Birth control (pills, patches, implants and more)

Some forms of contraception are readily available for purchase, including male and female condoms and the contraceptive sponge. However, treatments that need to be administered or prescribed by a health professional will require a visit to your GP, family planning clinic or sexual health clinic. These include the contraceptive pill, contraceptive implants and IUDs.

There can be a lot of uncertainty regarding what questions you’ll be asked and what information will be required when visiting a family planning service. Most often, your health care clinician will want to discuss your medical history and sexual history to understand what contraception would work best for you.

In the UK, most types of contraception are available for free through the NHS, including emergency contraception. Birth control is available from sexual health or GUM clinics, community contraception clinics, most GP surgeries and some young people’s services.

Birth control is available confidentially for anybody over the age of 16, as long as there is no serious risk to your safety or welfare. Between the ages of 13 and 16, birth control is also available confidentially so long as your healthcare provider believes you fully understand the information and decisions involved. They may encourage you to tell your parents, but they won’t do so themselves, unless there are concerns for your safety, in which case this will be discussed with you.

If you’re under the age of 13, your healthcare provider may wish to involve other people for your own protection. As the law states you cannot legally consent to sexual activity, these people may include your parents, legal guardians or a social worker.

Some forms of birth control are available without a prescription, including male and female condoms, and the contraceptive sponge. However most contraceptive pills will require a prescription, and any treatments administered by a healthcare professional, such as an IUD, will involve a visit to your GP or sexual health clinic.

How it works

The combination pill uses the hormones oestrogen and progestogen to help prevent unwanted pregnancy. As well as stopping the ovaries from releasing an egg each month, it also thickens the mucus of the cervix. This makes it more difficult for the sperm to reach an egg. Lastly, it thins the lining of your uterus so it’s less likely to accept a fertilised egg.

Pros

The pill appeals to many women because it doesn’t have to be inserted or implanted. The combination pill also reduces the severity of period symptoms and can be integrated into your daily routine. A lot of women also like the fact that they take something each day but not at the time of intercourse.

Cons

If you ever forget to take the combination pill, you may need to use a secondary birth control method as well. In order to be effective, the combination pill must be remembered on the days you are supposed to take it. Also, they do not protect you against STIs.

Another side effect includes the increased risk of deep venous thrombosis (DVT) by 0.06% to 0.2%. It is important to report any persistent headaches, chest pain or calf pain to your doctor immediately. There is also a small increase in breast cancer which disappears after stopping the pill.

What is a tubal occlusion?

Tubal occlusion is a surgical procedure that permanently prevents pregnancy. The fallopian tubes are sealed or blocked, preventing the eggs from reaching the sperm and becoming fertilised.

Pros

Tubal occlusion is one of the most effective methods of birth control. It should be effective immediately, and will not affect your sex drive or hormone levels.

Cons

Female sterilisation does not protect against STIs and cannot be easily reversed. Though very rare, the fallopian tubes can slowly rejoin and make you fertile again. There is a very small risk of serious complications such as internal bleeding, infection or organ damage. It is also thought to cause earlier menopause in some women.

What is a vasectomy?

A vasectomy is a surgical procedure that permanently prevents pregnancy. A small incision is made to the scrotum, and the tubes that carry a man’s sperm (vas deferens) are sealed or tied. This prevents sperm from being released during ejaculation.

Pros

A vasectomy is one of the most effective methods of preventing pregnancy, with long-term side effects being rare. It also allows you to have unprotected sex without the risk of unwanted pregnancy

Cons

A vasectomy is only effective after three months, during which time you’ll have to use a secondary birth control option. As a permanent option, it is also very expensive and may be impossible to reverse. It is commonly done under local anaesthesia but some men may feel pain during the surgery. It does not protect against STIs.

What are fertility awareness methods?

Otherwise known as natural family planning, there are three main types of fertility awareness methods. These are the temperature method, the cervical mucus method and the calendar method. It is most effective to combine all of these methods, known collectively as the “symptothermal method”.

If using the temperature method, you take your temperature every morning before you get out of bed. This will help you track days where are you are less fertile (known as safe days).

The cervical mucus method and calendar method also help you track days where are you are most fertile, by keeping track of your mucus (or discharge) every day or marking the days your periods start and end respectively.

Pros

Fertility awareness methods make you more aware of your fertility and can help you to plan how to reduce the risk of pregnancy. As a natural method, there are also no physical side effects, and these methods can help you recognise normal and abnormal vaginal secretions.

Cons

It takes between 3 and 6 menstrual cycles to fully learn fertility awareness methods effectively, and you have to successfully maintain a daily record. You will also still need to use another form of birth control, such as male and female condoms, during periods of fertility. Be aware that this is one of the least effective methods of preventing pregnancy, therefore you may still become pregnant when using this method. It does not protect against STIs.

What are emergency contraceptive pills?

Emergency contraceptive pills release hormones that either stop or delay ovulation. It is not recommended that these are used as a form of contraception.

One type, Levonelle, contains a synthetic version of progesterone called levonorgestrel. Taking Levonelle stops or delays ovulation and needs to be used within 72 hours of sexual intercourse. The other type of emergency contraceptive pill, ellaOne, contains ulipristal acetate. This prevents progesterone from working normally, also stopping or delaying the release of an egg. This needs to be used within 120 hours of unprotected sex.

Pros

Emergency contraceptive pills are a safe method of preventing pregnancy after unprotected sex.

Cons

You will not be protected from future pregnancy and will need to start using another form of contraception. You might also experience temporary side effects such as nausea, breast tenderness, headache or dizziness. Emergency contraceptive pills may require a visit to a clinic, and sometimes a prescription.

How you take the contraceptive pill will depend on the type that you use. The combination pill comes in 21-day packs, 28-day packs and 91-day packs. On the other hand, POPs only come in 28-day packs.

If you’re taking pills from a 21-day pack, take either the first pill from the packet marked the correct day of the week, or the first pill of the first colour. Continue taking these pills at the same time each day until the pack is finished. Then, stop for seven days, during which you will get a bleed. The next day should be the same day of the week as when you started, and you should now start your next pack.

If you’re taking pills from a 28-day pack, take the first pill from the section marked “start”. This will be an active pill. Continue taking one pill a day in the correct order until the pack is finished. During the seven days of placebo pills you will get a bleed. Start the next pack of pills after finishing the first. The 7 days of the placebo pill is useful to keep you in the habit of taking the pill each day.

To use a male condom, follow these steps. You should always put on the condom while the penis is erect and before it comes into contact with your partner’s body.

• Open the foil packaging carefully, making sure not to tear the condom
• Hold the tip of the condom between forefinger and thumb, and squeeze out the air
• Place the condom over the tip of the penis and unroll it fully to the base
• If the condom won’t unroll, it’s probably inside out. Repeat the previous steps with a new condom as there may be sperm on the condom.
• Withdraw the penis immediately from the vagina after ejaculation.

Female condoms provide couples with another contraceptive option to use before sex. Female condoms should always be inserted before the penis touches the vagina in order to prevent pregnancy.

If you’re uncertain of how to use female condoms, follow these steps:

• Remove the female condom from the packaging, being careful not to tear it
• Place the closed end of the condom into your vagina, using your middle finger and thumb to insert it. Use your finger to push the condom as far up into your vagina as possible
• The outer ring of the condom should rest closely on the outside of your vagina at all times during intercourse. If the outer ring enters your vagina, stop and put it back into place
• Guide your partner’s penis into the condom, making sure it doesn’t slip between your vagina and the condom
• After sex, remove the condom. Twist the outer ring so that the semen is contained within and gently pull the condom out of your vagina. Dispose of the condom in the bin, not the toilet

You may be looking to take a proactive approach to birth control and want to make contraception part of your daily routine. Some methods may be used only when you have sex, or some you could take at the same time each day. Creating a contraceptive routine reduces the likelihood that you forget about your birth control.

If you’re looking for a method you can use each time you have sex, consider male condoms, female condoms, diaphragms or cervical caps. If you’d rather a birth control option you can take daily, consider 28-day packs of the combined pill or the mini pill.

If you’re using the IUD as emergency contraception, this device is inserted into your womb by a doctor or nurse. It then releases copper to prevent the egg from implanting in your womb or being fertilised.

In contrast, emergency contraceptive pills use hormones to prevent pregnancy. Levonelle contains levonorgestrel, a synthetic version of the hormone progesterone that is usually produced by the ovaries. Taking Levonelle stops or delays ovulation.

Meanwhile, ellaOne contains ulipristal acetate, which prevents progesterone from working normally. This also stops or delays the release of an egg.

The emergency contraceptive pill can be used by most women, including those under 16 and those who cannot use hormonal contraceptives such as the combined pill or contraceptive patch.

However, you may not be able to take the emergency contraceptive pill if you have severe asthma, are allergic to anything in it, or take any medicines that may interact with it. These medicines include:

• Some medicines used to treat HIV, epilepsy or tuberculosis
• The antibiotics rifampicin and rifabutin
• Medicine which makes your stomach less acidic, such as omeprazole
• The herbal medicine St John’s Wort

If you need emergency contraception, it is available for free from a number of places:

• Contraception clinics
• Sexual health or GUM clinics
• Most pharmacies
• Most NHS walk-in centres and minor injuries units
• Some young people’s clinics
• Some GP surgeries
• Some A&E departments, though it is advised you phone first to check

You can find your nearest sexual health information and support services here.

If you’re already using regular contraception, you may still need to take the emergency pill in certain circumstances:

• If you forgot to use your regular contraceptive pills, or you had diarrhoea or vomiting in the week before the intercourse
• If you used your contraceptive patch or vaginal ring incorrectly
• If you were late having your contraceptive injection or contraceptive implant

If in doubt, use a secondary method of contraception such as male condoms or female condoms to help avoid unwanted pregnancy.

Your next period should come at the expected time and may be heavier. However, if it is lighter or shorter, or you miss your next period, you should do a pregnancy test and see a GP or healthcare professional.

The only way to be certain if emergency contraception has worked for you is to complete a pregnancy test. Pregnancy tests are accurate if the test is done within three weeks of the last time you had unprotected sex.

It is important to know that the emergency contraceptive pill will not continue to prevent pregnancy. If you have unprotected sex again, you’re still at risk of becoming pregnant.

However, you can continue using the IUDs as a regular contraceptive method. This will be a highly effective birth control option at preventing pregnancy.

A vasectomy, also known as male sterilisation, is a surgical procedure that permanently prevents pregnancy by cutting or sealing the tubes (vas deferens) that carry a man’s sperm. The female equivalent of a vasectomy is tubal occlusion.

Usually, this procedure is carried out under local anaesthetic and takes about 15 minutes. This means that you’re awake, however, you won’t feel any pain. On rare occasions, the procedure is completed using a general anaesthetic. This means that you’ll be asleep during the surgery.

During a vasectomy procedure, you’ll first be given local anaesthetic. A doctor will then make a small puncture (known as the no-scalpel method) or small cuts on the skin of your scrotum. This provides access to the vas deferens.

Vasectomies work by tying or sealing the vas deferens tubes with heat, stitches or plugs. On some occasions, a small piece of each tube is removed. This procedure usually takes between 10 and 15 minutes.

Once complete, you may be given dissolvable stitches or surgical tape. However, stitches are not always needed.

If you’ve had a vasectomy, you’ll usually need to avoid sex and strenuous activity for a week. During this time, it is common to have some mild discomfort, swelling and bruising of your scrotum. It is also common to have blood in your semen the first few times you ejaculate after the procedure. This isn’t harmful, and shouldn’t be cause for concern.

If you’re looking to ease your recovery, there are some steps you can take:

• Underwear. Wear tight-fitting underwear or athletic support for the first few days and nights. This helps support your scrotum and eases any discomfort or swelling. Make sure to change your underwear every day.
• Hygiene. You should be able to have a bath or shower after your operation, though it’s recommended that you check with your doctor beforehand. Afterwards, make sure you dry your genital area gently and thoroughly.
• Work. Although you can usually return to work after 1 or 2 days, you should avoid sport and heavy lifting for at least 1 week.
• Sex. You can have sex again as soon as you feel comfortable to do so. However, you’ll need to use another method of contraception for at least the first 12 weeks until you have done a clear sample. It can take this long to clear the remaining sperm from your tubes.

The first step in having a vasectomy should be consulting your GP or a healthcare professional. You will be able to discuss the procedure with them, and they will be able to inform you of its benefits and potential risks.

A vasectomy is then available on the NHS, however, the waiting list can be long.

The main advantage of a vasectomy compared to other types of contraception is that it’s permanent. Once sterilisation has worked you’ll no longer have to use contraception again.

Other advantages include it’s high effectiveness, that it does not interfere with sex and that any long-term effects on your health are rare.

Compared to other, less permanent forms of birth control, there can be a number of disadvantages unique to a vasectomy. These include:

• A vasectomy cannot be easily reversed, and reversals are very rarely provided on the NHS
• A vasectomy does not protect against STIs, so you may need to use a condom as well
• Surgery is required
• The vas deferens may rejoin and you’ll be fertile again, though this is rare.
• You will still need to use contraception for at least 12 weeks after the procedure. This is so that semen tests can confirm the vasectomy has been effective
• Possible complications may include swelling, bruising, bleeding inside the scrotum, infection, fluid buildup in the testicles, and long-term testicle pain.

While it is possible to have a vasectomy reversed, success isn’t guaranteed and vasectomy reversal is very rarely funded by the NHS. In the UK, a vasectomy reversal may cost several thousand pounds.

The sooner after the vasectomy you decide on reversal, the better its chances. Within ten years, the success rate of vasectomy reversal is around 50%. After ten years this can fall to less than 10%.

There are many myths surrounding sex that can increase the risk of unwanted pregnancy. The following myths are not effective for birth control:

• Can I get pregnant if it’s my first time? Women can get pregnant whenever ovulation occurs, even if they haven’t had sex before.
• Can I get pregnant if the man pulls out? Also known as the withdrawal method, pulling out does not prevent conception. Some ejaculate may be released before the man orgasms.
• Can I get pregnant if I don’t orgasm? Pregnancy can occur any time sperm can fertilise an egg. As ovulation occurs separate from sex, it is not necessary for the woman to orgasm in order to get pregnant.
• Can we use a balloon or clingfilm instead of a condom? Condoms are designed to provide a good fit and strong protection, and should not be substituted. Balloons and clingfilm don’t fit well and are easily torn during sex.

You may have heard of LAM (lactational amenorrhoea method), a form of birth control where women use breastfeeding as a form of natural contraception. LAM exists because breastfeeding stimulates the production of prolactin, a hormone that in high levels can stop you from ovulating.

However, LAM is risky as many women don’t know when they’ll start ovulating again. It is possible to get pregnant as soon as 3 weeks after birth, and while breastfeeding. To avoid unwanted pregnancy while breastfeeding, use regular contraception or birth control.

Washing immediately after intercourse does not prevent pregnancy, even if does make you feel clean. If sperm has already entered the uterus, showering or bathing will not be able to clear it. To avoid unwanted pregnancy, be sure to follow a tested birth control method.

Many women want to know how many days after their period they can become pregnant, however, the answer is more complicated than this. It is possible to conceive at any point during your menstrual cycle, although it is most likely during ovulation (usually around 12 to 14 days before your next period). This means that it’s still possible to become pregnant immediately before, right after your period and rarely during the period.

If you’re looking for immediate birth control, there are options available to you. Barrier methods include condoms, diaphragms, cervical caps and sponges all work immediately. Immediate protection is also available if you start taking the combination pill or using the vaginal ring on the first day of your period, have an implant inserted within the first five days of your period, or have a hormonal IUD inserted within a week of your period.

For the contraceptive patch, a week is required until you’re fully protected, while POPs require two days.

Birth control is available freely and confidentially if you’re under the age of 16, so long as you understand the information and decisions involved.

If you’re under the age of 13, your healthcare provider may involve your parents, legal guardians or a social worker. You will still be allowed access to birth control, but they will want to ensure your safety.

If you’re under 16 and want to start using birth control, you can get contraception for free from a number of places. These include sexual health or GUM clinics, community contraception clinics, some GP surgeries and some young people’s surgeries.

You can get free contraception as long as your healthcare provider believes that you fully understand the information and decisions involved.

Though uncommon, it is possible to conceive immediately after giving birth, even if your periods haven’t returned or you’re breastfeeding. Since ovulation usually occurs two weeks before your period arrives, it’s possible to become pregnant before your period.

The best method of postpartum contraception may depend on a number of factors. When choosing a contraceptive method, consider the following:

• How soon? Some methods of postpartum birth control can be used immediately after birth, while some require waiting a few weeks.
• Breastfeeding. While all methods are safe to use while breastfeeding, during the first few weeks some types of contraception may affect your milk supply.
• Effectiveness. Pregnancy can change the effectiveness of certain birth control options. For example, the contraceptive sponge and cervical cap are less effective for women who have recently given birth.

Depending on which type of contraception you want to use, you may need to wait a short amount of time before starting birth control. The contraceptive implant, contraceptive injection, POPs, male condoms and female condoms can all be used immediately after birth, as long as you have no conflicting medical conditions.

It is recommended that you wait four weeks after birth before using IUDs and IUSs. If you’re not breastfeeding and have no medical risk factors for a blood clot in a vein, you can start taking the pill again, or using a vaginal ring or contraceptive patch from three weeks after birth.

If you’re breastfeeding or have conflicting medical conditions, you should use POP, injections, implants or hormonal IUS.. After six weeks, you can also use a diaphragm or cervical cap.

You may be worried that birth control might affect your baby if you’re breastfeeding. Thankfully, while hormonal methods of contraception may cause a small amount of hormones to enter your milk, but no research has shown that this will pose a risk to your child.

If you’re looking to use birth control after pregnancy while breastfeeding, it’s advised that you wait six weeks before using the combined pill, vaginal ring or contraceptive patch. These birth control options contain oestrogen which may lower your milk production. Other methods such as male condoms, female condoms, contraceptive implants or contraceptive injections can be used immediately.

It is a myth that IUDs cause copper to enter your milk.

As there are many types of contraception available, it is difficult to guarantee what effect they may have on your periods. Depending on which method of birth control you use, your menstrual bleeding may be affected in different ways.

Some contraceptives may increase or decrease your bleeding. Others may make your periods longer, shorter, heavier or lighter. Spotting and irregular bleeding are also common when using hormonal contraceptives, especially during the first few months of use.

While there is no guaranteed way of using birth control to delay your period, combined contraceptive pills can help. If you take two packets of the pill back-to-back, you may be able to delay your bleeding by essentially missing a period. This should not be done for more than 3 packs in a row.

If you’re using a 21-day pack, skip the 7-day break when you would usually bleed and start a new packet immediately. For a 28-day pack, skip the placebo pills and start a new packet immediately after the first 21 days.

If you’ve stopped taking the birth control pill and your period hasn’t returned, the first thing is to make sure that you are not pregnant, If negative, you are suffering from amenorrhea. Thankfully, this is a common condition that usually resolves itself.

You should allow yourself up to 3 months after stopping the pill for your bleeding to return although it is still worth doing a pregnancy test to be certain. If your period still hasn’t returned after this time, consult your GP. They will attempt to identify any underlying conditions you may have that might be causing amenorrhea.

If you experience any of the following types of irregular bleeding, it is recommended that you see your GP:

• During pregnancy
• If it occurs after intercourse
• After using the same birth control method for over three months
• If you are younger than 8 or have shown no signs of puberty
• You are bleeding unexpectedly
• Your bleeding is very painful
• You are getting persistent spotting between your periods

Female condoms are a barrier birth control option that prevents sperm from meeting an egg. They are inserted into the vagina before intercourse.

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Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because of the wide spectrum of people she encounters every day.

Dr Alex Eskander is a consultant founder and director of the Gynae centre private practice in Harley Street since 1999. He is a member and a fellow of the Royal College of Obstetricians and Gynaeclogists since 1977. He has a special interest in family planning, pregnancy advice, ultrasound and colposcopy.

Dr Adam Abbs qualified as a doctor from Hull York Medical School in 2010. He started training in hospital medicine but then retrained as a general practitioner. Following leading the development of urgent care services in North Manchester, he joined Medicspot in April 2019. He has a special interest in urgent care and also volunteers for numerous children’s cancer charities.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.