26—APR—2021 20:25 GMT
  • Instagram
  • Facebook
  • Twitter
 

This is a 3-part series on the different types of contraception methods. If you want to revisit part 1, click here before continuing reading this article.

Injection

Contraceptive injection or Depo-Provera is an injection with progestogen hormone, which is similar to the progesterone hormone that is produced naturally by your body.

How it works

 

It works by preventing ovulation (the release of eggs), thickens cervical mucus and thin the lining of the uterus. It helps protect against pregnancy for 13 weeks.

 

With the injection, you may notice your bleeding patterns might change. In some, periods are seen to be irregular or last longer, and in others, periods will stop completely.

 

If you decide to get pregnant, it might take a while for your fertility and menstrual cycle to return back to normal. 

Some advantages are:

- used every 13 weeks 

- can be used if you are breastfeeding

- may be helpful for people with sickle cell disease as it can also help reduce painful crises

 

Some disadvantages are:

- does not protect against STIs

- your bleeding patterns may change which might not be acceptable for you

- there is a delay of up to one year from the time of the last injection before menstrual or fertility cycles resume back to normal 

- weight gain

 

Contraceptive injections are quite safe, but in some people, it can negatively impact bones by causing them to thin out. This problem resolves once you cease the use of injections. Your healthcare provider may recommend against the use of contraceptive injections if you have osteoporosis risk factors. 

depo provera.jpeg
Depo-Provera injectable contraceptive.
Image from The New York Times.

Implant

A contraceptive implant is a small ‘matchstick-type’ rod that is placed under the skin of your upper arm. 

How it works

 

This implant releases progestogen hormone, which is similar to the progesterone hormone produced in your body. It works by preventing ovulation (the release of eggs), thickens cervical mucus and thins the lining of the uterus.  They typically last for 3 years. 

 

With the implant, your bleeding patterns might change. In some, periods are seen to be irregular or last longer, and in others, periods can completely stop.

When it starts to work

The implant can be placed at any point of the menstrual cycle, but if it is placed within the first five days of your period, you will be protected from pregnancy immediately. If the implant is placed at any other point of the menstrual cycle, you should use an additional contraceptive method such as barrier protection for the first seven days.

How the implant is fitted

Before placing the implant, you will receive local anaesthetic to numb the inner area of your upper arm. Your doctor will then place the implant under your skin, which should feel like getting an injection. The entire process only takes a few minutes. 

 

After the placement of the implant, your doctor will run their fingers over the injection site to check that the implant is in place. This area may be a little sore for the first few days. Try to keep the area dry and clean and avoid banging into it. Once the injection site has healed, the implant won’t be visible anymore, but it can still be felt when you run your fingers over the area. 

How the implant is removed

 

When you feel like having your implant removed/ changed, your doctor will use local anaesthetic to numb the area. They will then make a small cut and pull the rod out. A dressing will be placed over the site to heal. The procedure is the same for when you’re getting a replacement, a new implant will be inserted into the same site.

 

At any point if you are having trouble with your implant, you should visit your healthcare practitioner.

Some advantages are:

- lasts for three years and is low maintenance 

- reduces heavy periods 

- can be used if you are breastfeeding 

- fertility resumes once the implant is removed

 

Some disadvantages are:

- does not protect against STIs

- your bleeding patterns may change which might not be acceptable for you

- headaches, breast tenderness and mood changes 

- may cause your acne to flare up 

 

Using the implant as a contraceptive method is very safe but rarely when the implant is put in, an infection may develop at the insertion site. 

implant.webp
Implant contraceptive.
Image from Best Health Magazine.

Intrauterine Device (IUD)

Intra- simply means inside, and uterine means uterus. So, an intrauterine device is a device that sits in your uterus. Told you medicine is easy! 

 

An IUD is a small, often T-shaped copper coil that is inserted into the uterus by a doctor or nurse. 

How it works

It releases copper to stop you from getting pregnant. The copper changes the cervical mucus and can stop a fertilised egg from implanting itself. It can last for about 5-10 years depending on the type of IUD inserted. 

When it starts to work

An IUD can be inserted at any point of your menstrual cycle and you’ll be protected from pregnancy immediately. 

 

An IUD can also be used as an emergency contraception. Some doctors may prefer to insert the IUD during the first few days of your period, as your cervix is usually a little softer and a bit more relaxed as blood leaves the uterus. 

How the implant is fitted

Before the device is fitted, the doctor or nurse has to check the position and size of your uterus, you may be tested from any STIs before inserting the coil. Inserting an IUD will take about 5 minutes. This process can be uncomfortable, and some might find it painful. You can discuss with your doctor to see if a local anaesthetic could be provided to help with the process. 

 

If you feel any pain or discomfort during the fitting process, let the medical staff know. You can ask to stop at any time.

 

After the insertion of the coil, you may get period-type pain and some light bleeding. Taking some painkillers can help ease the pain.

How to check if it's still in place

 

The coil has 2 thin threads attached to it that will hang out at the top of your vagina. Your doctor or nurse will teach you how to check to see if they are still in place. Ask for clarification if you have any questions. 

 

You should check to see if your coil is in place regularly every month. If you can’t feel the thread or think it has moved, you should visit your doctor, as you may not be protected against pregnancy. 

 

After the insertion of your coil, if you develop pelvic pain, fever and/ or a smelly vaginal discharge, you should visit your doctor, as this may mean you have an infection.

 

Some advantages are:

- does not protect against STIs

- works as soon as IUD is inserted

- works for 5-10 years

- can be used when breastfeeding

 

Some disadvantages are:

- periods may be heavier, longer or more painful 

- a doctor/ nurse will need to do an internal vaginal exam before inserting the coil

copper.jpeg
Intrauterine copper device.
Image from News Medical website

Intrauterine System (IUS)

An IUS is a small, T-shaped plastic device that is inserted into the uterus by a doctor or nurse.

How it works

It releases progestogen, a hormone that is similar to the progesterone hormone that is produced in the body. It prevents the release of egg from the ovary, thickens cervical mucus, and thins the uterine lining. The IUS can last anywhere from 3 -5 years depending on the type of device inserted.

When it starts to work

 

An IUS can be inserted at any point of your menstrual cycle. If inserted in the first five days of your period, it will protect you from pregnancy immediately. If inserted at any other time of your cycle, you may require additional contraceptive use, such as a barrier method for the first seven days.

How the implant is fitted

During your appointment, your doctor will have to do an internal vaginal exam, to check the position and location of the cervix and rule out any infections. Inserting an IUS will take about 5 minutes. This process can be uncomfortable, and some may find it painful. You can discuss with your doctor to see if a local anaesthetic could be provided to help with the process. 

 

After the insertion of the IUS, you may feel period-type pain and some light bleeding. Taking some painkillers can help ease the pain.

How to check if it's still in place

Like the IUD, the IUS has two thin threads attached to it that will hang out at the top of your vagina. You should check to feel this thread at regular intervals every month to ensure it is still in place. If you can’t feel the thread or think it’s moved, you should visit your doctor. 

 

After the insertion of your IUS, if you develop pelvic pain, fever and/ or a smelly vaginal discharge, you should visit your doctor, as this may mean you have an infection.

 

Some advantages are:

- certain types of IUS can be used specifically for heavy periods 

- can be used when breastfeeding 

- fertility resumes once IUS is removed 

 

Some disadvantages are:

- does not protect against STIs

- periods may change which may be unacceptable for some people

- acne, headache, breast tenderness 

- a doctor/ nurse will need to do an internal vaginal exam before inserting the coil

ius.jpg
Intrauterine system contraceptive.
Image from The Barkantine Practice

"When deciding on a contraceptive option that is best for you, it is also important to understand how effective it is. Effectiveness of a contraceptive method is usually measured by its’ perfect use and typical use."

Screenshot 2021-04-26 at 12.22.11 AM.png
Table 1. Differences between the different types of contraception

Perfect use* is when a contraceptive is used correctly all the time

Typical use** is what happens when it’s used in real life.

Additional Resources

 

You should be able to find most contraceptive options at GPs, clinics, sexual health clinics, and pharmacies and be able to speak to a healthcare provider to discuss your options. Here are some resources if you're looking for more information. 

 

US: 

https://www.plannedparenthood.org/learn/birth-control/birth-control-implant-nexplanon/what-happens-when-the-birth-control-implant-is-inserted

 

UK:

https://www.sexwise.org.uk/contraception/which-method-contraception-right-me

https://www.nhs.uk/conditions/contraception/which-method-suits-me/

 

Malaysia:

http://www.myhealth.gov.my/en/contraception/

 

New Zealand:

https://www.familyplanning.org.nz/advice

References

  1. How Effective Is Your Contraception? - Family Planning. (2021). Retrieved 25 January 2021, from https://www.familyplanning.org.nz/news/2014/how-effective-is-your-contraception

  2. If You're LGBTQIA, This Safer Sex Guide Is For You. (2021). Retrieved 25 January 2021, from https://www.healthline.com/health/lgbtqia-safe-sex-guide#condoms-and-barriers

  3. If You're LGBTQIA, This Safer Sex Guide Is For You. (2021). Retrieved 25 January 2021, from https://www.healthline.com/health/lgbtqia-safe-sex-guide

  4. Which method of contraception is right for me? | Sexwise. (2021). Retrieved 25 January 2021, from https://www.sexwise.org.uk/contraception/which-method-contraception-right-me