Contraceptive Choices

Contraception is divided into two types:

Short acting contraceptives – these are methods you have to think about regularly or each time you have sex. You must use them according to instructions

Longer acting contraceptives – these do not depend on you remembering to take or use them.

We offer all forms of contraception here at the Bray Women’s Health Clinic (with the exception of Female Sterilisation which requires a general anaesthetic and therefore a hospital stay.)

There are so many methods of contraception to choose from, it is worth taking the time to find out more about each one so that you can choose the method that suits you best.

When you visit the clinic you will be counseled on any or all methods that you think might suit your needs.

BRIEF SUMMARY OF CONTRACEPTION ON OFFER in the BWHC

LONGER ACTING METHODS:
Hormone INJECTION (“DEPO-PROVERA”)

Depo Provera contains a progestogen hormone which is similar to the natural progesterone that women produce in their ovaries. It acts to turn off your egg release from the ovary and so is as safe as the Pill if not safer at preventing pregnancy.

As it contains no oestrogen it is safe to be used by women who have health issues that make the pill unacceptable and is popular among women who are breastfeeding.

The injection is given with a small needle in either the arm or the thigh and lasts 12 weeks. It is over 99 % effective and often used by women who want very reliable contraception without the worry of taking tablets, etc.

The main disadvantage of the injection is that some women may gain weight while using it as well as experiencing changes in their bleeding patterns. Some bleed too much initially and then most ladies go on to have no periods at all while on the injection and for a few weeks or months after stopping it. This can be a problem if planning to get pregnant immediately and we advise women to change from the injection to a different contraceptive about 12 months before trying to conceive.

Hormone IMPLANT (“IMPLANON”)

Often called the “Bar”, the contraceptive implant is a small flexible plastic rod that is placed just under the skin in your upper arm. It releases a progestogen hormone similar to the natural progesterone that women produce in their ovaries. It prevents your ovaries from releasing an egg and works for up to three years. Once removed the hormone levels drop quickly back to normal so fertility returns within days.

The implant is well over 99%t effective and has been shown in studies to be more reliable than either male of female sterilisation and yet is 100% reversible. For this reason it has become a very popular form of contraception in Ireland.

Having it inserted is virtually painless thanks to the local anaesthetic we use and can be done soon after giving birth even if you are breastfeeding.

Hormone IUD (“MIRENA”)

The Mirena is an Intrauterine System of contraception that has been very popular in Ireland over the last 11 years. It is a made of a small T-shaped piece of plastic with a little tube of hormone running down its length. Soft plastic threads hang from the bottom of the device. That tube slowly releases a progestogen hormone similar to the natural progesterone that women produce in their ovaries.

It works for up to five years. If you are aged 45 or older when the IUS is fitted, it can be left in until the menopause or until contraception is no longer needed.

Mirena is over 99 % effective.

The device is inserted via the vagina into the cavity of the womb itself and so requires special training for the inserting doctor. We insert Mirenas as well as other intra uterine devices at the Bray Women’s Health centre every day.

Copper wire IUD (The “COIL”)

Copper Coils were once quite popular in Ireland but since the introduction of the Mirena coil have become less popular. They are still very much available to Irish patients and are a useful alternative especially for women who want reliable contraception without any hormones at all!

Copper coils are small, T-shaped, plastic devices similar to the Mirena but instead of hormone they have Copper wire coiled around the shaft and the arms of the “T”.Like a Mirena they are inserted into your uterus (womb). They also have one or two soft threads on the end. These thin threads hang through the opening at the entrance of your uterus (cervix) into the top of your vagina.

There are different types and sizes of IUD to suit different women. An IUD can stay in for 5–10 years, depending on type. If you are aged 40 or older when the IUD is fitted, it can be left in until the menopause.

Male Sterilisation (“VASECTOMY”)

A vasectomy operation involves removing a small piece of the tube inside the testicles (the VAS) in which sperm travel. It can be done under local anesthetic in a doctor’s office and we offer this procedure every month in the Bray Women’s Health Centre offices.

While very reliable; over 99 % effective in preventing pregnancies, the vasectomy is a surgery and can result in some complications. It must also be considered as a permanent choice as reversing the procedure isn’t always possible.

Female Sterilisation (“TUBAL LIGATION”)

The tubal ligation procedure is a highly effective and essential non- reversible choice in contraception. It requires a general anesthetic and as such cannot be done here in the clinic but we are happy to advise you of all the pros, cons and alternatives to this option. We can also provide you with referral letters to Gynaecology surgeons for the procedure.

Shorter Acting Methods:

Oestrogen + Progestagen Hormone tablet (The “PILL”)
The pill is an oral contraceptive tablet that contains the female hormones Oesrtrogen and Progestagen.
It is probably the most common form of contraception in Ireland aside from condoms. There are 15 different brands licensed for use in Ireland (although there are many more in other countries).
We dispense most brands directly at the clinic or can provide you with a prescription from your local chemist.
They all work but sending a chemical message to your ovaries telling them not to release an egg for the time being. When taken perfectly they are one of the most effective options available but errors can happen. Forgetting to take a tablet, vomiting or diarrhoea after taking one and taking certain other prescription medicines can all reduce your protection from the Contraceptive Pill!

There are non-contraceptive advantages of the Pill including:
Improvement in period pain and/ or irregular bleeding, relief from PMS, lightening of heavy periods. Protection from certain cancers especially of the Ovaries and Uterus.

Unfortunately the Oestrogen part of the Pill is not suitable for everyone. In very rare circumstances this hormone can cause serious medical problems like blood clots. For this reason certain women might be advised against using the Pill. Smokers, overweight women, diabetics, migraine sufferers, and others may only use the Pill with caution if at all.

Oestrogen + Progestagen ring (“NUVARING”)
The vaginal ring has been available in Ireland for over 10 years. It contains the same hormones as the Pill (oestrogen & progestagen) but is worn inside the vagina like a tampon. The Ring is designed to stay up inside the vagina for 3 weeks each month followed by a week’s break. It gives a convenient alternative to swallowing a pill each day. It may even be more reliable as you can’t forget to take it as you might forget a tablet.
The same advantages and disadvantages apply to the Ring as to the Pill because it contains Oestrogen but it has proven very popular among our patients in the clinic who were willing to try it out!

Oestrogen + Progestagen patch (“EVRA”)
Another alternative way to take the Pill hormones without actually swallowing a pill is the Evra patch. It contains the same hormones as the Pill (oestrogen & progestagen) but is worn on the skin ideally the leg, arm or buttocks.
Each patch is worn for 1 week and you need to apply a new patch each week for 3 weeks each month followed by a week’s break. It is also more convenient than swallowing a daily pill and may prove more reliable as a result.
The same advantages and disadvantages apply to the Ring as to the Pill because it contains Oestrogen.

Progestagen only tablet (The “MINI PILL”)
This pill contains a progestagen hormone which is similar to the natural progesterone women produce in their ovaries. Progestagen-only pills are different to combined pills because they do not contain any oestrogen.
There are 2 different types of minipill available in Ireland containing different progestagens.
They are named “NORIDAY” and” CERAZETTE” and both are available directly from our clinic.
They mainly work by thickening the mucus from your cervix. This makes it difficult for sperm to move through it and reach an egg. They also make the lining of the uterus thinner and sometimes they stop your ovaries releasing an egg. This is the main action of Cerazette and so this may mean that Cerazette is more effective than other Noriday but research has not yet confirmed this.
The Advantages of the minipill include the fact that women who may be advised not to use the oestrogen pill can often use the minpill as the risk of serious health problems with this hormone is much lower than with the pills that contain oestrogen. The main disadvantage of the minipill is that the lack of oestrogen may mean some unexpected bleeding for some ladies who use these products but we have years of experience in advising our patients how to improve these problems.

Diaphragms
A diaphragm fits inside your vagina and covers your cervix (the entrance to your womb) thus blocking sperm.
They are made of thin, soft latex or silicone with a flexible rim. To be effective, diaphragms need to be used with a spermicide.
You do not need to insert your diaphragm right before sex and so can be more convenient than a condom.
As these devices are less popular in Ireland than previously, they usually need to be purchased from the UK but we will be happy to fit and train you to use a diaphragm and then give you all the information you need to but one from reliable UK suppliers.

Condoms
Condoms aren't expensive and are widely available. They can be used with other methods of contraception. Condoms are an especially good choice if either of you have had sex with other people in the past.
Of all the barrier method options, condoms offer the most protection against STI s.
Female condoms aren't as effective as male condoms, but they may be a good choice if a partner won't use a male condom.

Natural Methods
Natural family planning requires a couple to learn when in the woman's cycle she can get pregnant (usually 4 days before and 2 days after ovulation).
It involves plotting your menstrual cycle, measuring your temperature each morning before getting out of bed and becoming familiar with changes in your vagina during the cycle. To prevent pregnancy, the couple must use a barrier method of birth control or not have sex during those days.
This method requires a lot of commitment and even then is not as reliable as most other options.

Emergency Contraception
Emergency contraception can be used to help prevent pregnancy after unprotected sex – whether you have not used any contraception or whether your usual method of contraception has failed (split condom, missed pill). Remember with emergency contraception, timing is everything.
It should not be seen as a regular method of contraception . It is much better to use a reliable method every time you have sex and to be aware that unprotected sex carries other risks: sexually transmitted infections and HIV.
If you have had unprotected sex, contact us straight way. Don’t be embarrassed, we see many women for emergency contraception.

What are the options if I have unprotected sex?
There are two options available to women to help prevent unintended pregnancy if they have unprotected sex. These are the emergency contraceptive pill (also known, incorrectly, as "The Morning After Pill" ) and the emergency contraceptive coil or IUD.

Up to 3 days after sex: The "Morning After Pill"
Also known (incorrectly) as the ‘morning after pill’, it must be taken within 72 hours/three days after unprotected sex. Within the first 24 hours the emergency contraceptive pill is 95% effective but the longer you leave it the less effective it will be. Women must take this pill as soon as possible after sex. The pill works either by stopping an egg being released, stopping sperm reaching the egg, or preventing a fertilised egg from settling in your uterus or womb. In case you get sick or feel unwell after having taken the pill, contact us immediately. Some women also experience a change in their menstrual pattern, including some irregular bleeding or spotting.

Up to 5 days: IUD (Coil)
If you have left it too late for the pill or this method is more suitable for you then you can still have an IUD or ‘coil’ fitted up to 5 days after unprotected sex, to prevent pregnancy occurring. It works by stopping an egg from being fertilised or implanted in your uterus (womb) and can be left in as a form of regular contraception or removed after a normal period.