The Combined Pill
How It Works: Containing both oestrogen and progesterone, the combined pill is taken daily and is the most common form of contraception in the UK, says Dr Jessica Braid, co-founder of Adio. “It is taken by around 1.5 million women for 21 days with a seven-day break, during which time you have a withdrawal bleed.” The combined pill prevents the ovaries from releasing an egg each month. It also thickens the mucus in the neck of the womb, making it harder for sperm to penetrate, and thins the womb lining. When used correctly, it’s over 99% effective.
Best For: It could be a good option if you struggle with acne – for many women, the pill clears up skin issues. In particular, Yasmin and Beyaz both use drospirenone with ethinyl estradiol to clear up excess oil.
Side Effects: As Zahra Ameen, consultant gynaecologist and obstetrician at the Cadogan Clinic explains, this type of pill can cause temporary side effects at first, including headaches, nausea, breast tenderness and mood swings. “If these don’t go after a few months, it may be worth changing to a different pill. Breakthrough bleeding and spotting is also common in the first few months,” she says.
Anything Else? “Taking the combined pill can increase your blood pressure, and it doesn’t protect you against STIs,” Zahra adds. At the same time, Jessica says it’s not suitable for women who smoke, suffer from migraines or who have a family history of breast cancer or blood clots, high blood pressure or arterial disease. It’s also not recommended if you’re over 35.
The Mini Pill
How It Works: Unlike the combined pill, the mini pill only contains progesterone. “The mini pill is available at two different dosages,” says Jessica. “The lower-dose pill needs to be taken within a three-hour window for it to be effective, whereas higher-dose progesterone pills are more forgiving in terms of when you take them, but can have higher side effects.” You’ll need to take one pill every day and there’s no break between packs – when you finish a pack, you start the next one the following day. These pills are 99% effective when taken correctly, but can be much less effective if not taken at the same time, or if pills are missed.
Best For: The mini pill is recommended for those who should avoid oestrogen, such as migraine sufferers. It can also be a good option if you struggle with heavy periods. Less than half of women will keep getting regular periods, and they are likely to be lighter and less painful. Some women will have no periods at all, whereas some will have irregular bleeding.
Side Effects: “It can cause acne, breast tenderness, an increased or decreased sex drive, mood changes, headache and migraine, nausea or vomiting, and small, fluid-filled sacs (cysts) on your ovaries,” says Zahra. “These cysts, however, are usually harmless and disappear without treatment. These side effects are most likely to occur during the first three to four months of taking the progesterone-only pill, but they generally improve over time. Rarely, some women can gain a little weight, but this is temporary and will settle after a few months and is usually down to fluid retention, not extra fat.
Anything Else? Some experts claim a long-term side effect of being on either form of the pill is nutrient depletion – with studies showing it can zap levels of vitamin B6, B12, B2, zinc and folate over time, all of which are important for conception and healthy pregnancy. “Hormonal contraceptives may also alter your hormonal balance in the long-term and increase your risk of depression,” adds Jessica.
How It Works: This small, flexible plastic rod is placed under the skin in your upper arm and releases progesterone into your bloodstream gradually, to prevent pregnancy for up to three years. It prevents ovulation but can also thicken cervical mucus to prevent sperm from swimming easily, and by thinning the lining of the womb to stop implantation.
Best For: The implant is long-acting, making it a great option for someone that wants a contraceptive they can forget about.
Side Effects: “The most common side effect for the implant is spotting (light bleeding or brown discharge), especially within the first six to 12 months,” adds Zahra. “Sometimes, periods can become longer and heavier, although most people find the implant makes their periods much lighter. Acne flare-ups can also happen, and headaches, breast tenderness, nausea and mood swings are also common during the first few months.”
Anything Else? Around 20% of women say they experience more bleeding when using the implant. Should this be the case, the experts recommend giving it at least three months for things to settle before making a decision. “If, however, you experience any contraindications within this time-frame – including a rise in blood pressure or migraines – you should stop immediately and chat to your GP,” says Jessica.
How It Works: As obstetrician and gynaecologist Dr Shree Datta tells us, there are two types of coil – an IUD and IUS – both of which sit inside your womb. “An IUD (intrauterine device) is a small T-shaped plastic and copper device that is inserted into your uterus by a medical professional. It releases copper to prevent pregnancy. An IUS (intrauterine system) releases progesterone, which thickens cervical mucus, making it harder for sperm to fertilise an egg. In some cases, it can stop ovulation, so an egg isn’t even released.” Both are over 99% effective at preventing pregnancy.
Best For: Those looking for a long-term solution – the IUS can last for three to five years, and the IUD up to ten years. As the IUD is a non-hormonal form of contraception, it’s also a good choice if you’re looking for a hormone-free solution.
Side Effects: Some women experience pain when having the coil fitted and during the first few days. “After that, side effects vary significantly between individuals,” says Shree. “They can include migration or expulsion from the womb, which occurs if the womb contracts around the coil and pushes it towards the cervix. Other side effects include pain or risk of infection. With IUDs, some women experience heavier and longer periods at first, before they return to normal after an adjustment period. This is not the case for the IUS, which is often considered a treatment for heavy periods, though some people do get spotting in the first three to six months of having it inserted.” With an IUS, one in five women have no period at all after a few months.
Anything Else? Some experts say that since the hormones released by the hormonal coil work locally within the uterus, rather than being systemically absorbed like with the pill, there are often fewer emotional side effects.
How It Works: The contraceptive injection releases progesterone into your bloodstream to prevent pregnancy. “This, in turn, prevents the release of an egg each month, i.e., ovulation,” says Zahra. “Depo-Provera is the most commonly given in the UK and lasts for 13 weeks. Occasionally, Noristerat may be given, which lasts for eight weeks. Sayana Press also lasts for 13 weeks, but it’s a new form of injection so isn’t available at all clinics or GP surgeries.”
Best For: The injection is a good solution if you struggle to take a pill at the same time every day, although you’ll need to remember to have repeat injections. It can also be helpful for women who can’t use contraception that contains oestrogen.
Side Effects: “Side effects can include weight gain, headaches, mood swings, breast tenderness and irregular bleeding. Your periods may become more irregular, heavier, shorter, lighter, or stop altogether,” adds Zahra.
Anything Else? Zahra also tells us that the injection doesn’t protect against STIs, so you may need to use condoms as well, and it can take up to a year for fertility to return to normal after your last injection. “With this in mind, it may not be suitable if you want to have a baby in the near future.”
The Vaginal Ring
How It Works: A small, soft, flexible ring made from plastic; it’s designed to be placed inside the vagina. You leave it in for 21 days at a time, removing it for seven days at the end of your cycle to induce a withdrawal bleed. However, not everyone will experience a withdrawal bleed. Working in the same way as the combined pill, it releases a steady dose of oestrogen and progesterone, although unlike the pill, you’re covered if you suffer from diarrhoea or vomiting.
Best For: With a smaller dose of oestrogen than most versions of the pill, the ring is a good option for those looking for hormone-light option. It’s effective immediately and once it’s fitted properly, it will stay put.
Side Effects: It has similar side effects to the contraceptive pill. A little spotting or breakthrough bleeding when it’s first inserted is not uncommon, but this should ease up after the first month or so.
Anything Else? The addition of oestrogen can help with issues such as acne and PMS symptoms, and while it doesn’t interrupt sex (you can have sex and use tampons while using it), some people don’t like the feeling of it during sex, if you can feel it at all.
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