Contraceptive Care

When it comes to your sexual health, it is important to choose the contraception that fits your situation and lifestyle.

At Roxboro Medical Centre your Limerick Doctor or nurse will discuss the different options with you to help you choose one that suits and works best for you as different options suit different people for different reasons.

It is important to note that some contraceptives are not recommended for some people.  This is especially true with oestrogen containing contraception.

Contraceptives come in three groups:

Short Acting Methods

Combined Oral Contraceptive Pill (“The Pill”)

The combined oral contraceptive pill is a tablet containing two female hormones, oestrogen and progesterone.  The Pill is 99% effective when used correctly, 91% when not always used correctly.  It works by stopping a woman ovulating (releasing an egg each month). There are many different brands of Pill with different combinations of hormones.

Advantages

  • reduction of bleeding/controlling periods,
  • reduction of period pain and PMT (pre-menstrual tension),
  • It can protect against cancer of the ovaries and womb lining.

Disadvantages

  • Forgetting to take a tablet, vomiting/diarrhoea after taking one and taking certain other prescription medicines can all reduce its effectiveness.
  • The oestrogen in the combined pill is not suitable for some women due to potential for complications such as blood clots.
  • Oestrogen containing contraceptives are not to be taken if breast feeding as it will dry up your supply of milk.

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Progesterone Only Pill (POP)

The progesterone only pill is a tablet that contains artificial female progesterone that is produced by the ovary.  It is 99% effective when used correctly, 91% when not used correctly.  You take the pill every day without a break. It works mainly by thickening the mucus of the cervix.  This makes it difficult for sperm to move through it and reach an egg.  They also make the lining of the uterus thinner and sometimes they stop the ovaries releasing an egg.

Advantages:

  • The POP can be used as an alternative for those who cannot take pills containing oestrogen.
  • It can also be used when breastfeeding.

Disadvantages:

  • the older POP pills required the pill to be taken within 3 hours of the same time every day.  The newer POP’s can be taken within a 12 hour window and still be effective.
  • The progesterone only pill can cause irregular bleeding or periods.

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“The Patch” (Evra)

The patch is another combined hormonal contraception.  It contains oestrogen and progesterone.  It is similar to a small plaster of 4x5cm in size.  Each patch is worn for 7 days on the skin usually the leg, arm, or buttocks and replaced weekly for 3 weeks.  There is then a patch free week where you will get a withdrawal bleed.  The patch is regarded as 99% effective when used correctly, 91% when not used correctly every time.  The hormones are absorbed through the skin to prevent ovulation.

Advantages:

  • Same advantages as that of the combined oral contraceptive pill without having to remember to take a tablet.

Disadvantages:

  • It has the same side effects as the combined oral contraceptive pill. So it is not suitable for some women and cannot be used in breastfeeding.
  • It can cost more than the Pill.

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Vaginal Ring (Nuvaring)

The vaginal ring is a flexible ring that contains oestrogen and progesterone.  It is inserted by the woman and worn inside the vagina for 3 weeks each month followed by a week’s break.  The vaginal ring is 99% effective when used correctly, 91% when not used correctly every time.  The hormones are absorbed from your vagina and prevent ovulation.

Advantages:

  • Convenient once a month self placement.
  • It delivers a lower dose of hormones than the Pill or Patch but is just as effective so may suit you if you have side effects from either the Pill or the Patch.

Disadvantages:

  • It has the same side effects as the combined oral contraceptive pill. So it is not suitable for some women and cannot be used in breastfeeding.
  • It can cost more than the Pill.

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Barrier Contraception

Barrier contraception work by preventing sperm from entering the womb

Examples include the Male and Female condom, diaphragms and caps.

Condom (Male and Female)

Condoms work by preventing the man’s sperm from meeting the woman’s fertile egg.  They are between 98-95% effective when used properly.

Advantages:

  • Condoms are widely available and cheap to buy.
  • They help prevent both partners from sexually transmitted infections.
  • They can be used with hormonal contraception or “dual protection” for additional protection.

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Diaphragm (“The Cap”)

The diaphragm covers your cervix (neck of womb), and this stops sperm from reaching your egg.  They are made of thin, soft latex or silicone with a flexible rim. To be effective, diaphragms need to be used with a spermicide.  They are 92-96% when used correctly.  You need to attend the surgery for a fitting and instruction on how to use your diaphragm.  We can then give you a prescription for your pharmacy.

Advantages:

  • It is useful for women who wish to avoid using hormones.
  • It can be more convenient than a condom as it does not need to be inserted right before having sex.

Disadvantages:

  • You must use spermicide every time you have sex using the diaphragm.
  • You must leave the diaphragm in place for at least 6 hours after sex, but must not leave it in for more than 24 hours.

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Long Acting Methods

Hormone Injection (“Depo-Provera”)

The injection called Depo-Provera contains progestogen.  A doctor or nurse gives the injection every 12 weeks into the upper buttock, arm or thigh.  The depo is 99% effective when used correctly.  The hormone sits in the muscle and is slowly absorbed over the 12 weeks and prevents ovulation.

Advantages:

  • Useful for women who forget to take a pill daily.
  • Can be used by women who cannot take oestrogen.
  • It may protect against cancer of the womb.

Disadvantages:

  • Must be given by a doctor or nurse.
  • It is not reversible
  • May cause irregular bleeding at first, which can then create a light period or no period at all in most cases.
  • It can take 6 to 12 months for regular periods and fertility to return to normal so it is recommended to change to a different form of contraception 12 months before trying to conceive.
  • It is advised not to be used long term without a break due to risk of developing osteoporosis (thinning of your bones).

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Hormone Implant (“The Bar”)

The “Bar” is a small flexible progesterone-containing rod, which is placed just under the skin on the upper inner arm.  It is regarded as 99% effective.  The rod slowly releases a female hormone progestogen.  This stops ovulation and also thickens the cervical mucus thus making it difficult for the sperm to enter the womb.  It also thins the lining of the womb.

Advantages:

  • Lasts for up to 3 years.
  • Is 100% reversible and can be removed anytime.
  • It can be inserted soon after giving birth even if you are breastfeeding.
  • It can reduce painful periods.

Disadvantages:

  • Must be inserted/removed by a trained doctor.
  • Can cause irregular bleeding or no bleeding at all

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Hormone IUD (“Mirena”)

IUD stands for intrauterine device. It is a small plastic device placed into the womb, containing the female hormone progestogen.  There are different kinds of hormone containing coils available in Ireland: Mirena, Kyleena (both last 5 years), Jaydess (lasts 3 years).  The IUD is regarded as 99% effective.  It stops the sperm reaching the egg, it delays the egg getting to the womb and prevents the egg implanting in the womb.

Advantages:

  • Works for up to 5 years.
  • If over 45, can be left in until menopause or until contraception is no longer needed.
  • It can be used in women who have never been pregnant or have delivered a baby via Cesarean section.
  • It can be used as a means to control heavy periods

Disadvantages:

  • A specially trained doctor must insert it.
  • It can have some discomfort on insertion.
  • It can cause irregular bleeding for first few months but after that, most women have lighter periods or none at all.

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The Copper Coil

The copper coil is a small plastic device covered in copper placed in the womb.  It is 99% effective.  It works by preventing sperm fertilizing an egg and preventing a fertilized egg implanting in the uterus.

Advantages:

  • It can last from 5-10 years
  • It works as soon as its inserted
  • It can be used as an emergency contraceptive.

Disadvantages

  • A specially trained doctor must insert it.
  • It may cause some women to have heavier and longer periods

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Emergency Contraception “Plan B”

Forgot your pill, the condom broke or the diaphragm wasn’t fitted correctly?  There are many reasons why your preferred choice of contraception didn’t go to plan.  That’s what emergency contraception is for.  There are 2 main types of emergency contraception, a pill or the copper coil.  The pills are either a 3 day or a 5 day pill.

3 Day Pill “morning after pill”

The 3 day pill contains the hormone progestogen and works by delaying ovulation.  They are 99% effective in preventing pregnancy if taken within 12 hours of unprotected sex. The effectiveness reduces as time passes.  The time limit for use after unprotected sex is 72 hours ie 3 Days.

5 Day Pill “newer morning after pill”

The 5 day pill contains ulipristal that works by delaying or stopping ovulation.  It should be taken as soon as possible but within 120 hours i.e. 5 days.  It is regarded at 99.5% effective.

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