliable contraception plays a vital role in empowering women to make informed decisions about their bodies, relationships, and future. With a wide range of contraceptive options available, it’s essential for women to have a comprehensive understanding of the choices at their disposal. In this article, we delve into the world of female contraception, exploring the different methods, their effectiveness, benefits, and considerations. Whether you’re seeking information for yourself or aiming to support the women in your life, this guide aims to provide valuable insights into the world of female contraception and contribute to informed decision-making for a healthier and more fulfilling reproductive journey.

Birth Control Pills. What is the contraceptive pill and how does it work?

There are two main oral contraceptive pills (OCP) that can be used regularly in order to prevent pregnancy in advance of sex. These are the combined pill and the mini-pill.

The combined pill has two female hormones and stops the ovaries releasing an egg each month. It needs to be taken daily at close to the same time each day. If a pill is missed it can be taken as soon as remembered and then the next dose taken at the usual time.  If used correctly this pill is 99.7 percent effective at preventing pregnancy.

The mini pill contains only one female hormone and works by making the mucous around the cervix (entrance to the womb) thicken which prevents sperm from entering the uterus and fertilising the egg. This pill is taken daily and it is important not to be more than 3 hours late in taking this pill. With perfect use it is 99.7% effective at preventing pregnancy.

Typical use tends to bring down the effectiveness in preventing pregnancy to around 93%.

How long until the contraceptive pill works?

You must take 7 combined hormone pills daily for 7 days in a row before this pill will be effective in preventing pregnancy. During those first 7 days an additional form of contraception ie condoms should be used to prevent pregnancy.

When first starting the mini-pill, addition contraception ie condoms should be used for the first 48 hours.

These pills can be made less effective by vomiting or diarrhoea, other medications that affect pill absorption or is you miss a pill or are more than 24 hours late in taking a pill.

What are the risks of the contraceptive pill?

Although it is not common to have serious health problems as a result of taking the oral contraceptive pill  it is not recommended in women who suffer from focal migraines, who have a history of blot clots, women with liver disease and women with unusual vaginal bleeding.

Common side effects of the OCP include tender breasts, nausea, spotting in between periods. It may also cause some weight gain, changes in mood and libido for some women.

What other types of contraception are there other than the pill?

Implants

Implanon is a small, approximately 4cm long, plastic implant that is inserted by a doctor into your upper arm. It slowly releases the hormone progestogen into your body. This works by preventing release of an egg each month and also by thickening cervical mucous and preventing sperm entry to the womb. It can last for up to 3 years and is about 99% effective at preventing pregnancy. Once removed periods usually return to normal within one month. There are risks and benefits to this choice of contraceptive and this should be discussed with your treating doctor at your appointment.

Vaginal Rings

The NuvaRing is a soft plastic ring with the hormones oestrogen and progestogen contained within preventing release of an egg from the ovaries and preventing sperm entry to the womb by increasing cervical mucous. A script is needed for this form of contraception but you can insert the ring by yourself similar to inserting a tampon.

The ring needs to be replaced every 4 weeks. The ring stays in for 3 weeks, is then removed and there is a 1 week wait before the insertion of a new ring. You will usually have a period within a couple of days of ring removal. If you wish to miss a period then a new ring can be inserted straight away.  When using the ring for the first time or after having break from the ring it can take up to 7 days to start working to prevent pregnancy. When used correctly is between 93-99% effective. A discussion around the risks and benefits of this contraceptive should be had with your treating doctor.

IUD Intrauterine devices (IUDs)

There are two main types of IUD available in Australia. The copper IUD and the Mirena IUD.  The IUD is inserted by a doctor or trained nurse into the womb through the cervix in a procedure and setting similar to as if you were having a pap smear. A small length of string which is attached to the device trails out of the womb into the vaginal canal. This is not something you will feel unless you reach into your vagina. It is used when it is time for the device to be removed and this will typically be done by a health professional.

IUD contraception has been in use for some time and while it is not 100% clear how it works to prevent pregnancy some of the known mechanisms include changes to sperm movement and survival within the womb and changes to the lining of the womb that make pregnancy less likely. Both IUD forms last for around 5 years and then need replacement if ongoing protection is planned. IUDs are about 99% effective in preventing pregnancy. As always, a discussion about the risks and benefits of this type of contraception should be had with your treating doctor.

Depo contraception

A Depo is a contraceptive injection containing the hormone progestogen. In Australia, the common injections are Depo-Provera and Depo-Ralovera. Each injection is around 99% effective in preventing pregnancy for 12-14 weeks and works by preventing the ovaries from releasing an egg each month and also thicken the mucous around the entrance to the womb to prevent sperm from entering. With typical use the effectiveness decreases to around 96%.

A doctor will issue a script for this medication and once purchased at the pharmacy it can be given by a doctor or nurse at a clinic. There are risks and benefits to this form of contraception and these should be discussed with your treating doctor during your appointment. This injection can be stopped at any time but it may take several months for fertility to return.

Barrier method contraception

Barrier contraceptive methods include things like the male and female condoms and diaphragms.

Male condoms are cheap and easily available at pharmacies and retail stores. These are a thin latex sheath worn on an erect penis and it acts by stopping the sperm from entering the vagina and womb during sex. With perfect use these are 98% effective. With typical use the effectiveness decreases to around 88%. A new condom needs to be used each time you have sex. To prevent condom breakage, care should be taken when applying it. The use of water based lubricant can also help.

Female Condoms are a thin stealth that fits inside the vagina. They are pre-lubricated with one end sitting over the entrance to the womb and the other open end remaining outside your body covering part of the vulva or vagina. It is a single use item and cannot be used at the same time as a male condom as this can cause it to shift out of place. It is available without a prescription and when used correctly is around 95% effective at prevent pregnancy. With typical use it is about 79% effective.

Both male and female condoms reduce the risk of STI transmission between sexual partners.

Diaphragms are soft silicon caps that are inserted into the vagina and cover the entrance to the womb (the cervix). They prevent sperm entering the womb. They must be fitted properly before sex to be effective and when used correctly are about 94% effective. With typical use they are around 82% effective. They should be removed within 6 hours of use, washed and re-used for one to two years. They do not prevent STIs.

Morning After Pill – Emergency Contraception

How does the morning after pill work?

The “morning after pill” is a form of oral emergency contraception used after sex to prevent pregnancy if you had sex without using contraceptive protection or when the chosen contraceptive method fails ie broken condom or missed contraceptive pills. In Australia there are two “morning after pills’ called Levonorgestrel (LNG) and Ulipristal Acetate (UPA).  These pills work  to prevent pregnancy by stopping the ovaries from releasing an egg. Although these have been called the “morning after pill” in reality they can be used anytime of the day for up to 5 days after unprotected sex.

How effective is the morning after pill?

Of the two available emergency oral contraceptives, UPA is more effective at prevent pregnancy that LNG. If taken within 5 days of unprotected sex, UPA prevents pregnancy in all but 1.4% of women and LGN prevents pregnancy in all but 2.2% of women. Taking an emergency contraceptive as early as possible, ideally within 24 hours, after unprotected sex increases the effectiveness of the pill. No script is needed and these are available over the counter at pharmacies.

The effectiveness of these medications can be reduced by vomiting or diarrhoea within 3 hours of taking a dose, taking them more than 5 days after unprotected sex and can also be affected by body weight (BMI>30kg/m2).

What are the side effects of the morning after pill?

Common side effects of both of the available emergency oral contraceptives include headache, dizziness, nausea, vomiting, abdominal cramping, vaginal spotting or altered vaginal bleeding patterns during your next menstrual cycle.

The emergency oral contraceptive pills are not suitable for people who have an allergy to components of this medication or who are known to be pregnant. They are not a form of abortion.

This medication may not be suitable for people who are breast feeding, have severe liver disease, severe asthma or people taking specific medication. If unsure it is best to discuss this medication with your doctor or pharmacist.

Do I need a pregnancy test?

If your period is more than 7 days late or it is lighter than usual then take a pregnancy test.

Does birth control protect me against STIs?

Condoms are the only contraceptive that provides protection against STIs but it is still possible for viruses, such as herpes simplex virus, to be active or shedding in places not covered by the condom causing transmission in areas of skin to skin contact.

Protecting yourself against sexually transmitted infections (STIs) is a multi-pronged approach. It involves activities like being educated about sexual health, being vaccinated against HPV, having regular cervical and STI screening with your general practitioner (GP) if you are sexually active to allow early detection and treatment. And importantly having open and honest discussions with your sexual partner or partners about each persons sexual history.

References

1. Contraception [Internet]. [cited 2023 Jul 5]. Available from: https://www.thewomens.org.au/health-information/contraception.
2. Contraception Options [Internet]. [cited 2023 Jul 5]. Available from https://shvic.org.au/for-you/contraception.
3. Decision making in contraception: Consultation essentials [Internet]. 2022 [cited 2023 Jul 5].
4. Black KI, Hussainy SY. Emergency contraception: oral and intrauterine options. Australian Family Physician. 2017 Oct;46(10):722-6.
5. Contraception Choices [Internet]. [cited 2023 Jul 5]. sheets/contraception-choices/