30% of pregnancies in the UK are unplanned. Therefore methods of contraception should be offered to all women of child bearing age.
This pill contains both oestrogen and progesterone. It works primarily by stopping ovulation, but also by thickening the cervical mucus and thinning the lining of the uterus.
The pill is taken around the same time for 21 days followed by a 7 day break in which there is a withdrawal bleed. If taken every day, this pill is 99% effective. If a pill is missed at the start or middle of the packet, take when remembered, preferably within 12 hours. If during the last 7 days of the packet, the next packet should be started without a break.
This pill contains only progesterone and works by thickening the cervical mucus and thinning the lining of the uterus. Pills such as Cerazette that contain a higher dose of progesterone may also work by inhibiting ovulation in some women.
Women should take this pill at the same time (within 3 hours) everyday. Newer pills can be taken within 12 hours. There is no break in the cycle, each packet is taken continuously. When taken correctly this pill is 99% effective.
This patch is applied to the arm, torso, buttock or lower abdomen. It releases a constant dose of oestrogen and progesterone into the circulation. The patch is applied on the first day of menstruation and then replaced every 3 weeks, with a patch free week inbetween.
Failure rates for the patch are around 98%.
Male condoms are the most commonly used method of contraception. They work by creating a barrier, therefore preventing sperm from entering the vagina. They should be put on an erect penis before intercourse and removed whilst the penis is still erect.
True failure rates for condoms are 98% but typically this can be as low as 85%, due to user error and other factors. Condoms have the added benefit of protecting individuals from sexually transmitted diseases (STI's).
Female barrier methods are less commonly used than male condoms. Femaie condoms provide a barrier against sperm, whereas diaphragms and caps provide a physical and chemical barrier due to the simultaneous use of spermicide.A diaphragm or cap should be left in place 6 hours after intercourse.
Diaphragms and caps, together with use of spermicide are 94% effective and female condoms are 95% effective in preventing pregnancy.
This stands for long acting reversible contraceptive methods. These methods do not reply on daily compliance and therefore have lower failure rates than those methods above.
This is a copper T-shaped device that is inserted into the uterus. It works by inhibiting fertilisation, as copper it toxic to the sperm. It also induces at inflammatory response in the endometrium, therefore preventing implantation.
Failure rates are low: less than 1%. Once inserted they can remain in place for up to 10 years, after which it will need to be replaced. If inserted after 40 years old, the IUD can remain in place until the menopause has been confirmed. This is 1 year after the last menstrual period if over 50 and 2 years if under 50.
This is a T-shaped system coated in progesterone and works primarily by preventing implantation. It also has a local effect on cervical mucus and the endometrium.
This system is licensed for 5 years of use, after which it will have to be replaced. Failure rates for this are less than 1%.
This is a small, flexible rod containing progesterone that is inserted under the skin in the medial aspect of the upper arm. Women should be able to feel it, but it won't be seen. It's mode of action is to prevent ovulation as well as thickening cervical mucus and thinning the endometrium.
Implanon lasts for 3 years, but can be removed at any time. Failure rates are less than 1%. Nearly half of women have the implant removed before 3 years due to altered bleeding. Some women have no bleeding, whilst others have very frequent and prolonged bleeding. Once removed fertility returns to normal. Women should be counselled about the possibility of implanon leaving a scar.
The injection (Depo-Provera) contains progesterone only. It works primarily inhibiting ovulation as well as thickening the cervical mucus, preventing sperm from entering the upper reproductive tract.
Injections, usually into the buttock, are given every 12 weeks. They can be given up to 2 weeks late with the same contraceptive effect but this is not advised. Failure rates if given every 12 weeks are <1%.
This is the most common method of contraception for older women.
Female sterilisation involves fallopian tube occlusion using Filshie clips, done through a laparoscopic procedure. The overall failure rate it 1 in 200 women.
Male sterilisation (vasectomy) involves both division of the vas deferens, as well as diathermy. After there needs to be 2 sperm counts to confirm azoospermia. The failure rate is 1 in 2000. It should be presented as an option to all women or couples considering female sterilization as it is a far simpler and less risky proceedure that may not have been considered.
Before each of these methods are chosen, the patient/couple need to be counselled as it is a permanent method and cannot be reversed easily or on the NHS.
This allows women to prevent pregnancy after unprotected sexual intercourse (UPSI) or contraceptive failure. There are two methods:
Oral progesterone-only emergency contraception containing levonorgesterel (Levonelle).
Copper intrauterine device (IUD)
Post-partum all women should be advised on contraception.
For women breastfeeding the only method contraindicated is the combined oral contraceptive pill as it contains oestrogen, and this will supress lactation. Any other method is suitable. Breastfeeding it itself may also be a form of contraception, but should not be relied on.
Women wanting to go on a pill should wait 3 weeks, until they have had their first period, before they start.
Women wishing to have an IUS/IUD inserted should wait 6 weeks in order for the uterus to return to normal size.
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