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DEFINITIVE GUIDE

Birth control (pills, patches, implants and more)

Birth control is an important part of many people’s lives. However, the large number of contraception options can be confusing.

Between 15 and 20 different types of contraception are commonly available to women and men, so it can be difficult to decide what is right for you. Types of contraception can include both short-term and long-term solutions and the contraceptive pill.

Learn about different contraception options so you can find an effective method that you’re comfortable with. Cut through the confusion with our definitive guide.

Written by Dr Abby Hyams and Dr Alex Eskander. Reviewed by Dr Adam Abbs. Last reviewed on 28/11/2019. Next review date 28/11/2022.

Fast facts

What is birth control?

Birth control (also known as contraception) is any method used to reduce the chance of becoming pregnant. These can be practices, medications or devices. There are a range of different contraceptive methods available, including male and female condoms, birth control pills, IUDs (coils), injections, implants, male and female sterilisation and the withdrawal or calendar method. Given all the choices available, this guide can help you find a contraceptive method you’re confident in.

Where can I get birth control?

Contraception is available for free, even if you’re under the age of 16, from sexual health or GUM (genitourinary medicine) clinics, community contraception clinics, most GP surgeries and some young people’s services. Before booking an appointment, try and identify which contraceptive method best suits your lifestyle and circumstances. If you are under the age of 16 your doctor or nurse may have to assess your decision making. They may only be able to prescribe something if a parent is present if they feel this is necessary.

CHAPTER ONE

How do I get birth control?

In the UK, most forms of contraception are available for free from GP surgeries, sexual health clinics, community contraception clinics and young people’s services. However, there can be many lingering fears about what questions you will be asked and what information is required.

Some contraceptives such as condoms are readily available over the counter, while others such as the birth control pill require prescriptions. If you’re looking for clarification on how to get birth control, we can help with:

Can I get birth control without a prescription? And what questions will I be asked?

Can I get contraception over the counter?

Some forms of contraception are readily available for purchase, including male and female condoms and the contraceptive sponge. However, treatments that need to be administered or prescribed by a health professional will require a visit to your GP, family planning clinic or sexual health clinic. These include the contraceptive pill, contraceptive implants and IUDs.

What to expect when getting birth control

There can be a lot of uncertainty regarding what questions you’ll be asked and what information will be required when visiting a family planning service. Most often, your health care clinician will want to discuss your medical history and sexual history to understand what contraception would work best for you.

Tip

At this time, you are also free to ask any questions you may have about birth control. This is the perfect opportunity for you to clear up any doubts or uncertainties you might have.

Is birth control free?

In the UK, most types of contraception are available for free through the NHS, including emergency contraception. Birth control is available from sexual health or GUM clinics, community contraception clinics, most GP surgeries and some young people’s services.

Can I get birth control confidentially?

Birth control is available confidentially for anybody over the age of 16, as long as there is no serious risk to your safety or welfare. Between the ages of 13 and 16, birth control is also available confidentially so long as your healthcare provider believes you fully understand the information and decisions involved. They may encourage you to tell your parents, but they won’t do so themselves, unless there are concerns for your safety, in which case this will be discussed with you.

If you’re under the age of 13, your healthcare provider may wish to involve other people for your own protection. As the law states you cannot legally consent to sexual activity, these people may include your parents, legal guardians or a social worker.

Do I need a prescription for birth control?

Some forms of birth control are available without a prescription, including male and female condoms, and the contraceptive sponge. However most contraceptive pills will require a prescription, and any treatments administered by a healthcare professional, such as an IUD, will involve a visit to your GP or sexual health clinic.

CHAPTER TWO

What are the types of birth control?

Birth control is available in a range of methods. To make things simpler, these can be divided into four categories: hormonal birth control, barrier birth control, IUDs and emergency contraception.

Hormonal birth control, such as pills, injections and implants, use hormones to stop the egg and sperm meeting so that it can’t be fertilised. Barrier birth control, including male and female condoms, create a barrier to prevent sperm from reaching an egg. IUDs are small, plastic devices inserted into your uterus, this works by making the womb inhospitable to a fertilised egg and making it hard for the sperm to get through. If you are unsure what types of birth control are available, we can help with:

What are the types of contraception? And are there any natural contraceptive methods?

Combination pill

How it works

The combination pill uses the hormones oestrogen and progestogen to help prevent unwanted pregnancy. As well as stopping the ovaries from releasing an egg each month, it also thickens the mucus of the cervix. This makes it more difficult for the sperm to reach an egg. Lastly, it thins the lining of your uterus so it’s less likely to accept a fertilised egg.

Pros

The pill appeals to many women because it doesn’t have to be inserted or implanted. The combination pill also reduces the severity of period symptoms and can be integrated into your daily routine. A lot of women also like the fact that they take something each day but not at the time of intercourse.

Cons

If you ever forget to take the combination pill, you may need to use a secondary birth control method as well. In order to be effective, the combination pill must be remembered on the days you are supposed to take it. Also, they do not protect you against STIs.

Another side effect includes the increased risk of deep venous thrombosis (DVT) by 0.06% to 0.2%. It is important to report any persistent headaches, chest pain or calf pain to your doctor immediately. There is also a small increase in breast cancer which disappears after stopping the pill.

Progestogen-only pills (POPs)

What are they?

Also known as the mini pill, progestogen-only pills contain the hormone progestogen. These pills thicken the mucus within the cervix to stop sperm from reaching an egg. The desogestrel POP can also stop ovulation.

Pros

As an oral contraceptive, you don’t need to insert or implant anything if that makes you uncomfortable. You can also use it at any age, as well as when breastfeeding. Also, POPs do not increase the risk of DVT like the combined pills.

Cons

POPs can affect your periods, making them lighter, irregular, or stopping them altogether. Some also require you to take them at the same time every day. They do not protect you against STIs.

Contraceptive patch

What is it?

A contraceptive patch releases the hormones oestrogen and progestogen through your skin and into your body. These hormones help stop the ovaries from releasing an egg each month and help stop sperm from reaching an egg after sex.

Pros

As you only have to replace the patch once a week, you don’t need to think about it daily. It’s very easy to use, doesn’t interrupt sex, and can make your periods lighter, less painful, and more regular. It may also reduce the risk of ovarian, womb and bowel cancer, as well as fibroids, ovarian cysts and non-cancerous breast disease. If you develop side effects, the patch can be easily removed.

Cons

Contraceptive patches can cause skin irritation, itching and soreness, as well as temporary side effects such as headaches or breast tenderness. They can also cause spotting and bleeding between periods. As the contraceptive patch doesn’t protect you against STIs, you may also need to use a condom as well. It also increases the risk of blood clots and breast cancer.

Condoms (Male)

What are they?

Male condoms are thin tubes of latex (or similar material) that are unrolled over the penis. As a barrier method of birth control, this blocks sperm from entering the vagina. You can use a male condom each time you have sex.

Pros

Male condoms are the best method to reduce your risk of most STIs.

Cons

It is possible for condoms to break, causing unwanted pregnancy. It is also easy to forget to use them or have an allergic reaction. Condoms have a high failure rate which ranges from 2% to 32%. To be effective it must be worn before penetration and the male part must be withdrawn from the vagina immediately after ejaculation.

Condoms (Female)

What are they?

Female condoms are thin tubes of latex that are inserted into the vagina before intercourse. As a barrier method of contraception, they block sperm from reaching an egg.

Pros

Like male condoms, female condoms are the best method of contraception to reduce the risk of some STIs. They can also be inserted up to eight hours in advance of intercourse, reducing the risk of forgetting in the heat of the moment.

Cons

Female condoms are also able to break, leading to unwanted pregnancy. Allergic reactions are also possible.

Diaphragms and cervical caps

What are they?

Diaphragms and cervical caps are two barrier methods of contraception that help stop unwanted pregnancy by preventing sperm from meeting an egg. Diaphragms are circular domes made of silicone with a flexible rim. Cervical caps are also made of silicone, but are smaller.

Pros

If you cannot use a hormonal contraceptive method, diaphragms and caps may be best suited for you. They can be left in for multiple acts of intercourse within 24 hours if using a diaphragm, or 48 hours if using a cap, as long as you insert more spermicide every 6 hours.

Cons

Diaphragms and cervical caps can increase the risk of toxic shock syndrome. They have to be left in the vagina for 4-6 hours after sex, which some women may find uncomfortable. It is also possible to develop an allergic reaction to spermicide.

Contraceptive implant

What is it?

A contraceptive implant is a small, flexible plastic rod that is inserted beneath the skin of your upper arm. It releases the hormone progestogen into your bloodstream to help prevent unwanted pregnancy. Progestogen thickens the mucus of your cervix, making it difficult for sperm to reach an egg. Progestogen also thins the lining of your uterus, making it less likely to accept a fertilised egg.

Pros

The contraceptive implant has one of the highest effectiveness rates of any birth control option. It also lasts up to three years, meaning long-term results, but can be removed at any time. Your fertility returns as soon as it is removed.

Cons

The contraceptive implant can disrupt periods, making them heavier or occasionally causing amenorrhea (loss of periods) or polymenorrhea (more frequent periods). It can also cause side effects, including headaches, nausea, breast tenderness and acne, as well as increase the risk of blood clots and breast cancer.

Contraceptive injection

What is it?

A contraceptive injection releases the hormone progestogen into your bloodstream. By thickening the mucus of your cervix and thinning the lining of your uterus, this helps reduce the risk of pregnancy.

Pros

Contraceptive injections are long-lasting, effective for either 8 or 13 weeks. They do not interrupt sex and don’t rely on you remembering to take them daily. Contraceptive injections can also reduce heavy, painful periods for some women.

Cons

Most women who use the contraceptive injection notice changes to their period, including amenorrhea (having no period). Other side effects include nausea, headaches, acne, hair loss and a decreased sex drive. It can take up to a year for your fertility to return after stopping using this form of contraception.

Contraceptive sponge

What is it?

A contraceptive sponge is a round plastic sponge which is saturated with spermicide and inserted into the vagina. This then blocks and kills the sperm, helping prevent pregnancy.

Pros

Contraceptive sponges can be left in for multiple acts of intercourse during a 24 hour period.

Cons

The sponge has to be left in the vagina for six hours after sex, which some women may find uncomfortable or unpleasant. It is possible to develop sensitivity or an allergic reaction to spermicide. There’s also a potential risk of toxic shock syndrome by using contraceptive sponges. The effectiveness of sponges is low, meaning there is a high risk of pregnancy, compared to other forms of contraception. They do not protect against STIs.

Vaginal ring

What is it?

A vaginal ring is a flexible ring around 2 inches wide that is inserted into your vagina. It releases the hormones oestrogen and progestogen into your bloodstream, preventing the release of an egg each month and helping to block sperm.

Pros

The vaginal ring is effective for three weeks from insertion and is easy to put in and take out. Because it can be left for three weeks, it also doesn’t have to be remembered every day or each time you have sex. It can also lighten periods and reduce premenstrual effects. Unlike oral combined pills, there is no increase in DVT with the vaginal ring.

Cons

Progesterone-only contraception can cause a number of side effects, including spotting, bleeding, increased vaginal discharge and headaches. You also need to remember to change it and insert a new one after three weeks. Vaginal rings do not protect against STIs.

Intrauterine device (IUD)

What is it?

An intrauterine device (IUD) is a small T-shaped instrument made of plastic and copper that is inserted into the womb. The IUD releases copper that alters the cervical mucus, making it more difficult for sperm to reach an egg and survive, as well as for a fertilised egg to implant itself.

Pros

An IUD can protect against pregnancy for either 5 or 10 years, depending on the type. It starts working immediately, doesn’t interrupt sex and is safe to use while breastfeeding. Because it uses copper, there are also no hormonal side effects, such as acne, breast tenderness or nausea. The IUD is one of the most effective ways of emergency contraception if inserted within 5 days of intercourse.

Cons

The downsides of IUDs can include pain during insertion and heavier periods. It also does not protect you from STIs, and if you get an infection when it is fitted can cause a pelvic infection if not treated. It is recommended that you have a negative chlamydia test before insertion or take prophylactic antibiotics against chlamydia after insertion.

Intrauterine system (IUS)

What is it?

An IUS is a small, T-shaped plastic device that is inserted into your womb. It releases the hormone progestogen which thickens the cervical mucus and thins the lining of the womb. This means that sperm find it difficult to move through the cervix and makes the womb lining hostile for implantation of the fertilised egg and may prevent ovulation in many women.

Pros

An IUS can work for either 3 or 5 years, without needing to be changed. It is also highly effective, doesn’t interrupt sex and is safe to use while breastfeeding. It may also make your periods lighter, shorter and less painful.

Cons

An IUS can make your periods irregular or stop them completely (which some people find distressing). There are also potential side effects such as headaches, acne, breast tenderness and changes in mood and libido. It does not protect against infection.

Tubal occlusion

What is it?

Tubal occlusion, or female sterilisation, is a surgical procedure that permanently prevents pregnancy. The fallopian tubes are sealed or blocked, preventing the eggs from reaching the sperm and becoming fertilised.

Pros

Tubal occlusion is one of the most effective methods of birth control. It should be effective immediately, and will not affect your sex drive or hormone levels.

Cons

Female sterilisation does not protect against STIs and cannot be easily reversed. Though very rare, the fallopian tubes can slowly rejoin and make you fertile again. There is a very small risk of serious complications such as internal bleeding, infection or organ damage. It is also thought to cause earlier menopause in some women.

Vasectomy

What is it?

A vasectomy is a surgical procedure that permanently prevents pregnancy. A small incision is made to the scrotum, and the tubes that carry a man’s sperm (vas deferens) are sealed or tied. This prevents sperm from being released during ejaculation.

Pros

A vasectomy is one of the most effective methods of preventing pregnancy, with long-term side effects being rare. It also allows you to have unprotected sex without the risk of unwanted pregnancy

Cons

A vasectomy is only effective after three months, during which time you’ll have to use a secondary birth control option. As a permanent option, it is also very expensive and may be impossible to reverse. It is commonly done under local anaesthesia but some men may feel pain during the surgery. It does not protect against STIs.

Fertility awareness methods

What are they?

Otherwise known as natural family planning, there are three main types of fertility awareness methods. These are the temperature method, the cervical mucus method and the calendar method. It is most effective to combine all of these methods, known collectively as the “symptothermal method”.

If using the temperature method, you take your temperature every morning before you get out of bed. This will help you track days where are you are less fertile (known as safe days).

The cervical mucus method and calendar method also help you track days where are you are most fertile, by keeping track of your mucus (or discharge) every day or marking the days your periods start and end respectively.

Pros

Fertility awareness methods make you more aware of your fertility and can help you to plan how to reduce the risk of pregnancy. As a natural method, there are also no physical side effects, and these methods can help you recognise normal and abnormal vaginal secretions.

Cons

It takes between 3 and 6 menstrual cycles to fully learn fertility awareness methods effectively, and you have to successfully maintain a daily record. You will also still need to use another form of birth control, such as male and female condoms, during periods of fertility. Be aware that this is one of the least effective methods of preventing pregnancy, therefore you may still become pregnant when using this method. It does not protect against STIs.

Emergency contraceptive pills

What are they?

Emergency contraceptive pills release hormones that either stop or delay ovulation. It is not recommended that these are used as a form of contraception.

One type, Levonelle, contains a synthetic version of progesterone called levonorgestrel. Taking Levonelle stops or delays ovulation and needs to be used within 72 hours of sexual intercourse. The other type of emergency contraceptive pill, ellaOne, contains ulipristal acetate. This prevents progesterone from working normally, also stopping or delaying the release of an egg. This needs to be used within 120 hours of unprotected sex.

Pros

Emergency contraceptive pills are a safe method of preventing pregnancy after unprotected sex.

Cons

You will not be protected from future pregnancy and will need to start using another form of contraception. You might also experience temporary side effects such as nausea, breast tenderness, headache or dizziness. Emergency contraceptive pills may require a visit to a clinic, and sometimes a prescription.

Emergency intrauterine device

This is the most effective way of emergency contraception. A copper IUD is inserted in the uterus within 5 days of intercourse.

Pros

There is less of a failure rate than the emergency pills and it can be left as a permanent method of contraception for 5-10 years.

Cons

You have to make an urgent appointment to have it fitted which may not be easy, is more expensive than pills, and insertion may be associated with some pain, heavy periods and sometimes displacement of the coil requiring removal.

CHAPTER THREE

How to use birth control effectively?

The effectiveness of birth control methods can range from 70% to more than 99.7%. However, to help ensure this you need to make sure that you are using your contraceptive correctly. Contraceptive pills, condoms, IUDs and emergency contraception all require different approaches in order to minimise the possible risk of unwanted pregnancy.

If you want to ensure you are using birth control effectively, we can help with:

How to put on a condom? And how to use birth control pills?

How to use birth control pills

How you take the contraceptive pill will depend on the type that you use. The combination pill comes in 21-day packs, 28-day packs and 91-day packs. On the other hand, POPs only come in 28-day packs.

If you’re taking pills from a 21-day pack, take either the first pill from the packet marked the correct day of the week, or the first pill of the first colour. Continue taking these pills at the same time each day until the pack is finished. Then, stop for seven days, during which you will get a bleed. The next day should be the same day of the week as when you started, and you should now start your next pack.

If you’re taking pills from a 28-day pack, take the first pill from the section marked “start”. This will be an active pill. Continue taking one pill a day in the correct order until the pack is finished. During the seven days of placebo pills you will get a bleed. Start the next pack of pills after finishing the first. The 7 days of the placebo pill is useful to keep you in the habit of taking the pill each day.

Important

Though it may be nothing to worry about, if you don’t have a period during the week of placebo pills, do a pregnancy test, if negative continue with a new pack as usual.

How to use male condoms

To use a male condom, follow these steps. You should always put on the condom while the penis is erect and before it comes into contact with your partner’s body.

  • Open the foil packaging carefully, making sure not to tear the condom
  • Hold the tip of the condom between forefinger and thumb, and squeeze out the air
  • Place the condom over the tip of the penis and unroll it fully to the base
  • If the condom won’t unroll, it’s probably inside out. Repeat the previous steps with a new condom as there may be sperm on the condom.
  • Withdraw the penis immediately from the vagina after ejaculation.

How to use female condoms

Female condoms provide couples with another contraceptive option to use before sex. Female condoms should always be inserted before the penis touches the vagina in order to prevent pregnancy.

If you’re uncertain of how to use female condoms, follow these steps:

  • Remove the female condom from the packaging, being careful not to tear it
  • Place the closed end of the condom into your vagina, using your middle finger and thumb to insert it. Use your finger to push the condom as far up into your vagina as possible
  • The outer ring of the condom should rest closely on the outside of your vagina at all times during intercourse. If the outer ring enters your vagina, stop and put it back into place
  • Guide your partner’s penis into the condom, making sure it doesn’t slip between your vagina and the condom
  • After sex, remove the condom. Twist the outer ring so that the semen is contained within and gently pull the condom out of your vagina. Dispose of the condom in the bin, not the toilet

How to check IUDs

If you’ve had an IUD inserted, you should regularly check that it’s still in place. IUDs have two thin threads that hang slightly from your womb into the top of your vagina. Commonly known as “strings”, if the IUD withdraws into the cervical canal or uterus these strings can retreat. When fitting your IUD, your healthcare professional should teach you how to check this.

To check your IUD, first wash your hands. While sitting or squatting, insert your index or middle finger into your vagina until you touch your cervix (it will feel firm and rubbery). You should be able to feel the string ends. If so, your IUD is still in place and should be working.

Important

If you can’t feel the strings or think that they feel longer or shorter than the last time you checked, your IUD may have moved. Visit your GP to make sure that you are still protected against pregnancy and do not have unprotected intercourse until they have been checked.

How to use emergency contraception

Using the emergency pill is as simple as swallowing an oral contraceptive. If you’re using Levonelle, this has to be taken within three days of sex to prevent pregnancy. If you’re using ellaOne, this has to be taken within five days of sex.

Alternatively, emergency IUDs will have to be inserted either up to 5 days after sex or up to 5 days after the earliest time you could have ovulated to prevent pregnancy. The advantages to these are that they are then left in for years and you don’t have to worry about pregnancy, or taking medication.

CHAPTER FOUR

What’s the best birth control for me?

Not every method of birth control will be suitable for all people. While studies have shown that most women prioritise effectiveness, safety and ease of use when choosing a contraceptive, many other factors can influence your decision.

The effects of age, health and lifestyle can guide you towards the specific method of birth control that’s right for you. If you’re looking to identify the best contraceptive method for you, we can help with:

Does smoking affect birth control? And what happens if I can’t use hormonal contraceptives?

Can I make contraception part of my daily routine?

You may be looking to take a proactive approach to birth control and want to make contraception part of your daily routine. Some methods may be used only when you have sex, or some you could take at the same time each day. Creating a contraceptive routine reduces the likelihood that you forget about your birth control.

If you’re looking for a method you can use each time you have sex, consider male condoms, female condoms, diaphragms or cervical caps. If you’d rather a birth control option you can take daily, consider 28-day packs of the combined pill or the mini pill.

What if I’m uncomfortable inserting contraceptives into my vagina?

If you are uncomfortable inserting contraceptives into your vagina, there are still birth control options available to you. These include:

  • Contraceptive implants
  • Contraceptive injections
  • Contraceptive pills
  • Natural methods

Can I use birth control if I smoke?

While those who smoke can still use most types of contraception, those who smoke over the age of 35 should avoid certain birth control options. The combined pill, contraceptive patch and vaginal ring may not be suitable methods of birth control in this case. Instead, consider using IUDs, IUSs, contraceptive implants, contraceptive injections or POPs.

What if I can’t use a certain contraceptive?

While there is a range of birth control options available for women, not all are suitable for everyone. Certain health conditions or requirements can make types of contraceptive inappropriate for use:

Hormonal contraceptives. Some contraceptives use the hormones oestrogen and progestogen. For women with medical conditions such as breast cancer, and women at increased risk of thrombosis, these contraceptives are unsuitable. Instead, consider IUDs, male condoms, female condoms, diaphragms or cervical caps.

Contraceptives containing oestrogen. These contraceptives are unsuitable for women who are over 35 and smoke, are very overweight, take certain medicines, or have problems with blood circulation or migraines with aura. If you fall into any of these groups, consider IUDs, IUSs, contraceptive implants, contraceptive injections or POPs.

Taking other medications. Some contraceptives can be affected when taken in combination with other medicines. Unaffected methods of birth control include IUDs, IUSs, contraceptive injections, male condoms, female condoms, diaphragms and cervical caps.

What if I want to get pregnant in the near future?

If you’re thinking of conceiving in the near future, temporary methods of birth control can be easily stopped. If using the combined pill, vaginal ring or contraceptive patch, you should be able to get pregnant within 3 months after use is stopped. If using the contraceptive injection, it may take up to one year for fertility to return after stopping.

If you’re looking to conceive soon, consider individual-use methods of birth control such as:

  • Male condoms
  • Female condoms
  • Diaphragms
  • Cervical caps
CHAPTER FIVE

Side effects of birth control

No contraception is without potential disadvantages. When choosing the right method of birth control for you, it is essential that you understand the possible side effects. Common side effects of birth control include headaches, nausea, breast tenderness and mood swings.

If you have any concerns about the side effects of birth control, we can help with:

Are there any side effects of contraceptive pills? And what are the side effects of implant birth control?

Side effects of contraceptive implants

Potential side effects of contraceptive implants include:

  • Headaches
  • Nausea
  • Breast tenderness
  • Mood swings
  • Irregular bleeding (spotting) or amenorrhea
  • Acne or aggravated acne
  • Scarring at the site of insertion and removal of the implant
  • In rare cases, infection where the implant has been fitted

Side effects of contraceptive injections

Contraceptive injections can cause the following side effects:

  • Changes to your period
  • Weight gain
  • Headaches
  • Acne
  • Hair loss
  • Decreased libido
  • Mood swings

Side effects of contraceptive pills

The side effects of the combined pill can include:

  • Headaches and nausea
  • Breast tenderness
  • Mood swings
  • Raised blood pressure
  • In very rare instances, contraceptive pills may cause blood clots. Your GP will check whether you have certain risk factors before prescribing the pill.

Side effects of contraceptive patches

Contraceptive patches can have a range of common and uncommon side effects. These include:

  • Bleeding between periods (breakthrough bleeding) or spotting (light, irregular bleeding)
  • Skin irritation, soreness or itching
  • Headaches and nausea
  • Breast tenderness
  • Mood swings
  • On very rare occasions, people using the patch may develop a blood clot. Avoid the patch if you’ve had a blood clot before or have other conditions such as diabetes or obesity.

Side effects of IUDs

Having an IUD fitted can cause some temporary side effects, however, these usually go away after 3-6 months. Occasionally, side effects can be more severe. Side effects can include:

  • Pain when the IUD is inserted
  • Backache or cramping for a few days after having an IUD put in
  • Irregular or heavier periods, or spotting between periods
  • A very rare chance of pelvic infection, damage to the womb or rejection of the IUD

Side effects of IUSs

Having an IUS fitted can have the following side effects:

  • Irregular periods or amenorrhea
  • Headaches
  • Acne
  • Breast tenderness
  • Vaginal bleeding and pain
  • Small fluid-filled cysts on the ovaries. These are uncommon and usually disappear without treatment
  • Very rarely, a pelvic infection may develop (most commonly within the first 20 days after the IUS is fitted)

Side effects of vaginal rings

If using vaginal rings, the following side effects may occur:

  • Spotting or bleeding
  • Headaches and nausea
  • Breast tenderness
  • Mood swings
  • Vaginal discharge
  • A very small risk of blood clots. Avoid using vaginal rings if you have a history of blood clots.
  • Discomfort if not fitted correctly
  • Infections if not changed regularly
CHAPTER SIX

Emergency contraception

If another method of birth control has failed you, or you have had unprotected sex, emergency contraception can help. There are two forms of emergency contraception: the emergency contraceptive pill, commonly known as the 'morning after pill', and IUDs or coils.

Women aged 16 and over can purchase emergency contraceptive pills over the counter without a prescription. However, inserting an IUD will require a visit to your GP or sexual health clinic as it must be fitted by a doctor or nurse. If you have any concerns about how emergency contraception works, or where to get it, we can help with:

Who can use emergency contraception? And what are the chances of getting pregnant after taking the morning after pill?

How does emergency contraception work?

If you’re using the IUD as emergency contraception, this device is inserted into your womb by a doctor or nurse. It then releases copper to prevent the egg from implanting in your womb or being fertilised.

In contrast, emergency contraceptive pills use hormones to prevent pregnancy. Levonelle contains levonorgestrel, a synthetic version of the hormone progesterone that is usually produced by the ovaries. Taking Levonelle stops or delays ovulation.

Meanwhile, ellaOne contains ulipristal acetate, which prevents progesterone from working normally. This also stops or delays the release of an egg.

Who can use emergency contraception?

The emergency contraceptive pill can be used by most women, including those under 16 and those who cannot use hormonal contraceptives such as the combined pill or contraceptive patch.

However, you may not be able to take the emergency contraceptive pill if you have severe asthma, are allergic to anything in it, or take any medicines that may interact with it. These medicines include:

  • Some medicines used to treat HIV, epilepsy or tuberculosis
  • The antibiotics rifampicin and rifabutin
  • Medicine which makes your stomach less acidic, such as omeprazole
  • The herbal medicine St John’s Wort

Where can I get emergency contraception?

If you need emergency contraception, it is available for free from a number of places:

  • Contraception clinics
  • Sexual health or GUM clinics
  • Most pharmacies
  • Most NHS walk-in centres and minor injuries units
  • Some young people’s clinics
  • Some GP surgeries
  • Some A&E departments, though it is advised you phone first to check

You can find your nearest sexual health information and support services here.

What if I’m already using regular contraception?

If you’re already using regular contraception, you may still need to take the emergency pill in certain circumstances:

  • If you forgot to use your regular contraceptive pills, or you had diarrhoea or vomiting in the week before the intercourse
  • If you used your contraceptive patch or vaginal ring incorrectly
  • If you were late having your contraceptive injection or contraceptive implant

If in doubt, use a secondary method of contraception such as male condoms or female condoms to help avoid unwanted pregnancy.

How will I know if my emergency contraception has worked?

Your next period should come at the expected time and may be heavier. However, if it is lighter or shorter, or you miss your next period, you should do a pregnancy test and see a GP or healthcare professional.

The only way to be certain if emergency contraception has worked for you is to complete a pregnancy test. Pregnancy tests are accurate if the test is done within three weeks of the last time you had unprotected sex.

Am I protected from future pregnancy?

It is important to know that the emergency contraceptive pill will not continue to prevent pregnancy. If you have unprotected sex again, you’re still at risk of becoming pregnant.

However, you can continue using the IUDs as a regular contraceptive method. This will be a highly effective birth control option at preventing pregnancy.

Important

Emergency contraception does not prevent sexually transmitted infections (STIs).

CHAPTER SEVEN

Vasectomy

If you’re considering a permanent method of birth control, a vasectomy might be right for you. A vasectomy is a simple surgical procedure which ties or seals the vas deferens, the tubes that carry sperm. If successful, this means that you won’t need to use other types of contraception.

However, as a permanent procedure it is important that you understand the advantages and disadvantages of a vasectomy, as well as the potential risks involved. Vasectomy reversals are not usually available on the NHS, and are not always effective. If you have any questions about vasectomies, we can help with:

What is a vasectomy? and how does a vasectomy work?

What is a vasectomy?

A vasectomy, also known as male sterilisation, is a surgical procedure that permanently prevents pregnancy by cutting or sealing the tubes (vas deferens) that carry a man’s sperm. The female equivalent of a vasectomy is tubal occlusion.

Usually, this procedure is carried out under local anaesthetic and takes about 15 minutes. This means that you’re awake, however, you won’t feel any pain. On rare occasions, the procedure is completed using a general anaesthetic. This means that you’ll be asleep during the surgery.

Important

You should only have a vasectomy if you’re certain that you don’t want any more children or any children at all. A vasectomy is a permanent solution, and though reversal is possible it’s expensive and not guaranteed.

How does a vasectomy work?

During a vasectomy procedure, you’ll first be given local anaesthetic. A doctor will then make a small puncture (known as the no-scalpel method) or small cuts on the skin of your scrotum. This provides access to the vas deferens.

Vasectomies work by tying or sealing the vas deferens tubes with heat, stitches or plugs. On some occasions, a small piece of each tube is removed. This procedure usually takes between 10 and 15 minutes.

Once complete, you may be given dissolvable stitches or surgical tape. However, stitches are not always needed.

How long does it take to recover from a vasectomy?

If you’ve had a vasectomy, you’ll usually need to avoid sex and strenuous activity for a week. During this time, it is common to have some mild discomfort, swelling and bruising of your scrotum. It is also common to have blood in your semen the first few times you ejaculate after the procedure. This isn’t harmful, and shouldn’t be cause for concern.

If you’re looking to ease your recovery, there are some steps you can take:

  • Underwear. Wear tight-fitting underwear or athletic support for the first few days and nights. This helps support your scrotum and eases any discomfort or swelling. Make sure to change your underwear every day.
  • Hygiene. You should be able to have a bath or shower after your operation, though it’s recommended that you check with your doctor beforehand. Afterwards, make sure you dry your genital area gently and thoroughly.
  • Work. Although you can usually return to work after 1 or 2 days, you should avoid sport and heavy lifting for at least 1 week.
  • Sex. You can have sex again as soon as you feel comfortable to do so. However, you’ll need to use another method of contraception for at least the first 12 weeks until you have done a clear sample. It can take this long to clear the remaining sperm from your tubes.

How to get a vasectomy

The first step in having a vasectomy should be consulting your GP or a healthcare professional. You will be able to discuss the procedure with them, and they will be able to inform you of its benefits and potential risks.

A vasectomy is then available on the NHS, however, the waiting list can be long.

Advantages of a vasectomy

The main advantage of a vasectomy compared to other types of contraception is that it’s permanent. Once sterilisation has worked you’ll no longer have to use contraception again.

Other advantages include it’s high effectiveness, that it does not interfere with sex and that any long-term effects on your health are rare.

Disadvantages of a vasectomy

Compared to other, less permanent forms of birth control, there can be a number of disadvantages unique to a vasectomy. These include:

  • A vasectomy cannot be easily reversed, and reversals are very rarely provided on the NHS
  • A vasectomy does not protect against STIs, so you may need to use a condom as well
  • Surgery is required
  • The vas deferens may rejoin and you’ll be fertile again, though this is rare.
  • You will still need to use contraception for at least 12 weeks after the procedure. This is so that semen tests can confirm the vasectomy has been effective
  • Possible complications may include swelling, bruising, bleeding inside the scrotum, infection, fluid buildup in the testicles, and long-term testicle pain.

Can a vasectomy be reversed?

While it is possible to have a vasectomy reversed, success isn’t guaranteed and vasectomy reversal is very rarely funded by the NHS. In the UK, a vasectomy reversal may cost several thousand pounds.

The sooner after the vasectomy you decide on reversal, the better its chances. Within ten years, the success rate of vasectomy reversal is around 50%. After ten years this can fall to less than 10%.

Important

Even if a surgeon rejoins the vas deferens tubes, pregnancy still may not be possible. Before going ahead with a vasectomy, make sure you’ve consulted with your GP or a healthcare professional about your options.

CHAPTER EIGHT

Birth control myths debunked

There are many myths and misconceptions about contraceptives, with these often proving confusing and harmful. Their prevalence leads to many people overlooking the importance of birth control and taking risks with their sexual health.

Thankfully, these myths are easily dispelled. If you are looking for clarification on a birth control myth, we can help with:

Can I get pregnant if it’s my first time? And can pregnancy be prevented by jumping?

Birth control sex myths

There are many myths surrounding sex that can increase the risk of unwanted pregnancy. The following myths are not effective for birth control:

  • Can I get pregnant if it’s my first time? Women can get pregnant whenever ovulation occurs, even if they haven’t had sex before.
  • Can I get pregnant if the man pulls out? Also known as the withdrawal method, pulling out does not prevent conception. Some ejaculate may be released before the man orgasms.
  • Can I get pregnant if I don’t orgasm? Pregnancy can occur any time sperm can fertilise an egg. As ovulation occurs separate from sex, it is not necessary for the woman to orgasm in order to get pregnant.
  • Can we use a balloon or clingfilm instead of a condom? Condoms are designed to provide a good fit and strong protection, and should not be substituted. Balloons and clingfilm don’t fit well and are easily torn during sex.

Could I become pregnant even though I’m breastfeeding?

You may have heard of LAM (lactational amenorrhoea method), a form of birth control where women use breastfeeding as a form of natural contraception. LAM exists because breastfeeding stimulates the production of prolactin, a hormone that in high levels can stop you from ovulating.

However, LAM is risky as many women don’t know when they’ll start ovulating again. It is possible to get pregnant as soon as 3 weeks after birth, and while breastfeeding. To avoid unwanted pregnancy while breastfeeding, use regular contraception or birth control.

Does washing immediately after intercourse prevent pregnancy?

Washing immediately after intercourse does not prevent pregnancy, even if does make you feel clean. If sperm has already entered the uterus, showering or bathing will not be able to clear it. To avoid unwanted pregnancy, be sure to follow a tested birth control method.

Can I get pregnant at any time during my menstrual cycle?

Many women want to know how many days after their period they can become pregnant, however, the answer is more complicated than this. It is possible to conceive at any point during your menstrual cycle, although it is most likely during ovulation (usually around 12 to 14 days before your next period). This means that it’s still possible to become pregnant immediately before, right after your period and rarely during the period.

Is birth control effective immediately?

If you’re looking for immediate birth control, there are options available to you. Barrier methods include condoms, diaphragms, cervical caps and sponges all work immediately. Immediate protection is also available if you start taking the combination pill or using the vaginal ring on the first day of your period, have an implant inserted within the first five days of your period, or have a hormonal IUD inserted within a week of your period.

For the contraceptive patch, a week is required until you’re fully protected, while POPs require two days.

Tip

If you’re ever in doubt, use a secondary method of birth control such as condoms to help reduce the risk of unwanted pregnancy for 2 weeks after starting contraception.

CHAPTER NINE

Birth control for under 16s

Birth control can be a stressful experience for all of us - but especially when you’re under 16. Thankfully, a range of contraceptive methods are still available to you, provided confidentially and with sensitivity. In the UK, any young person can be provided with birth control, provided they fully understand the treatment, its risks and how to take it

If you have questions about how birth control might affect you, we can help with:

How old do you have to be to go on the pill in the UK? And is contraception available for free?

Is birth control available under the age of 16?

Birth control is available freely and confidentially if you’re under the age of 16, so long as you understand the information and decisions involved.

If you’re under the age of 13, your healthcare provider may involve your parents, legal guardians or a social worker. You will still be allowed access to birth control, but they will want to ensure your safety.

Where to get free contraception

If you’re under 16 and want to start using birth control, you can get contraception for free from a number of places. These include sexual health or GUM clinics, community contraception clinics, some GP surgeries and some young people’s surgeries.

You can get free contraception as long as your healthcare provider believes that you fully understand the information and decisions involved.

Will they tell my parents?

If you’re concerned that getting contraception means your parents finding out, don’t worry. As long as you’re between the ages of 13 and 16, you’re allowed the same rights to confidentiality as adults.

Birth control is available confidentially so long as your healthcare provider believes you understand the information and decisions involved. They may encourage you to tell your parents, but they won’t do so themselves.

If you’re under the age of 13, your healthcare provider may wish to involve other people for your own protection. These people may include your parents, legal guardians or a social worker. As the law states you cannot legally consent to sexual activity, your healthcare provider will have your best interests in mind.

Is birth control safe for teenagers?

As long as there are no conflicting health conditions, birth control is as safe for teenagers as adults. However, because teenagers are more likely to forget to use single-use contraceptives such as male and female condoms, long-acting reversible birth control options are usually recommended. These include IUDs, IUSs and contraceptive implants.

CHAPTER TEN

Birth control after pregnancy

After the joy of a successful pregnancy, it can be easy for birth control to slip your mind. However, there are still many important questions concerning contraception after delivery.

A number of points of confusion often arise for new mothers, including when birth control is required, what methods are suitable, and how these methods impact breastfeeding. If you are a new mother, or soon to be one, we can help with:

Can I use contraception after pregnancy while breastfeeding? And what methods of birth control are available?

How soon after pregnancy (postpartum) do I need to use birth control?

Though uncommon, it is possible to conceive immediately after giving birth, even if your periods haven’t returned or you’re breastfeeding. Since ovulation usually occurs two weeks before your period arrives, it’s possible to become pregnant before your period.

Which birth control method is suitable for me?

The best method of postpartum contraception may depend on a number of factors. When choosing a contraceptive method, consider the following:

  • How soon? Some methods of postpartum birth control can be used immediately after birth, while some require waiting a few weeks.
  • Breastfeeding. While all methods are safe to use while breastfeeding, during the first few weeks some types of contraception may affect your milk supply.
  • Effectiveness. Pregnancy can change the effectiveness of certain birth control options. For example, the contraceptive sponge and cervical cap are less effective for women who have recently given birth.

When can I use birth control after having a baby?

Depending on which type of contraception you want to use, you may need to wait a short amount of time before starting birth control. The contraceptive implant, contraceptive injection, POPs, male condoms and female condoms can all be used immediately after birth, as long as you have no conflicting medical conditions.

It is recommended that you wait four weeks after birth before using IUDs and IUSs. If you’re not breastfeeding and have no medical risk factors for a blood clot in a vein, you can start taking the pill again, or using a vaginal ring or contraceptive patch from three weeks after birth.

If you’re breastfeeding or have conflicting medical conditions, you should use POP, injections, implants or hormonal IUS.. After six weeks, you can also use a diaphragm or cervical cap.

What birth control is safe during breastfeeding?

You may be worried that birth control might affect your baby if you’re breastfeeding. Thankfully, while hormonal methods of contraception may cause a small amount of hormones to enter your milk, but no research has shown that this will pose a risk to your child.

If you’re looking to use birth control after pregnancy while breastfeeding, it’s advised that you wait six weeks before using the combined pill, vaginal ring or contraceptive patch. These birth control options contain oestrogen which may lower your milk production. Other methods such as male condoms, female condoms, contraceptive implants or contraceptive injections can be used immediately.

It is a myth that IUDs cause copper to enter your milk.

Can I use emergency contraception after pregnancy?

If you have had sex without using birth control, or think your contraception might have failed, you can use emergency contraceptive pills after 21 days from birth. Meanwhile, emergency IUDs can be used from 28 days after birth.

Important

If you use an emergency pill containing ulipristal acetate (ellaOne) while breastfeeding, you should avoid breastfeeding for one week after use. During this week express and discard your breast milk.

CHAPTER ELEVEN

Birth control and periods

When deciding which birth control method is right for you, you may overlook how it can impact your period. However, birth control can often ease the symptoms of your bleeding. Your period may become longer, shorter, heavier or lighter depending on the method of contraception you use.

Other side effects include spotting and irregular bleeding, as well as missed menstrual periods (known as amenorrhea). These can be alarming but are most often the result of hormones within birth control that stop ovulation each month. If you have any concerns about the impact of birth control on your periods, we can help with:

How does birth control affect my period? And why am I not getting my period on birth control?

How will birth control affect my periods?

As there are many types of contraception available, it is difficult to guarantee what effect they may have on your periods. Depending on which method of birth control you use, your menstrual bleeding may be affected in different ways.

Some contraceptives may increase or decrease your bleeding. Others may make your periods longer, shorter, heavier or lighter. Spotting and irregular bleeding are also common when using hormonal contraceptives, especially during the first few months of use.

Can I use birth control to delay or stop my period?

While there is no guaranteed way of using birth control to delay your period, combined contraceptive pills can help. If you take two packets of the pill back-to-back, you may be able to delay your bleeding by essentially missing a period. This should not be done for more than 3 packs in a row.

If you’re using a 21-day pack, skip the 7-day break when you would usually bleed and start a new packet immediately. For a 28-day pack, skip the placebo pills and start a new packet immediately after the first 21 days.

Important

If you’re using POPs as birth control, taking two packets back-to-back will not delay your period. However, you may be able to switch to the combined pill or another type of contraception in order to delay your period.

What happens if I stop taking the birth control pill and my period doesn’t come back?

If you’ve stopped taking the birth control pill and your period hasn’t returned, the first thing is to make sure that you are not pregnant, If negative, you are suffering from amenorrhea. Thankfully, this is a common condition that usually resolves itself.

You should allow yourself up to 3 months after stopping the pill for your bleeding to return although it is still worth doing a pregnancy test to be certain. If your period still hasn’t returned after this time, consult your GP. They will attempt to identify any underlying conditions you may have that might be causing amenorrhea.

When should I see a doctor about irregular bleeding?

If you experience any of the following types of irregular bleeding, it is recommended that you see your GP:

  • During pregnancy
  • If it occurs after intercourse
  • After using the same birth control method for over three months
  • If you are younger than 8 or have shown no signs of puberty
  • You are bleeding unexpectedly
  • Your bleeding is very painful
  • You are getting persistent spotting between your periods
CHAPTER TWELVE

GRAPHIC: photos and videos of birth control

The following images, videos and infographics show the range of contraceptive methods available, including female condoms, birth control injections and diaphragms.

While this provides an indication of what treatments are available, it is still recommended that you see a GP. Your GP will be able to guide you towards the best birth control method to suit you. We can help with:

What do the types of contraception look like?

Condoms (Female)

Female condoms are a barrier birth control option that prevents sperm from meeting an egg. They are inserted into the vagina before intercourse.

Condoms (Male)

Male condoms are a barrier option of birth control which prevents the sperm from fertilising an egg. They are placed over the penis before intercourse.

Contraceptive implant

A contraceptive implant is a small, flexible plastic rod that is inserted under the skin of your upper arm. It releases the hormone progestogen into your bloodstream which thickens the mucus of your cervix, making it difficult for sperm to reach an egg. It also thins the lining of your uterus, making it less likely to accept a fertilised egg.

Contraceptive injection

Contraceptive injections release the hormone progestogen into your bloodstream to help prevent pregnancy. This thickens the mucus of your cervix, helping prevent sperm from reaching and fertilising an egg. It also thins the lining of your uterus so that it is less likely to accept a fertilised egg.

Contraceptive patch

Contraceptive patches are small, thin, sticky patches that release hormones into your body through your skin. By releasing oestrogen and progestogen, the patch helps stop the ovaries from releasing an egg each month and helps stop sperm from reaching an egg during sex.

Diaphragms and cervical caps

Diaphragms and cervical caps are barrier methods of birth control that prevent unwanted pregnancy by stopping sperm from meeting an egg. Diaphragms are circular domes made of silicone with a flexible rim, while cervical caps are smaller.

Emergency contraceptive pills

Emergency contraceptive pills release hormones to stop or delay ovulation.

Intrauterine device (IUD)

These are small T-shaped devices made of plastic and copper that are inserted into your womb. They release copper which alters the cervical mucus, making it more difficult for sperm to reach an egg and survive, and for a fertilised egg to implant itself.

CHAPTER THIRTEEN

Get same day treatment with Medicspot

Our vision is to change lives with convenient, accessible healthcare. With over 200 private doctor clinics across the UK, you can find your nearest surgery and see a GP in minutes.

Your private GP can discuss different birth control methods with you and prescribe the contraceptive pill or any treatments that need to be administered by a healthcare professional. We can help with:

Where is your nearest doctor surgery? And how can Medicspot help?

How it works

How it works The Medicspot clinical station allows your GP to measure your blood pressure, offer personalised advice, and prescribe medication as needed.

Find your nearest clinic today.

CHAPTER FOURTEEN

About the authors

Written by Dr Abby Hyams and Dr Alex Eskander. Reviewed by Dr Adam Abbs. Last reviewed on 28/11/2019. Next review date 28/11/2022.

Dr Abby Hyams

Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because of the wide spectrum of people she encounters every day.

Dr Alex Eskander

Dr Alex Eskander is a consultant founder and director of the Gynae centre private practice in Harley Street since 1999. He is a member and a fellow of the Royal College of Obstetricians and Gynaeclogists since 1977. He has a special interest in family planning, pregnancy advice, ultrasound and colposcopy.

Dr Adam Abbs

Dr Adam Abbs qualified as a doctor from Hull York Medical School in 2010. He started training in hospital medicine but then retrained as a general practitioner. Following leading the development of urgent care services in North Manchester, he joined Medicspot in April 2019. He has a special interest in urgent care and also volunteers for numerous children’s cancer charities.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.