Contraception

What is Contraception?

Contraception, commonly known as birth control, refers to methods or devices used to prevent pregnancy. It enables individuals to decide if and when they want to have children, thus giving them control over their reproductive health. Contraception can also provide additional health benefits, such as regulating menstrual cycles and reducing the risk of certain reproductive system cancers.

Who is Suitable for Contraception?

Contraception is suitable for most sexually active individuals who wish to avoid pregnancy. This includes:

• Adolescents and Young Adults: Often seeking to delay pregnancy until they are older and more prepared.
• Adults: Those who have achieved their desired family size or wish to space their children.
• Individuals with Health Conditions: Some health conditions make pregnancy risky, so contraception can be a vital part of their healthcare.
• Couples: Those who want to plan their families and ensure the well-being of the mother and child.
• People in Non-Monogamous Relationships: Those who have multiple sexual partners may use contraception to prevent unintended pregnancies.

What are the Benefits of Contraception?

Contraception offers numerous benefits, including:

• Prevention of Unintended Pregnancies: This is the primary benefit, allowing individuals and couples to plan if and when they want children.
• Health Benefits: Some methods can reduce the risk of certain cancers (e.g., ovarian and endometrial), treat acne, and manage menstrual disorders.
• Empowerment: It gives individuals control over their reproductive health and life planning.
• Economic Benefits: By allowing individuals to plan pregnancies, contraception can help improve financial stability for families.
• Reduced Risk of STIs: Barrier methods, such as condoms, can also help prevent sexually transmitted infections (STIs).

Types of Contraceptive Methods

There are several different methods of contraception for both women and men, which may suit you at different times in your life.

Barrier Methods

These are the most common and involve using a physical barrier to prevent the sperm from entering the woman's uterus. Methods include:

• Male condom: a thin latex or polyurethane covering rolled over the erect penis before sexual intercourse.
• Female condom: a polyurethane tube inserted into the vagina before sexual intercourse.
• Spermicides: a substance that kills the sperm.

Hormonal Methods

Synthetic and natural hormones may be taken orally, implanted into body tissue or placed in the vagina. They prevent ovaries from releasing eggs, thicken mucus around the cervix and thin the womb's lining. They are up to 99.7% effective, depending on the method used and how they are used. 

Options include:

• The combined oral contraceptive pill (COCP) contains oestrogen and progesterone hormones.
• Mini pill or progesterone-only pill(POP): contains a synthetic form of only one hormone, progesterone.
• Vaginal ring: A 'one size fits all' ring placed into the vagina to release hormones slowly. The ring only lasts for three weeks.

Intrauterine Devices (IUD)

An intrauterine device (IUD) is a small, T-shaped contraceptive inserted into the uterus by a doctor. IUDs are a long-acting form of birth control and can remain in place for several years. 

There are two main types of IUDs: those that release hormones, such as levonorgestrel (a type of progesterone), and those that are non-hormonal and made of copper. The hormonal IUDs work by thickening the cervix's mucus, making it difficult for sperm to reach and fertilise an egg and by thinning the lining of the uterus, preventing implantation. The copper IUD creates a uterine environment that is inhospitable to sperm.

Most IUDs are more than 99% effective and work by changing the environment of the uterus so sperm cannot survive. One such type of intrauterine contraceptive device is Mirena.

Sterilisation

Sterilisation is a type of permanent contraception. It involves either a vasectomy (for men) or a tubal ligation (for women) and is used for individuals who do not intend to have children in the future.

Your Choice of Contraceptive Method 

The choice may depend on the following:

• a person's age
• health condition
• frequency of sexual activity
• number of sexual partners 
• desire to have children 
• certain medical conditions 

Always discuss the birth control method you choose with your doctor.

What is Mirena?

A Mirena is an IUCD (intrauterine contraceptive device) that releases progesterone (levonorgestrel) to the uterus. 

What is Mirena Used For?

Mirena is used as:

• a popular type of long-acting, reversible contraception. 
• treatment for heavy and painful periods.

How is a Mirena IUD Applied?

Mirena can be inserted as an outpatient (in clinic rooms). This is best performed during or shortly after menstruation. 

Generally, women who have previously had a vaginal delivery will find placement in the clinic rooms quite straightforward. The cervical opening will be slightly larger.

A woman who has never had a vaginal delivery may find this procedure uncomfortable or painful. However, this is still an option that you will discuss. 

Before the procedure, you will be given information on taking anti-inflammatory tablets, such as Ibuprofen, Naproxen, or Mefenamic acid. 

It is also possible to insert the Mirena under sedation as a Day Surgery procedure.

Mirena Insertion Procedure

Dr Alyousif will:

• Ask you to lie on your back, and she will insert a speculum into your vagina (similar to a Pap smear). 
• Clean the cervix with a special solution. The cervix is gently dilated. Following this, the Mirena is inserted. 

This procedure takes about 10-15 minutes.

What To Expect After Mirena Insertion

Most women will experience minor pelvic cramps for about 24 hours. Paracetamol or Ibuprofen can be used to control the cramps. 

There may be light bleeding for a few days. You should avoid intercourse, tampons, baths and swimming for 48 hours to minimise the risk of infection.

If you are not satisfied with Mirena, you can easily remove it. It is effective for five years.

Potential Side Effects of an IUCD

Some women will experience extreme dizziness during insertion (vaso-vagal response). This will pass after a few minutes.

Most women find their first period much lighter but can continue much longer.

Most women experience irregular bleeding or spotting for the first 3-6 months. This is generally resolved after six to twelve weeks.

In the long term, 95% of women will find menstruation much lighter and less painful. 30% of women will not have periods as long as the Mirena is in.

Contraceptive Implant

What is Implanon?

Implanon is the brand name for the contraceptive implant containing the hormone Etonogestrel, a hormone similar to the hormone progesterone, which is naturally produced by the female body.

This form of contraceptive is highly effective and lasts up to three years. It is an ideal method for young women leading busy lifestyles requiring safe and effective contraception. 

How Effective Is the Implanon Contraceptive?

Implanon is at least 99.7% effective. 

This means that if 1,000 women use Implanon for a year, it is possible that three women could become pregnant. 

How Does Implanon Work?

The Implanon implant slowly releases progestogen into the bloodstream to prevent pregnancy for up to three years. The implant works by:

• Preventing ovulation (egg release from the ovary),
• Thickening the mucus of the cervix so that sperm cannot enter the uterus (womb) and
• Changing the lining of the uterus, thereby making it unsuitable for pregnancy.

Some medications can reduce the effectiveness of Implanon. It is important to inform doctors you have an Implanon when another medication is prescribed.

About the Implanon Procedure

The Implanon insertion procedure is quick and simple.

Using a small flexible rod, a contraceptive implant is inserted under the skin of the upper arm. During the procedure, your arm is under a local anaesthetic.

Alternatives to Implanon Contraceptive

Mirena IUS

This intrauterine device is a highly effective form of contraception with minimal hormonal side effects. It lasts up to five years and, like Implanon, has the advantage of being a 'set and forget' method of contraception.

Intrauterine Contraceptive Device

We have practitioners who are experienced in both Implanon and Mirena insertions. Please ask reception for details.

Contraception Prognosis

Most contraceptive methods have high success rates when used correctly. Hormonal methods such as the pill, patch, or IUDs have a success rate of over 99% with perfect use. Even methods with lower typical-use effectiveness, like condoms, still significantly reduce the risk of pregnancy compared to no contraception.

The health benefits of contraception also contribute to a positive prognosis, including regulated menstrual cycles, reduced menstrual cramps, and lower risks of certain cancers (e.g., ovarian and endometrial cancer). Additionally, the use of barrier methods like condoms can protect against sexually transmitted infections (STIs).

Contraception Risks

While contraception is generally safe, each method comes with its own set of potential risks and side effects:

• Hormonal Methods:
• Side Effects: Nausea, weight gain, mood changes, breast tenderness, and spotting between periods.
• Risks: Increased risk of blood clots, stroke, and heart attack, especially in smokers and women over 35.
• Intrauterine Devices (IUDs):
• Side Effects: Cramping and irregular bleeding after insertion.
• Risks: Uterine perforation (rare), increased risk of pelvic inflammatory disease (especially in the first 20 days after insertion).
• Barrier Methods:
• Side Effects: Possible latex allergy for those sensitive to latex.
• Risks: Lower effectiveness with typical use compared to other methods, potential for condom breakage.
• Permanent Methods:
• Risks: Surgical risks such as infection or complications from anaesthesia.
• Natural Methods:
• Risks: Higher failure rates due to the need for precise monitoring and abstention during fertile periods.

What if Contraception is Delayed?

Delaying the use of contraception can lead to several consequences:

• Unintended Pregnancies: Without effective contraception, the risk of unintended pregnancies increases significantly, which can have profound personal, social, and economic impacts.
• Health Risks: For individuals with health conditions that make pregnancy dangerous, delayed contraception can pose serious health risks.
• Unplanned Parenthood: Lack of contraception can lead to unplanned parenthood, which can affect life plans and overall well-being.
• STI Transmission: Without barrier methods like condoms, the risk of sexually transmitted infections increases.

Cost of Contraceptives

• Oral Contraceptives (Pills): Between $15 to $50 per month, depending on the brand and whether it is subsidised under the Pharmaceutical Benefits Scheme (PBS).
• Contraceptive Patches and Vaginal Rings: Around $30 to $50 per month, depending on the brand and PBS subsidy.
• Injectable Contraceptives: Approximately $25 to $50 per injection, typically administered every three months.
• Implants (e.g., Implanon): Around $40 to $60, with additional costs for insertion and removal if not covered by Medicare or private health insurance.
• Intrauterine Devices (IUDs):
• Copper IUD: Around $70 to $120.
• Hormonal IUD: Around $180 to $250, with additional costs for insertion and removal, which may be covered by Medicare or private health insurance.
• Condoms: $10 to $20 for a pack of 12.
• Emergency Contraception (Morning-After Pill): Around $20 to $35.
• Permanent Methods (e.g., Sterilization): The cost can vary widely but generally ranges from $1,500 to $6,000 for procedures like tubal ligation or vasectomy, often covered by Medicare or private health insurance.