Contraception

What is an IUD? 

The IUD is a small T-shaped device, which consists of plastic or copper stem, the edge of which is attached to two thin threads. These thin strands are extending from the cervix into the vaginal vault. The IUD is placed by your physician and the effect will last for at least five years.

How effective is the IUD? 

Of the 100 women who have regular intercourse and are not using contraception, about 90% of them will become pregnant within a year. Of the 100 women using IUD, up to 2% of these women may become pregnant within a year. For some newer types of IUDs, less than one woman in 100 will become pregnant after many years of use.

How does the IUD works? 

The main way by which the IUD exerts its action is by preventing the sperm to approach the egg. It can also cause the following:

• To make the egg less flexible as it passes through the tubes and
• ​To prevent the implantation of the fertilised egg in the endometrium.

What are the benefits of IUDs?

• It’s effect starts from the time it is placed,
• The woman does not have to worry about contraception throughout the time the IUD is in place
• It’s contraceptive effect lasts for at least five years,
• ​ It does not disrupt sexual intercourse.

What are the disadvantages of IUDs?

• Your periods may become more severe and last longer, sometimes more painful. These symptoms usually disappear after a few months. There is a very small possibility that the coil may contribute in developing an intrauterine infection in the first 20 days after it is placed. For this reason, some doctors advise to check for the diagnosis of potential pathogens in the vagina and the cervix of the woman prior to place the IUDs. If a woman falls into the category of increased risk of the possibility of sexually transmitted infections (women who frequently change sexual partners or their sexual partner has other sexual partners in parallel) then the IUD is not the right method of contraception, as pelvic inflammatory disease can occur very easily. • It is possible that the womb ejects the IUD. This is more likely to occur in the period immediately after installation and may not come to your attention.
• ​For this reason, your doctor will tell you how it is possible to check the threads of the coil each month.
• The IUD can penetrate the uterine wall when is placed. This is extremely rare when the coil is placed by an experienced doctor.
• If you become pregnant while having an IUD inserted, then the pregnancy that develops can be found outside the uterus in one of the fallopian tubes. For this reason, you need to inform your doctor early.
• The IUD does not protect you from sexually transmitted diseases.

Can any woman use the IUD? 

No, the IUD is inappropriate for some categories of women. For this reason, the doctor will take the appropriate history to determine whether there are reasons why this method is contraindicated. Situations that this contraceptive method should be avoided are:

• ​When the woman suffers from heavy vaginal bleeding that their cause has not been investigated sufficiently,
• When the woman suffers from a Sexual Transmitted Disease,
• She had an ectopic pregnancy in the past
• Suffering from heavy and painful periods and
• Sexual partner has simultaneously other sexual partners.

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How to insert an IUD? 

The IUD is inserted by your doctor in the days at the end of the period or a few days after the period. The doctor will perform a pelvic exam to determine the location and size of the uterus prior to placement of IUD. You must be sure there is no chance that you are pregnant before placing the coil. Sometimes the fitting of IUDs can be uncomfortable, which is why before you start the process it is sensible to take a painkiller. You can discuss this with your doctor. After having the coil, it is possible in the early days to feel some discomfort similar to menstrual pain, as well as noticing some very slight vaginal bleeding. In such case the use of painkillers daily is sufficient.

What to do if a woman does not feel well after placing IUDs? 

If the woman feels severe pain in the lower abdomen with hot and smelly vaginal fluids in the first three weeks after placement of IUD, then she should consult her doctor as soon as possible. This is necessary to exclude the possibility of a pelvic infection.

How one would know that the IUD is in place? 

The IUD has two threads that are attached to one end of IUD and projecting from the cervix to the top of the vagina. Your doctor will show you how it is possible to feel these threads and to check that the IUD remains in place. You should be familiar with this process from the first month and from there onwards to make this test once every two months usually after the end of your period. It is quite unlikely that the IUD can be expelled by itself, but if you are not able to feel the threads, or if you think you can actually feel the IUD, then tell your doctor as soon as possible. Meanwhile, use an additional contraceptive method such as condom.

Can the woman use tampons if she has placed the IUD?

There is no problem with using either tampons or sanitary towel during the period in women using intrauterine device (IUD).

How often you need to visit the doctor after placing IUDs? 

You need to visit your doctor about six weeks after placing the IUD and from there on, once a year during your regular gynecological check-up.

What if I change my mind? 

Then the IUD can be removed easily in the office of your gynecologist. What you should have in mind is that you must use an additional contraceptive method such as condoms, for at least 7 days prior to removal the IUD. The woman’s fertility returns immediately after removal of IUD.

Does the IUD affect my periods? 

Periods of women can be both prolonged and more severe especially in the first months after placing the coil. Sometimes there is also a very light vaginal bleeding between the first few cycles of your period after placing the coil.

What if in the unlikely event I become pregnant while using the IUD? 

It is quite rare to happen. In such a case, however, there is a possibility for the pregnancy to lie outside the uterus, in one of the tubes. Therefore, if this happens you should consult your doctor as soon as possible. If you decide to continue with the pregnancy and it is found that this is not ectopic pregnancy, the IUD should be removed as soon as possible by your doctor. This would reduce the likelihood of spontaneous abortion. However, despite the removal of IUD, spontaneous abortion can still happen. If you do not have spontaneous abortion, the IUD is not going to harm the fetus.

Can a woman use IUD soon after her baby’s birth? 

The IUD is usually placed 6 weeks postpartum. If sex begin before placing the IUD, then you need to use another contraceptive method.

What is the MIRENA coil?  

A MIRENA coil is a small T-shaped intrauterine system device which contains the hormone progestogen. A trained doctor will put it into your womb. The MIRENA coil slowly releases the progestogen hormone. At the moment, the MIRENA coil is licensed to be used for up to five years.

How effective is an MIRENA coil? 

Out of every 100 women who don’t use any contraception, 80 to 90 will get pregnant in a year. Out of every 100 women who use an MIRENA coil, less than one woman will get pregnant in a year. It is more effective than the contraceptive pill and the standard Intrauterine device (Standard coil).

Can anything make the MIRENA coil less effective? 

Once an MIRENA coil has been put into your womb you are protected from getting pregnant unless the MIRENA coil is removed or comes out.

How does the MIRENA coil works? 

A MIRENA coil works in a number of ways:

• It thickens the mucus in your cervix, so it helps to stop sperm reaching an egg.
• It makes the lining of your womb thin.
• In some women it stops the ovaries releasing an egg (ovulation), but most women who use a MIRENA coil ovulate.

What are the advantages of the MIRENA coil?

• It works as soon as it is put in.
• t works for at least five years.
• After you have used an MIRENA coil for about three months or so your periods usually become much lighter and shorter, so an MIRENA coil can be useful if you normally have very heavy painful periods.

What are the disadvantages of the MIRENA coil?

• A MIRENA coil usually reduces or gets rid of period pain.
• Most women have slight bleeding between their periods, for the first three months or so.
• You may get temporary side-effects such as headaches, acne and breast tenderness. If you do get any of these they usually go away after a few months.
• Some women may have cysts on their ovaries in the first few months. These are not dangerous and do not need to be removed. 0ften there are no symptoms, but some women may have pain. These cysts usually disappear without treatment.
• The womb can push the MIRENA coil out (expulsion). This is most likely soon after it has been put in and you may not know it has happened. This is why your doctor will teach you how to check your MIRENA coil every month.
• The MIRENA coil might go through (perforate) the womb or cervix when it is fitted. This may cause pain, but often there are n0 symptoms. The MIRENA coil may have to be removed by surgery. Perforation is very rare when a MIRENA coil is fitted by an experienced doctor.

Can anyone use a MIRENA coil? 

Not everyone can use a MIRENA coil and your doctor or nurse will need to ask you about your medical history. Some of the conditions which mean you should not use a MIRENA coil are:

• if you have cancer of the womb or ovary;
• if you have had a tumour on your liver;
• if you have irregular or heavy bleeding from your vagina with no known cause;
• if you have had a heart attack or stroke (severe arterial disease);
• if you have at untreated genital infection; or
• if you have an artificial heart valve.

If I haven’t had a child, can I use a MIRENA coil? 

Having a MIRENA coil fitted might be more uncomfortable if you haven’t had children, but you can use one.

How is a MIRENA coil fitted? 

A MIRENA coil has to be put in and removed by a specially trained doctor. It is put in either during your period or a few days after. The doctor must make sure there is no chance of you being pregnant before they fit an MIRENA coil. It is easier to put the MIRENA coil in during your period as your cervix will be a little softer. The doctor will examine you internally to find the position and size of your womb before he or she fits the MIRENA coil. It can be uncomfortable having an MIRENA coil fitted and you might want to have a painkiller or a local anaesthetic. Talk to your doctor about this beforehand. You may get a period-type pain and some bleeding for a few days after the MIRENA coil is fitted. You can talk to your doctor about taking painkillers to help with this.

After is fitted, do I have to do anything? 

A MIRENA coil has two threads attached to the end which hang a little way down from your womb into the top of your vagina. The doctor or nurse will teach you to feel for the threads to make sure the MIRENA coil is still in place. You should do this regularly in the first month and then after each period or at regular intervals. It is very unlikely that an MIRENA coil will fall out, but if you cannot feel the threads you should see your doctor 0r nurse straight away. In the meantime, use an extra contraceptive method, such as condoms. Rarely, your partner may say he can feel the threads during sex. If this is the case, get your doctor or nurse to check the threads and either move them out of the way or shorten them.

Is it safe to use tampons if I have a MIRENA coil fitted?

You can use either tampons or towels during your periods if you have a MIRENA coil.

How often do I need to see a doctor? 

You need to have your MIRENA coil checked by a doctor or nurse six weeks after it is put in, and then once a year. The MIRENA coil can stay in for five years.

What if I changed my mind? 

Your doctor can take out the MIRENA coil at any time. If you are not going to have another MIRENA coil put in, and you do not want to become pregnant, you will need to use an extra contraceptive method, such as condoms, for a week before the MIRENA coil is taken out. This is to stop sperm getting into your body. Sperm can live for several days inside your body, and could fertilize an egg once the MIRENA coil is removed.

Will a MIRENA coil affect my periods? 

Most women find that after the first few months, their periods become lighter than usual. Some women may find that their periods stop altogether. If this happens to you, do not worry as it is perfectly healthy. Your periods will return to normal after the MIRENA coil is taken out.

What if I get pregnant while I am using the MIRENA coil? 

It is very rare to get pregnant with the MIRENA coil, but if you miss a period and are worried that you might be pregnant you should see a doctor or nurse as soon as possible. If you are pregnant your doctor will need to take out the MIRENA coil.

I’ve just had a baby. Can I use anMIRENA coil? 

You can have a MIRENA coil fitted about six weeks after you have given birth. If you have sex in the meantime you should use another contraceptive method until then.

How soon can a MIRENA coil fitted after an abortion or miscarriage? 

You can have a MIRENA coil fitted immediately after an abortion or miscarriage.

I want to have a baby. Will I be able to get pregnantas soon as the MIRENA coilis removed? 

​Your usual fertility returns as soon as the MIRENA coil is taken out. You will usually have a period within a month of the MIRENA coil being removed.

What is it? 

The combined pill is usually just called the pill. It contains two hormones -oestrogen and progestogen. These are similar to the natural oestrogen and progesterone women produce in their ovaries.

How effective is the pill? 

How effective any contraceptive is depends on how old you are, how often you have sex and whether you use the method properly Out of every 100 women who don’t use any contraception 80 to 90 will get pregnant within a year. If women use the pill carefully less than one woman in 100 will get pregnant in a year. If women are less careful in the way they use their pill, more women will get pregnant.

Can anything make the pill less effective? 

The pill may not work properly if:

• You miss a pill.
• You vomit within three hours of taking the pill.
• You have very severe diarrhea.
• You take a prescribed medicine that affects how the pill works.

How does the pill works?

• It stops your ovaries releasing an egg each month (ovulation).
• It thickens the mucus from your cervix and so makes it less easy for sperm to get through to meet an egg.
• ​It makes the lining of your womb thin.

What are the advantages of the pill?

• The pill doesn’t interfere with sex.
• The pill usually makes your periods shorter, lighter and less painful.
• The pill can help to relieve the symptoms women often experience before their period (pre-menstrual syndrome).
• The pill gives good protection against two types of cancer – cancer of the ovary and cancer of the womb.
• The pill protects you against some pelvic infections which can cause you to become infertile.
• The pill reduces the risk of fibroids (tumors in the womb that are not cancerous), cysts on your ovaries and breast disease which isn’t cancerous.
• ​If you are healthy and a non-smoker, you can take the pill until your menopause.

What are the disadvantages of the pill?

The pill is not suitable for some women. your doctor or nurse will need to ask you a lot of questions about your health to find out if you can take the pill. You may get temporary side-effects .u hen you first start the pill. These side-effects include:

• headaches
• breast tenderness
• weight gain or loss
• bleeding between periods
• mood changes
• feeling less interested in sex.

These side-effects should stop after about three months. If not, changing your type of pill may help. The pill is not suitable:

• If you are over 35 and you also smoke.
• The pill may increase your blood pressure.
• The pill does not protect you against sexually transmitted diseases (STDs).

Not all of the combined pills are suitable for all women. How suitable a particular pill is depends on your own and your family’s medical history. You will need to talk about this with your doctor, The pill can have some serious side-effects, but these are rare. A few women may develop a blood clot which can block a vein (venous thrombosis) or an artery (arterial thrombosis or heart attack or stroke). If you have had a previous thrombosis, you should not use the pill.
The risk of venous thrombosis is greatest if any of the following apply to you: you are very overweight, are immobile (in a wheelchair), have varicose veins or a member of your family had a venous thrombosis before they were 45.
The risk of arterial thrombosis is greatest if any of the following apply to you: you smoke, are diabetic, have high blood pressure, are very overweight, or a member of your family had a heart attack or stroke before they were 45. You may need to have some special blood tests.
Depending on the results, the combined pill may not be suitable for you.

• There is some research that suggests taking the combined pill when you are young and using it for several years may slightly increase the small risk of you getting breast cancer unusually early (before the age of 35). More research is being carried out into this.
• There is also some research to suggest a link between using the pill and developing cervical cancer. Other research has not shown this, so new research is being carried out to provide a clearer picture.
• Some research suggests a link between using the combined pill and developing a very rare liver cancer.

Over the years the pill has often been blamed for side-effects which were due to other causes, particularly smoking. The pill is much safer medically than many people think, and for most women its benefits outweigh the possible risk.

Can anyone use the pill? 

Not everyone can take the pill and a doctor will ask you for details of your own and your family’s medical history It’s important to give as much information as you can about this. Some of the conditionswhich mean you should not take the pill are:

• If you have had thrombosis (blood clots) of any type.
• If you get a special type of migraine known as focal or crescendo migraines.
• ​If you have abnormal bleeding from your vagina (for example, between periods or after sex).
• If you have heart or circulatory disease.
• If you have an active disease of the liver.
• If you have cancer of the breast, ovary or womb.

Are there different types of pill? 

Yes, there are different types of pill to suit different women.

The 21 day pill: You take one pill a day for 21 days then no pills for the next seven days. Each pill has the same amount of hormone in it (these are called monophasic pills). This is the most common type of pill.

The phasic pills: You have two or three sections of different coloured pills in the pack. They contain different amounts of hormone so you must take them in the right order. You take one pill a day for 21 days then no pills for the next seven days.

The Every Day pill: You take one pill a day for 28 days with no break between packets. There are 21 active pills and seven inactive pills which don’t contain any hormones. It is important to take these pills in the right order.

How do I start the pill? 

The 21 day pill and the phasic pill You take your first pill on the first day of your period. You are then immediately protected against becoming pregnant. If you start the pill any later than this you will not be protected for seven days. So if you do have sex you need to use an extra contraceptive method, such as a condom.

The Every Day pill 
It is very important to take these pills in order as seven of the pills are inactive. Always start with the first pill from the red part of the pack. If you take your first pill on the first day of your period you will be protected from day 15. So you need to use an extra contraceptive method for the first 14 days.

How do I take the pills after this? 
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The 21 day pill and the phasic pill 
You take all 21 pills in the pack. You must take phasic pills in the right order. You then don’t take any pills for the next seven days and you will probably bleed during this time. You then start the next pack of pills whether or not you are still bleeding. You will always start a new pack of pills on the same day of the week, it can be useful if you make a note of that day.

The EveryDay pill 
You must take the 28 pills in the pack in the right order. When you finish a pack you should start another the next day You must always start with the first pill from the red part of the pack.

Am I protected during the seven day break?

You are protected during the seven day break if you have taken all the 21 pills properly and you start the next pack on time. And it is important not to have longer than a seven day break. Having sex during these seven days is only safe if you start the next packet on time. Never make the mistake of starting your next pack late or missing any of the first seven pills in the pack. This is much more risky than missing a couple of pills in the middle of the pack. This is because during the seven day break your ovaries are not getting any effects from the pill. If you ever make this break longer than seven days your ovaries might release an egg.

What makes the pill less effective? 

The following make the pill less effective:

• If you miss a pill If you vomit within three hours of taking the pill or if you have very severe diarrhoea.
• If this happens continue taking the pill as usual and use an extra method, such as a condom, for seven days after the stomach upset. If the seven days of using extra contraception goes into your pill free week start a new pack of pills immediately and do not have the usual break.
• ​If you take a prescribed medicine that affects how the pill work. These include antibiotics and some treatments for epilepsy In this case you may have to use an extra contraceptive method, such as condoms, while you are taking the medicine and for seven days afterwards. If the seven days of using extra contraception goes into your pill free week, start a new pack of pills immediately and do not have the usual break. If you are prescribed any drugs, tell the person giving you the prescription that you take the combined pill.

What do I do if I forget a pill? 

If you are no more than 12 hours late in taking a pill, don’t worry just take the pill straight away and carry on with the pack as usual.
If you are more than 12 hours late and there are no more than seven pills left in the pack: Take the last pill you missed right away but leave any other pills you have missed in the pack. Take the rest of the pack as usual and use an extra contraceptive method, such as condoms, for the next seven days. When you have finished the pack start your next pack the next day. Do not have the usual seven day break between packs. You may have some bleeding when you are taking the pill but this is quite normal.

What’s involved if I take emergency pills?

You take two special sets of pills within 12 hours from the time of unprotected sex.

How do emergency pills work? 

The pills may stop an egg being released (ovulation). Or they may stop a fertilized egg settling in your womb (implanting).

When do I take them? 

You must take the set of 2 pills within 12 hours of having unprotected sex. However the pills can prevent pregnancy up to 3 days (72 hours) after the accident.

How effective are the emergency pills? 

Over 95% of women who take emergency piils do not become pregnant.

What are the disadvantages of the emergency pills? 

You may feel sick, although this may be less likely if you take the pills with food. Some doctors prescribe tablets to stop you being sick, or you can buy anti-sickness tablets from a pharmacy. Emergency pills are suitable for most women, but a few women will not be able to use them. Your doctor will be able to give you advice.

Do I need to see a doctor after I take them? 

It is a good idea to have a check-up with your doctor. This will usually be about 3 weeks after you have taken the pills. Have a check-up whether or not you have had a period. If you do not get a period within 3 weeks, you will need to see your doctor to make sure all is well.

Can the emergency pills fail? 

The emergency pills have a failure rate of up to 5%. They are most likely to fail if: . you take them more than 72 hours after unprotected sex;

• you vomit within 3 hours of taking the pills;
• you have had unprotected sex at another time since your last period; or .you have unprotected sex after taking the pills.

What if I vomit within 3 hours of taking the pills? 

Speak to your doctor as soon as possible. He/she may give you extra pills and anti-sickness tablets to stop you vomiting again. Or they may suggest fitting a copper IUD.

If the emergency pills fail will they harm the baby? 

If you do become pregnant, the emergency pills you took have not been shown to affect the pregnancy or harm the baby.

Can anybody take emergency pills? 

If you have had a blood clot (thrombosis), you may not be able to take emergency pills. If you have bad migraine at the time, this may mean you should not take them.

Why shouldn’t I use emergency pills regularly? 

Emergency pills are not as effective as using any other contraceptive method regularly. If you do not want to become pregnant you should always use contraception when you have sex.

Is there any other method of emergency contraception?

Yes, you can have an IUD fitted. It must be fitted within 5 days of having unprotected sex, or within 5 days of the earliest time you could have released an egg (ovulation).

How does the IUD work? 

​It may stop fertilization or a fertilised egg to implant in the endometrium.