I remember looking forward to Year 9 for two reasons: 1) After having endured two-years of single-sex education, it was the first time we actually got to interact with boys, albeit in the form of set dances (gross). And 2) It was the first time we got to learn about sex ed.
More than a decade later, I’m embarrassed to say there’s one aspect of my sex education I don’t remember – contraception. Having just come off the pill after suffering from bad mood swings, I found myself wondering what other options were out there.
What I really needed was a refresher in Contraception 101.
Figuring I wasn’t alone in this conundrum, I spoke to Dr Deborah Bateson from Family Planning NSW to lay out all the different contraceptive options available to both men and women, as well as how contraceptive use is impacted by our age and our relationship status.
Some people find it hard to remember to take the pill every day. (Image: iStock)
What are the different types of contraceptives available?
There are a number of ways to categorise contraceptives, but it’s useful to do so in terms of their “duration of action:” that is, how long you are able to use the contraceptives for.
There are five main categories that can be classified in this way:
As the name indicates, these methods of contraception are both permanent and long-lasting. They include:
- Vasectomy: a surgical procedure for men, whereby each vas deferens (the tubes that carry sperm to the penis) are surgically cut or blocked.
- Tubal ligation: a surgical procedure for women, whereby the fallopian tubes are blocked to prevent an egg from travelling along the tube to the uterus.
“Permanent methods should be viewed as non-reversible, and we usually recommend them to men and women who are a little older – generally in their mid or late 40s – and have completed their families,” says Dr Bateson.
“While vasectomies can be reversed in a number of cases, it isn’t possible to guarantee that reversal will result in a pregnancy, so it’s best to consider this a permanent method of contraception.”
Long acting reversible contraceptives (LARC).
LARC methods of contraception, sometimes called ‘set and forget’ methods, last for up to five or even 10 years, but are reversible at any time. There are a number of options available in this category, including:
- Intrauterine devices (IUDs): small, plastic T-shaped devices that are inserted in the uterus. They can be either a hormonal IUD, which prevents pregnancy using the progestogen hormone, or a copper IUD, which affect the sperm and stops sperm from fertilising the egg, and also affects the transport of the egg in the fallopian tubes. It also changes the lining of the womb, making it less suitable for a pregnancy. IUDs are inserted and removed by a trained health professional and can last up to five or 10 years, depending on their type. They are over 99 per cent effective at preventing pregnancy and immediately reversible on removal.
A subdermal implant is a matchstick-sized rod that is inserted under the skin of the inner, upper arm. (Image: iStock)
- Subdermal implants: a matchstick-sized rod that is inserted under the skin of the inner, upper arm. The implant continuously releases a low dosage of a progestogen hormone into the blood stream to prevent ovulation. It is 99.9 per cent effective and immediately reversible upon removal, and can remain inserted for up to three years. The insertion and removal of the implant requires a small procedure provided by a trained health professional.
- Contraceptive injections: these injections, known as Depot Medroxyprogesterone Acetate (DMPA), are an injection you receive from your doctor every 12 weeks. These hormonal injections prevent ovulation and are over 99 per cent effective at preventing pregnancy when used correctly. However, because users need to remember to receive these injections on time (which is often difficult to do), women using this method can be at higher risk of pregnancy than those who use other LARC methods (around 94 per cent effective in typical use).
Short acting reversible contraceptives.
Short acting reversible contraceptives are not as long-lasting as LARC methods and rely on you remembering to do something every day or every month. They consist of:
- Combined oral contraceptive pill: taken daily, these pills contain two hormones, oestrogen and progestogen, that prevent ovulation and are up to 99.7 per cent effective when taken perfectly – that is, every day. “There is a misunderstanding that it is dangerous to use an oral contraceptive pill long-term, or back-to-back pills packs without the sugar pills to skip periods,” comments Dr Bateson, “These are not true. For many women, it is perfectly fine to skip your period for months in a row, and to use the pill for as long as needed – it all depends on the individual’s choice.”
- Progestogen-only pill: sometimes referred to as the “mini pill”, contains one hormone; progestogen. This is often used by women who need to avoid oestrogen due to side effects or medical reasons. This pill has to be taken within the same three-hour window each day, which makes it easier to miss than the combined pill.
- Vaginal ring: this small, plastic ring is inserted into the vagina by the user once a month, and slowly releases hormones to prevent ovulation, in the same way as the combined pill. It is then taken out for a week and replaced with a new ring. When used perfectly this method is more than 99 per cent effective, but in typical use it is around 91 per cent effective.
When it comes to contraception, knowledge is power. (Image: iStock)
These methods of contraception block the sperm from reaching the uterus, thus preventing pregnancy. They include:
- Male condoms; Typically made of latex (but non latex options are available) these are rolled onto the penis before sex and collect sperm. They are disposable and have a single usage, and while they can be up to 98 per cent effective when used correctly, male condoms can have up to an 18 per cent failure rate. This is due to factors such as breakage and incorrect application. Both male and female condoms are the only methods of contraception that prevent STIs and they can be used at the same time as other more effective methods of contraception (such as a LARC) to simultaneously prevent pregnancy and STIs including HIV.
- Female condoms: made from polyurethane, this device is inserted into the vagina before intercourse. It has two flexible rings on either side; one of which rings is closed and rests inside the vagina, while the other has an opening and sits outside the labia. When used correctly, these are 95 per cent effective at preventing pregnancy, but can be as low as 78 per cent. “Unfortunately, female condoms are not very widely available,” comments Dr Bateson.
- Diaphragms: a circular, cap-like device (made from silicone) that is inserted into the vagina before intercourse, which covers the cervix and blocks sperm from entering the uterus. These can be up to 94 per centeffective at preventing pregnancy when applied correctly, but as low as 88 per cent in typical use.
While they can be up to 98% effective when used correctly, male condoms can have up to an 18% failure rate. (Image: iStock)
These methods are usually used in cases of emergency, notably after having engaged in unprotected sex or when other methods of contraception have failed, such as a missed pill or broken condom.
The most common form of emergency contraception is the emergency contraceptive pill, known sometimes as the morning after pill, which consists of a single dose of the progestogen hormone called levonorgestrel (LNG) to reduce your chances of pregnancy when taken within 72 to 96 hours of intercourse. The morning after pill is available over the counter at pharmacies.
There is, however, another, new emergency contraceptive pill available on a prescription which is called ulipristal acetate or UPA which is licensed for use up to 120 hours (five days) after unprotected intercourse. A copper IUD is also a lesser known method of emergency contraception: