2Why is contraception important? Prevents unplanned pregnancies and can give you the freedom to choose the right time for parenthoodProtects you from sexually transmitted infections (condoms only)
3What are the available methods of contraception? Condoms (male and female)Combined pill (micro-pill)Progestin-only pill (mini-pill)Intrauterine Systems (IUS)Contraceptive implantsVaginal ringContraceptive injectionsContraceptive patchesIntrauterine device (IUD)Diaphragms and caps plus spermicideNatural family planning (e.g. temperature method)Sterilisation (male and female)
4Male & female condoms What are they? Latex or polyurethane sheaths which fit over a man's penis (male condom) or inside a woman’s vagina (female condom)How do they work?Prevent sperm from entering the woman's vaginaPrevent sexually transmitted infections (STIs) from passing from person to person if used properly.
5Male & female condoms What are their main advantages? Only necessary when having sexMay protect both partners from STIs, including HIVNo side-effectsReadily available in a variety of brands, textures, and sizes.What are their main disadvantages?Can interrupt sexCan sometimes slip off or splitMust be handled carefully following ejaculationMedium efficacy in preventing unintended pregnancy
6Oral contraceptive pills There are around 70 different types of oral contraceptive pill available, containing various doses and mixes of hormonesWhat is the combined pill (micropill)?Oral tablets containing two hormones: an estrogen and a progestinHow do they work?Prevent the female body from releasing an egg each monthThicken the mucus of the entrance to the womb, making it difficult for sperm to get through
7Oral contraceptive pills What are the main advantages of the combined pill?Do not interrupt sex or force couples to make changes to their sexual habitsSafe for most womenSome protection against ovarian cancer, cancer of the womb, and benign cysts of the breastDecrease menstrual crampsMore regular periodsLighter and shorter periodsCompletely reversibleEasy to useCan have positive effects on skin, e.g. improve acne.
8Oral contraceptive pills What are the main disadvantages of the combined pill?Offer no protection against sexually transmitted infections (STIs)Not suitable for women aged over 35 years, smokers, or women who are breastfeedingCan be expensive (free of charge in some countries) (note to teacher: check national availability and cost)Can produce certain rare but dangerous complicationsCan be responsible for mood changes in certain womenMay give rise to nuisance side effects such as headaches, bloating, and breakthrough bleeding in some womenMust be taken correctly on an almost daily basis.
9Oral contraceptive pills What is the progestin-only (mini) pill?Oral pills that contain a progestin hormoneHow do they work?Thicken the mucus at the entrance to the womb, which makes it difficult for sperm to get throughChange the lining of the wombMay also prevent ovulation in some women
10Mini (progestin-only) pills What are their main advantages?Few serious side-effectsDo not interrupt sexCan be used while breastfeedingAre useful for women who cannot take estrogensCan be used at any ageWhat are their main disadvantages?May cause irregular periodsDo not protect against STIsMust be taken at the same time everydayMay initially induce temporary side-effects such as: spotty skin, breast tenderness, bloating, and headaches
11Contraceptive patches What are they?Stick-on patches, which slowly release estrogen and progestin hormones through the skinStuck onto your bottom, thigh, stomach or upper bodyChanged weekly – with no patch used on the fourth week of your cycle.How do they work?Prevent ovulationThicken the mucus around the neck of the womb, making it difficult for sperm to enter
12Contraceptive patches What are their main advantages?Do not have to be used daily (replaced every week)Do not interrupt sexEasy to useEfficacy unaffected by vomiting or diarrhoeaWhat are their main disadvantages?Not suitable for women aged over 35 years, smokers, or women who are breastfeedingVisible to others (e.g. partner)May rarely cause skin irritationDo not protect against STIsMay evoke temporary side-effects such as headaches, breast tenderness, bleeding between periods..
13Contraceptive injections What are they?Injection containing progestin only or a combination of progestin and estrogen, given by a trained doctor or nurse either once every month or once every three monthsHow do they work?Prevent ovulation and / orThicken mucus around the neck of the womb making it difficult for sperm to enter
14Contraceptive injections What are their main advantages?Semi-long-acting hormonal method without the need for a daily doseDo not interfere with sexProgestin only injections can be used during breastfeeding and for those women who do not tolerate estrogenMay reduce heavy painful periods and help with premenstrual symptomsWhat are their main disadvantages?Depending on the type of injection, periods and fertility may take up to a year to return after stopping injectionsMay induce headaches, dizziness, spotty skin, tender breasts, mood swings, weight gain and bloating. As the injection cannot be removed from the body, side effects may continue during the time it is inserted and for some time afterwardsDo not protect against STIs
15Contraceptive implants What are they?Tiny flexible tubes impregnated with a progestin hormone, and inserted just under the surface of the skin on the inside of your upper arm by a trained doctor or nurse. The implant is effective for three yearsHow do they work?Thicken the mucus in the neck of the womb to make it difficult for sperm to enterChange the lining of the wombPrevent ovulation
16Contraceptive implants What are their main advantages?Can be fitted and forgottenDoes not interfere with sexCan be used while breastfeedingIs useful for women who cannot take estrogensMay reduce heavy, painful periodsWhat are their main disadvantages?May cause irregular bleeding for the first few monthsCan cause side effects such as headaches, tender breasts, changes in mood and sex drive, and bloatingDo not protect against STIsIt may take a while until fertility is vestured
17Vaginal ring What are they? Contains estrogen and progestin, and is inserted into the vagina. It is kept in place for three weeks, and then removed for a one week break. A new ring is inserted following the week break.How do they work?Prevent the female body from releasing an egg each monthThicken the mucus of the entrance to the womb, making it difficult for sperm to get through
18Vaginal ring What are their main advantages? An alternative form of hormonal contraception which is used only once every four weeksMay make a woman’s periods more regular, lighter and may reduce crampingWhat are their main disadvantages?Can cause vaginal irritation, discomfort or dischargeMay cause nausea and breast tendernessSome women may be able to feel itDo not protect against STIs
19Intra-uterine systems (IUS, also known as hormonal coil) What are they?Plastic T-shaped device with a cylinder containing progestin. Inserted in the cavity of the womb by a trained doctor or nurse. Can stay in place for up to five yearsHow do they work?Thicken the mucus in the neck of the uterus, making it difficult for sperm to enterChange the lining of the womb
20IUS What are their main advantages? Can be fitted and forgotten - effective for up to five yearsDo not interrupt sexOption for women who cannot tolerate estrogens and those breast-feedingPeriods usually become much lighter and shorter, and less painfulCan offer protection against pelvic infections and cancer of the uterine liningNormal fertility returns quickly when the IUS is removedNot affected by other medicinesWhat are their main disadvantages?Can cause irregular bleeding for the first three monthsMay cause temporary side-effects such as headaches, breast tenderness and nauseaDo not protect against STIsCan be expelled or displaced by the wombMay rarely perforate the womb or cervix
21Intra-uterine devices (IUD) What are they?Small plastic and copper T-shaped devices,which are inserted into the cavity of the wombby a trained doctor or nurseHow do they work?Prevents sperm and eggs from meeting by immobilizing the sperm on their way to fallopian tubes and changing the line of the womb so that it cannot accept an egg
22IUD What are their main advantages? Can be fitted and forgotten - effective for three to ten yearsDo not interrupt sexNormal fertility returns as soon as it is removedWhat are their main disadvantages?May cause heavier, longer or more painful periods, increased cramping and dizzinessCan increase the risk of pelvic infectionsDo not protect against STIsCan be expelled or displaced by the wombCan perforate the womb or cervix
23Diaphragms & caps What are they? Dome-shaped circles made of rubber or silicone thatis inserted into the vagina, requires initial fitting bya doctor or nurseCoated with spermicidal cream for extra protectionMust be left in for at least six hours after intercourse (and no more than 24 hours)How do they work?Forms a barrier between the sperm and the entrance of the womb
24Diaphragms & caps What are their main advantages? Necessary only when having sexNo serious health risksCan be inserted at any convenient time before sexWhat are their main disadvantages?Insertion can interrupt sexSpermicide can be messyInsertion and expulsion need to be practicedCan cause vaginal irritation
25Natural family planning What are they?Withdrawal method - penis is withdrawn from the vagina prior to ejaculationNatural method – sex is avoided at fertile times of the month. Fertility is monitored using the following methodsKeep a daily record of your body temperature using a special fertility thermometerLook for changes in the stickiness of the mucus around the entrance to the wombCalculate when ovulation is most likely to take place by counting the number of days from your last period (this only works if your periods are regular)Look for other signs such as mood changes and breast tenderness which tend to happen in the second half of your menstrual cycle (measured from the start of one period to the beginning of the next)
26Natural family planning What are its main advantages?Can be used to plan as well as avoid a pregnancyDoes not involve any chemical agents or physical devicesNo physical side-effectsAllows women to become more aware of their fertilityHelps women communicate about their fertility and sexualityAcceptable to all faiths and culturesWhat are its main disadvantages?The withdrawal method is highly unreliable because small drops of sperm can escape from the penis into the vagina before the man ejaculatesFertile periods not confirmed until three to six cycles are completedNecessary to keep daily recordsEvents such as illness, stress and travel may make fertility indicators harder to interpretNecessitates intercourse avoidance during the fertile timeBoth partners need to be very committed to the methodDoes not protect against STIs
27Emergency contraception What is it?Emergency method that can be used after unprotected sex or when another contraception method has failed (e.g. split of condom)Only intended as a back-up, not to be used regularlyHow does it work?Emergency methods work mainly by preventing ovulation and fertilisationThey also have local effects on the uterusThey are not effective once the process of fertilisation and implantation has begun
28Emergency contraception What options are there?Emergency (or morning after) pills - can be taken up to 72 hours or three days after intercourse. However, the sooner you take them, the more effective they are. Contains either a combination of estrogen and progestin or progestin only, and can be taken up to 72 hours after unprotected intercourseIUDs – can be fitted up to 120 hours (5 days) after unprotected sex by a trained doctor or nurse
29Sterilisation What is it? Permanent method of contraception for people who do not want children now or in the futureHow does it work?Male sterilisationThe tubes that carry sperm are cut, so thatwhile a man can still ejaculate, no sperm is presentFemale sterilisationThe fallopian tubes are cut or blocked so thatthe egg cannot travel down to meet sperm
30Sterilisation What are its main advantages? Almost 100% effective Does not interrupt sexCan be performed and forgottenWhat are its main disadvantages?Cannot be reversed (except by using complex and dangerous surgery which is not successful in all cases)Do not protect against STIs
31Contraceptive effectiveness MethodReliabilityThe number of women out of 1000 who get pregnant in the course of one year with perfect useMale condom1-6Reasonable70Female condom750Combined pill1-6Very high0.3Progestin-only pill1-64Patch1-610Vaginal ring1-6Injection1-6Implant70.5IUD7High5IUS1-61Diaphragm1-660Male sterilisation70.1Female sterilisation1-6Withdrawal method1-6Unreliable100Natural method7Low- reasonable30-90Family Planning Association. Contraception and sexual health guide. Accessed on 1 April 2005 at:National Institute of Clinical Excellence. Appraisal Consultation Document: Guidance on the use of liquid-based cytology for cervical screening (Review of existing guidance number 5). April Accessed on 1 April 2005 at:Apter D, Boros A, Baumgärtner W et al. Eur J Contracept Reprod Health Care 2003; 8:van Vloten W, van Hasalen C, van Zuuren E et al. Cutis; 2002; 69 (suppl 4): 2-15.Crandall CJ. Polycystic Ovarian Disease (Stein-Leventhal Syndrome). Accessed on 1 April 2005 at:Yasmin SmPC, Schering Healthcare Ltd UK.Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Stewart F, Cates W, Stewart GK, Kowal D, Guest F. Contraceptive Technology; Seventeenth Revised Edition. New York NY: Irvington Publishers, 1998.
32Things to consider Am I ready for sex? Which contraceptive method is best for me? Why?Where will I get this contraception from?Who can I talk to for more advice?What can I do and who can I turn to if things go wrong?