1. Be prepared…

2. Why is contraception important?
Prevents unplanned pregnancies and can give you the freedom to choose the right time for parenthood
Protects you from sexually transmitted infections (condoms only)

3. What are the available methods of contraception?
Condoms (male and female)
Combined pill (micro-pill)
Progestin-only pill (mini-pill)
Intrauterine Systems (IUS)
Contraceptive implants
Vaginal ring
Contraceptive injections
Contraceptive patches
Intrauterine device (IUD)
Diaphragms and caps plus spermicide
Natural family planning (e.g. temperature method)
Sterilisation (male and female)

4. Male & 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 vagina
Prevent sexually transmitted infections (STIs) from passing from person to person if used properly.

5. Male & female condoms What are their main advantages?
Only necessary when having sex
May protect both partners from STIs, including HIV
No side-effects
Readily available in a variety of brands, textures, and sizes.
What are their main disadvantages?
Can interrupt sex
Can sometimes slip off or split
Must be handled carefully following ejaculation
Medium efficacy in preventing unintended pregnancy

6. Oral contraceptive pills
There are around 70 different types of oral contraceptive pill available, containing various doses and mixes of hormones
What is the combined pill (micropill)?
Oral tablets containing two hormones: an estrogen and a progestin
How do they work?
Prevent the female body from releasing an egg each month
Thicken the mucus of the entrance to the womb, making it difficult for sperm to get through

7. Oral contraceptive pills
What are the main advantages of the combined pill?
Do not interrupt sex or force couples to make changes to their sexual habits
Safe for most women
Some protection against ovarian cancer, cancer of the womb, and benign cysts of the breast
Decrease menstrual cramps
More regular periods
Lighter and shorter periods
Completely reversible
Easy to use
Can have positive effects on skin, e.g. improve acne.

8. Oral 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 breastfeeding
Can be expensive (free of charge in some countries) (note to teacher: check national availability and cost)
Can produce certain rare but dangerous complications
Can be responsible for mood changes in certain women
May give rise to nuisance side effects such as headaches, bloating, and breakthrough bleeding in some women
Must be taken correctly on an almost daily basis.

9. Oral contraceptive pills
What is the progestin-only (mini) pill?
Oral pills that contain a progestin hormone
How do they work?
Thicken the mucus at the entrance to the womb, which makes it difficult for sperm to get through
Change the lining of the womb
May also prevent ovulation in some women

10. Mini (progestin-only) pills
What are their main advantages?
Few serious side-effects
Do not interrupt sex
Can be used while breastfeeding
Are useful for women who cannot take estrogens
Can be used at any age
What are their main disadvantages?
May cause irregular periods
Do not protect against STIs
Must be taken at the same time everyday
May initially induce temporary side-effects such as: spotty skin, breast tenderness, bloating, and headaches

11. Contraceptive patches
What are they?
Stick-on patches, which slowly release estrogen and progestin hormones through the skin
Stuck onto your bottom, thigh, stomach or upper body
Changed weekly – with no patch used on the fourth week of your cycle.
How do they work?
Prevent ovulation
Thicken the mucus around the neck of the womb, making it difficult for sperm to enter

12. Contraceptive patches
What are their main advantages?
Do not have to be used daily (replaced every week)
Do not interrupt sex
Easy to use
Efficacy unaffected by vomiting or diarrhoea
What are their main disadvantages?
Not suitable for women aged over 35 years, smokers, or women who are breastfeeding
Visible to others (e.g. partner)
May rarely cause skin irritation
Do not protect against STIs
May evoke temporary side-effects such as headaches, breast tenderness, bleeding between periods..

13. Contraceptive 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 months
How do they work?
Prevent ovulation and / or
Thicken mucus around the neck of the womb making it difficult for sperm to enter

14. Contraceptive injections
What are their main advantages?
Semi-long-acting hormonal method without the need for a daily dose
Do not interfere with sex
Progestin only injections can be used during breastfeeding and for those women who do not tolerate estrogen
May reduce heavy painful periods and help with premenstrual symptoms
What are their main disadvantages?
Depending on the type of injection, periods and fertility may take up to a year to return after stopping injections
May 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 afterwards
Do not protect against STIs

15. Contraceptive 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 years
How do they work?
Thicken the mucus in the neck of the womb to make it difficult for sperm to enter
Change the lining of the womb
Prevent ovulation

16. Contraceptive implants
What are their main advantages?
Can be fitted and forgotten
Does not interfere with sex
Can be used while breastfeeding
Is useful for women who cannot take estrogens
May reduce heavy, painful periods
What are their main disadvantages?
May cause irregular bleeding for the first few months
Can cause side effects such as headaches, tender breasts, changes in mood and sex drive, and bloating
Do not protect against STIs
It may take a while until fertility is vestured

17. Vaginal 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 month
Thicken the mucus of the entrance to the womb, making it difficult for sperm to get through

18. Vaginal ring What are their main advantages?
An alternative form of hormonal contraception which is used only once every four weeks
May make a woman’s periods more regular, lighter and may reduce cramping
What are their main disadvantages?
Can cause vaginal irritation, discomfort or discharge
May cause nausea and breast tenderness
Some women may be able to feel it
Do not protect against STIs

19. Intra-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 years
How do they work?
Thicken the mucus in the neck of the uterus, making it difficult for sperm to enter
Change the lining of the womb

20. IUS What are their main advantages?
Can be fitted and forgotten - effective for up to five years
Do not interrupt sex
Option for women who cannot tolerate estrogens and those breast-feeding
Periods usually become much lighter and shorter, and less painful
Can offer protection against pelvic infections and cancer of the uterine lining
Normal fertility returns quickly when the IUS is removed
Not affected by other medicines
What are their main disadvantages?
Can cause irregular bleeding for the first three months
May cause temporary side-effects such as headaches, breast tenderness and nausea
Do not protect against STIs
Can be expelled or displaced by the womb
May rarely perforate the womb or cervix

21. Intra-uterine devices (IUD)
What are they?
Small plastic and copper T-shaped devices,
which are inserted into the cavity of the womb
by a trained doctor or nurse
How 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

22. IUD What are their main advantages?
Can be fitted and forgotten - effective for three to ten years
Do not interrupt sex
Normal fertility returns as soon as it is removed
What are their main disadvantages?
May cause heavier, longer or more painful periods, increased cramping and dizziness
Can increase the risk of pelvic infections
Do not protect against STIs
Can be expelled or displaced by the womb
Can perforate the womb or cervix

23. Diaphragms & caps What are they?
Dome-shaped circles made of rubber or silicone that
is inserted into the vagina, requires initial fitting by
a doctor or nurse
Coated with spermicidal cream for extra protection
Must 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

24. Diaphragms & caps What are their main advantages?
Necessary only when having sex
No serious health risks
Can be inserted at any convenient time before sex
What are their main disadvantages?
Insertion can interrupt sex
Spermicide can be messy
Insertion and expulsion need to be practiced
Can cause vaginal irritation

25. Natural family planning
What are they?
Withdrawal method - penis is withdrawn from the vagina prior to ejaculation
Natural method – sex is avoided at fertile times of the month. Fertility is monitored using the following methods
Keep a daily record of your body temperature using a special fertility thermometer
Look for changes in the stickiness of the mucus around the entrance to the womb
Calculate 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)

26. Natural family planning
What are its main advantages?
Can be used to plan as well as avoid a pregnancy
Does not involve any chemical agents or physical devices
No physical side-effects
Allows women to become more aware of their fertility
Helps women communicate about their fertility and sexuality
Acceptable to all faiths and cultures
What 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 ejaculates
Fertile periods not confirmed until three to six cycles are completed
Necessary to keep daily records
Events such as illness, stress and travel may make fertility indicators harder to interpret
Necessitates intercourse avoidance during the fertile time
Both partners need to be very committed to the method
Does not protect against STIs

27. Emergency 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 regularly
How does it work?
Emergency methods work mainly by preventing ovulation and fertilisation
They also have local effects on the uterus
They are not effective once the process of fertilisation and implantation has begun

28. Emergency 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 intercourse
IUDs – can be fitted up to 120 hours (5 days) after unprotected sex by a trained doctor or nurse

29. Sterilisation What is it?
Permanent method of contraception for people who do not want children now or in the future
How does it work?
Male sterilisation
The tubes that carry sperm are cut, so that
while a man can still ejaculate, no sperm is present
Female sterilisation
The fallopian tubes are cut or blocked so that
the egg cannot travel down to meet sperm

30. Sterilisation What are its main advantages? Almost 100% effective
Does not interrupt sex
Can be performed and forgotten
What 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

31. Contraceptive effectiveness
Method
Reliability
The number of women out of 1000 who get pregnant in the course of one year with perfect use
Male condom1-6
Reasonable 70
Female condom7 50
Combined pill1-6
Very high
0.3
Progestin-only pill1-6 4
Patch1-6 10
Vaginal ring1-6
Injection1-6
Implant7
0.5
IUD7
High 5
IUS1-6 1
Diaphragm1-6 60
Male sterilisation7
0.1
Female sterilisation1-6
Withdrawal method1-6
Unreliable
100
Natural method7
Low- reasonable
30-90
Family 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.

32. Things 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?