Contraception

Your Comprehensive Guide to Contraception

Why are there different methods of contraception?

Contraception (birth control) aims to prevent pregnancy. There are many different methods and your choice of contraceptive method will depend on your preferences as a couple, your contraceptive needs and your medical condition. Some methods are more effective than others. Some methods or combinations of methods will help to protect you from sexually transmitted diseases (STDs), in addition to preventing pregnancy. You should discuss the available options with your doctor before deciding.

The different types of contraception available in Ireland are:

Male condom

What is it?

A condom is a thin sheath that fits over a man's erect penis during sexual contact. They act as a physical barrier preventing bodily fluids from passing between sexual partners and so preventing pregnancy and/or the transmission of STDs.

What are the benefits of male condoms?

  • They are easily purchased without prescription at chemists, family planning clinics or from vending machines in many bars/nightclubs.
  • They reduce the risk of STDs, including HIV.
  • There are no medical side effects.

Condoms

What are the drawbacks to male condoms?

  • They must be put on the penis as soon as it becomes erect and before any contact takes place with the vagina. 
  • They also have to be used with care as they can slip off or split.
  • Men should withdraw as soon as they have ejaculated and be careful not to spill any semen.
  • They cannot be used with oil-based products, as these will damage the rubber.

How effective are male condoms?

Approximately 94—98% effective with correct and careful use. The failure rate can be much higher if condoms are not used properly or consistently. Only use condoms approved with the BSI kitemark on the packet.

Find out more about how to use condoms correctly.

Female condom

What is it?

Female condoms are seven-inch-long pouches of polyurethane with two flexible rings. They are inserted into the vagina before intercourse and cover the cervix, vagina and the area around the vagina. They act by preventing sperm from entering the vagina.

What are the benefits of female condoms?

  • They can be inserted at any time before sex.
  • They are stronger than the male condom and can be used with oil-based products.
  • They are particularly useful for women who suffer from allergic reactions to the spermicidal lubricants used with condoms.
  • They reduce the risk of contracting STDs, including HIV..
  • There are no medical side effects

What are the drawbacks of female condoms?

Insertion takes practice – they can slip, so you need to be sure that the penis enters the condom and is not inserted between the condom and the vaginal wall.

How effective are female condoms?

Approximately 95% effective, if used correctly. If not used correctly, the chance of pregnancy can be much higher.

Contraceptive Pill

There are two types of contraceptive pill – the combined pill and the progestogen-only pill (mini-pill).

What is the combined pill?

The combined pill is a hormonal method of contraception. It contains two hormones (oestrogen and progestogen), which prevent an egg from being released by a woman's ovary each month.

Contraceptive pill

What are the benefits of using the combined pill?

The combined pill can reduce pre-menstrual syndrome (PMS) and period pain and heavy periods.

  • It protects against cancer of the ovary and womb.
  • No devices or spermicide are necessary, so it does not restrict spontaneity of sex.
  • The combined pill is suitable for healthy, non-smokers up to the menopause.

What are the drawbacks of the combined pill?

The combined pill is not suitable for women who have high blood pressure, circulatory disease, diabetes or some other medical conditions. It is not suitable for women who are breastfeeding.

  • It is not suitable for smokers over 35 years. Women who are overweight may be advised to use another method of contraception.
  • It is not reliable if taken more than 12 hours late, after vomiting and diarrhoea, or if taking other drugs, such as antibiotics.
  • It may cause some side effects. However, these are generally temporary.  
  • There is no protection against STDs.

How effective is the combined pill?

Approximately 99% effective, if taken correctly. If pills are forgotten and no precautions are taken it is less effective.

A recommended approach when appropriate, is to use the ‘double dutch’ method of contraception — the pill to prevent pregnancy and condoms to prevent STDs.

What is the progestogen-only pill?

The progestogen-only pill or mini pill contains only one hormone – progestogen. This encourages the cervical mucus to form a thick barrier to stop sperm entering the womb. It may also make the lining of the womb thinner to prevent it accepting a fertilised egg and may prevent an egg from being released.

What are the benefits of using the progestogen-only pill?

  • Useful for women who are breastfeeding, older women, smokers and other women who cannot use the combined pill.
  • It can help to relieve PMS and painful periods.
  • Does not interrupt sex.
  • What are the drawbacks to the progestogen-only pill?
  • It has to be taken at the same time or within three hours every day.
  • It is not reliable if taken more than three hours late or following vomiting and diarrhoea. Certain medication can also reduce its effectiveness.
  • It can cause irregular bleeding or periods may cease completely.
  • There is no protection against STDs.

How effective is the progestogen-only pill?

Approximately 98% effective, if taken correctly.

Read more about the combined and progestogen-only pills

Contraceptive injection

What is it?

This is an injection of hormones that provides a longer acting alternative to the pill. The injection is given by a health care professional approximately every 12 weeks. It works by slowly releasing the hormone progestogen into the body to prevent ovulation (an egg being released).

What are the benefits of the contraceptive injection?

  • An injection lasts for 12 weeks and is a very reliable method of contraception – it is useful for women who forget to take their pill.
  • It offers some protection against cancer of the womb.
  • It does not interrupt sex.

What are the drawbacks to contraceptive injections?

  • You must have the next injection on time, every three months, or it becomes ineffective.
  • You may experience irregular bleeding.
  • It is likely to cause changes in your periods. Periods often become irregular or stop entirely.
  • Its effects cannot immediately be reversed if you decide you do not want to continue with the injection – any side effects will continue until the effects of the injection wear off.
  • Regular periods and fertility may take a year or more to return after stopping the injections.
  • There is no protection against STDs.
  • Some women may gain weight on the injection.

How effective is a contraceptive injection?

More than 99% effective, if taken correctly.

Contraceptive Patch

What is it?

The contraceptive patch is a thin, beige patch, about the size of a plaster, which releases oestrogen and progestogen into the bloodstream through the skin. Each patch is worn for seven days, for three weeks, followed by a patch-free week. This prevents ovulation (an egg from being released). The only contraceptive patch available in Ireland at present is called Evra.

What are the benefits of the patch?

  • As the patch is applied once a week, it may be easier to remember than taking a daily pill.
  • Unlike the pill, it is not affected by vomiting and diarrhoea.
  • It does not interrupt sex.

What are the drawbacks of the patch?

  • It may not be suitable for all women – i.e. those woman who cannot take the combined pill for medical reasons, such as high blood pressure.
  • It may be seen on the skin.
  • It does not protect against STDs.
  • It costs more than the pill.

How effective is the patch?

The patch is 99% effective if used properly.

Diaphragm/cap

What is it?

The diaphragm or cap is a circular dome made of rubber, which is fitted by the woman over her cervix (neck of the womb) before sex. It acts as a barrier to stop sperm getting through to the uterus. It should be used with a spermicide.

Spermicides are sperm-killing chemicals available as foam, jelly, foaming tablets, vaginal suppositories, or cream. A doctor or nurse will fit a diaphragm initially to check which size you need and teach you how to use it.

What are the benefits of a diaphragm and spermicide?

  • The diaphragm does not affect your menstrual cycle. 
  • You need only use it when you are sexually active. 
  • Neither you or your partner should be aware that it is there – and there is no need for it to interfere with sex, as you can insert it at a convenient time in advance.
  • It may protect against cancer of the cervix.
  • Protects against some types of STDs.

What are the drawbacks to a diaphragm and spermicide?

  • The diaphragm must stay in place for six hours after sex — more spermicide must be inserted again if you have sex within six hours. 
  • Spermicides may cause irritation or an allergic reaction. 
  • Cystitis (inflammation of the bladder) may be a problem for some users.

How effective is a diaphragm and spermicide?

Approximately 92—96% effective, if used correctly. If not used correctly, the chance of pregnancy can be much higher.

Implants

What are Implants?

An implant is a soft tube, about the size of matchstick that is placed under the skin of the upper arm. It can be felt, but not seen. The implant releases a steady flow of the hormone progestogen into the bloodstream, which creates a barrier in the cervix making it difficult for a sperm to meet an egg. It also stops ovulation (an egg being released) and thins the lining of the womb.

The implant is fitted during your period. The procedure takes about ten minutes and is done under local anaesthetic. It is similar to having an injection. The implant is effective for three years. Local anaesthesia is again required when the implant is eventually removed.

Progestogen Implant

What are the benefits of using an implant?

  • From time of fitting you are protected from pregnancy for three years (you can have it removed earlier if you decide you want to stop using it).
  • You can breast feed if you have an implant.
  • It does not interrupt sex.
  • Fertility returns very quickly after removal.

What are the drawbacks to implants?

  • Periods are often irregular, particularly in the first year.
  • There may be side effects like acne, weight gain, and tender breasts.
  • There is no protection against STDs.
  • Insertion and removal must be done by a specially trained doctor.

How effective are implants?

Implants are approximately 99% effective.

Intrauterine Contraceptive Device (IUCD)/The Coil

What is it?

The IUCD (‘The Coil’) is a small plastic and copper device that is put into the womb. It stops sperm from meeting the egg, by delaying the egg from getting to the womb – or may prevent an egg from settling in the womb.

What are the benefits of an IUCD?

  • It works from the moment it is placed in the uterus and can stay in place for five years or more.
  • It does not interrupt with sex.

What are the drawbacks to an IUCD?

  • It is unsuitable for women who have more than one sexual partner, as this can increase the risk of infection. 
  • Periods may be heavier and more painful. 
  • There is no protection against STDs.
  • Insertion and removal must be done by a specially trained doctor.

How effective is an IUCD?

Approximately 98—99% effective.

Intrauterine System (IUS)

What is it?

The IUS is a small T-shaped plastic intrauterine device that contains the hormone, progestogen. It is placed in the womb and thickens the mucus at the neck of the womb – making it difficult for sperm to meet the egg. The physical structure of the device is very similar to an IUD – and the technique for inserting the device is very similar.

The proprietary name for the only IUS currently available in Ireland is Mirena.

What are the benefits of an IUS?

  • It is effective as soon as it is placed in the womb and lasts for at least five years.
  • It is useful for women with heavy, painful periods as it makes periods lighter, shorter and less painful.
  • It does not interrupt sex.

What are the drawbacks to an IUS?

  • Periods are usually irregular for up to 12 weeks after insertion.
  • Other temporary side effects may occur.
  • It offers no protection against STDs.

How effective is an IUS?

More than 99% effective.

Natural Methods

What are natural methods of contraception?

Couples using a natural method of contraception take a record of the fertile and infertile times of a woman’s cycle, to plan when to take measures to avoid pregnancy. The woman must keep a daily record of body temperature, changes in cervical mucus and other signs of ovulation. On fertile days (about 7—10 days during each menstrual cycle), couples should avoid sex or use another method of contraception.

The withdrawal method involves removing the penis from the vagina just before semen starts coming out (ejaculation). Sperm are often deposited in the vagina before or during withdrawal, so this method is unreliable.

What are the benefits of using natural methods?

  • There are no harmful or uncomfortable side-effects.
  • Natural methods can be used at any stage of a woman's reproductive life, as long as her menstrual cycle is regular.

What are the drawbacks to using natural methods?

  • Couples must be very organised and disciplined for natural methods of birth control to be effective as sex must be avoided at fertile times of the cycle.
  • Women with irregular cycles may not be able to use this method.
  • Stress, illness, childbirth, hormonal treatments, and the menopause can make natural methods unreliable.
  • Method takes time to learn and must be taught by a specially trained teacher.
  • There is no protection against STDs.

How effective are natural methods?

Approximately 98% effective if used correctly but correct use requires considerable commitment to this method of contraception.

Female Sterilisation

What does female sterilisation involve?

Female sterilisation (tubal ligation) involves cutting or blocking the fallopian tubes, which mean that the egg and sperm cannot meet to fertilise.  Under anaesthesia, a small incision is made just below the naval to reach the fallopian tubes which are then clipped and sealed. Female sterilisation is a permanent method of contraception.

Female sterilisation

What are the benefits of female sterilisation?

  • It is of benefit for couples who feel their family is complete or who are certain that they will never want to have children.
  • Many couples find greater sexual freedom once the risk of unwanted pregnancy has been removed. 
  • Sterilisation does not interfere with sex and it works immediately.

What are the drawbacks to female sterilisation?

  • Sterilisation is permanent and reversal is difficult and often unsuccessful.
  • While a very safe operation, there is a very small risk of damage to other organs during the procedure. 
  • There is a risk of ectopic pregnancy at a later date if the procedure is carried out when you are young.
  • It offers no protection against STDs.

How effective is female sterilisation?

Over 99% effective. The failure rate is between 1 and 3 per 1000.

Male Sterilisation (vasectomy)

What does male sterilisation involve?

A vasectomy is a permanent surgical technique in which the tubes that carry the sperm are cut, so that sperm are no longer present in semen when a man ejaculates. The procedure takes 10—15 minutes and is generally carried out under local anaesthetic.

Vasectomy

What are the benefits of male sterilisation?

  • It is of benefit for couples who feel their family is complete or who are certain that they will never want to have children.
  • Orgasm and ejaculation are not affected – the only difference is that there will be no sperm in the semen. 
  • It has no effect on the production of male hormones or the sex drive.
  • It can be done in a doctors surgery or clinic under local anaesthetic.

What are the drawbacks to male sterilisation?

  • Male sterilisation takes longer to work than female sterilisation and sperm can take a few months to disappear from semen, so you will need to use another method of contraception until you have had tests to show that you have no sperm in the semen.
  • There may be discomfort and swelling for a short time after the procedure.
  • It is permanent and reversal can be difficult, and often unsuccessful.
  • It offers no protection against STDs and HIV.

How effective is male sterilisation?

Over 99% effective. The failure rate is about 1 in 1000.

Vaginal Ring

What is it?

The vaginal ring is a flexible, transparent, plastic ring, which releases low doses of oestrogen and progestogen, absorbed directly through the lining of the vagina into the blood stream. This prevents ovulation (an egg being released). It is the equivalent of a very low dose pill.

The ring is inserted into the vagina by the woman herself and remains in place for three weeks, after which it should be removed. After a one-week ring free period, a new ring is inserted. The name of the only vaginal ring available in Ireland at present is NuvaRing.

What are the benefits of the vaginal ring?

  • The vaginal ring is particularly suitable for women who forget to take the pill, as it requires no daily administration.
  • It can be inserted and removed by the woman herself, and does not have to be fitted by a nurse or doctor.
  • Unlike the pill, it is not affected by vomiting or diarrhoea.
  • It does not interrupt sex.

What are the drawbacks of the vaginal ring?

  • It may not be suitable for all women – i.e. those woman who cannot take the combined pill for medical reasons, such as high blood pressure.
  • It can sometimes be felt during sex and some women may not be comfortable inserting it.
  • It may cause increased vaginal discharge.
  • The ring does not offer protection against sexually transmitted diseases.
  • It is more expensive than taking the combined pill orally.

How effective is the vaginal ring?

The vaginal ring is 99% effective if properly used.

Emergency contraception

If you have had sex without using contraception, of you think your contraception has failed, you can use emergency contraception. If you act quickly, this will usually prevent pregnancy. Emergency contraception can be obtained in pharmacies without a prescription.

There are two types of emergency contraception:

  • The emergency contraception pills (‘morning after pill’)
  • The intrauterine device

Emergency contraception pills usually work by stopping the release of an egg. They may also stop sperm from fertilising the egg. The emergency contraception pill stops a pregnancy before it is established – it does not cause abortion (this can only take place after a fertilised egg has implanted in the womb).

The emergency contraception pill must be taken within 72 hours (3 days) of you having had unprotected sex – preferably within 12 hours. The earlier they are taken the more effective they are. EllaOne (ulipristal acetate) is an emergency contraceptive which can be taken within 120 hours (five days) of having unprotected sex. However again, it is most effective if taken as soon as possible after having unprotected sex.

Emergency contraception pills are not suitable as an ongoing method of contraception – they should only be used in an emergency. Other methods of contraception are more reliable over time.

The intrauterine device (IUCD) is described above, as it can also be used as an ongoing form of contraception. Your doctor can fit the IUCD in your womb up to five days after you have had unprotected sex. It can stop an egg from being fertilised or implanting in your womb. An IUCD is the most effective method of emergency contraception.

Reviewed: June, 2016