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What contraception method is the right one for you?

Contraception options abound - but questions surrounding their safety have raised alarm bells.

By Professor Kerryn Phelps
For women in need of contraception, there are important decisions to be made on deciding which form of contraception is best for you.
It usually comes down to a matter of convenience and reliability balanced against the potential risks of the different options.
Your needs may change with your age, your stage of life, whether you experience side effects from a type of contraception or your circumstances change, or if you have medical reasons which rule out some options.
There is no way to eliminate every risk or side effect of a medication, so what are your options for preventing unwanted pregnancy and how significant are the risks?
Decisions about contraception usually come down to convenience and reliability balanced against potential risks, including protection from sexually transmitted infections (STIs).
Here's a brief guide to a range of contraceptives. Always consult with your doctor before reaching a final decision.
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Progesterone-only “Mini-pill”

What is it? An oral contraceptive pill.
Reliability: 91-99 percent.
Advantages: Effective. May suit women who can't take OCP.
Disadvantages: Must be taken at same time daily. No protection against STIs. Irregular periods.
Risks and precautions: May cause headache, acne, weight gain, mood change and bloating. May not work if you miss a pill.

Combined oestrogen-progesterone oral contraceptive pill (OCP)

What is it? Hormones to stop ovulation.
Reliability: 95-99 percent.
Advantages: Convenient. Regulates cycle. May improve acne and reduce period pain.
Disadvantages: No protection against STIs. May reduce libido. May cause depressed mood.
Risks and precautions: Increased risk of blood clots. Possible increased risk of breast cancer.

Condoms

What is it? A rubber sheath over the penis before vaginal contact.
Reliability: 98 percent if used correctly every time.
Advantages: Protects against STIs. No medication side effects. Easily available.
Disadvantages: May slip off or break.
Risks and precautions: Some people allergic to latex (latex-free versions are available).
Unplanned pregnancies can be a bit of a surprise! Supplied

Copper intrauterine device

What is it? A plastic/copper device inserted into the uterus.
Reliability: 99 percent.
Advantages: Hormone-free. Insert-and-forget convenience. Works for five or 10 years. Easily removed.
Disadvantages: No protection against STIs. Must be inserted by a doctor.
Risks and precautions: May increase period pain or heaviness of periods. Small risk of pelvic infection.

Mirena IUD

What is it? A plastic device containing progesterone.
Reliability: 99 percent.
Advantages: Insert-and-forget convenience. Lasts five years. No need for daily pill. Lightens periods.
Disadvantages: No STI protection. Must be inserted by a doctor, occasionally under anaesthetic.
Risks and precautions: May cause irregular periods. Side effects may include headache, acne, weight gain, mood change and bloating.

Tubal ligation

What is it? Fallopian tubes which carry egg to the uterus are cut and tied.
Reliability: Almost 100percent.
Advantages: Permanent female contraception.
Disadvantages: No protection against STIs. May not be reversible if you change your mind.
Risks and precautions: Requires laparoscopic surgery. Future pregnancy may require surgery or IVF.

Withdrawal (coitus unterruptus)

What is it? A sexual technique of removing the penis from the vagina before ejaculation.
Reliability: 73-96 percent depending on technique.
Advantages: Free. Convenient. No medication side effects.
Disadvantages: No protection against STIs. Relies on excellent timing and control.
Risks and precautions: Higher risk of pregnancy than other methods.

Vasectomy

What is it? A surgical procedure which cuts the tubes that carry sperm from the testes.
Reliability: 99.9 percent.
Advantages: Permanent male contraception. Woman has no risk of side effects
Disadvantages: No protection against STIs. May not be reversible if you change your mind. Consider storing sperm in case of a later change of mind.
Risks and precautions: Sperm count may take several months to drop to zero.

Hormone implant (Implanon)

What is it? Plastic rod containing progesterone, surgically inserted into the upper arm. Lasts three years.
Reliability: Over 99 percent advantages: Insert-and-forget convenience. Relieves period pain.
Disadvantages: No STI protection. Must be surgically removed. May get spotting.
Risks and precautions: pain and bruising at insertion site. Possible headaches, acne, weight gain and breast tenderness.
Know what contraceptives suite you best. Supplied

Diaphragm

What is it? A cup-shaped silicone device that is a form of barrier contraception. Inserted into the vagina before intercourse to prevent sperm entering uterus. Needs to remain in place at least six hours after sex.
Reliability: 85-95 percent.
Advantages: Few side effects.
Disadvantages: No protection against STIs. Not spontaneous.
Risks and precautions: Must be used with a spermicide. Rubber allergy is possible.

Vaginal ring (NuvaRing)

What is it? Small ring containing oestrogen and progesterone, inserted into vagina. Removed during periods and replaced.
Reliability: Around 91 percent.
Advantages: Lower hormone dose than contraceptive pills.
Disadvantages: No STI protection. Must be removed, replaced and correctly positioned.
Risks and precautions: Increased blood clot risk. May cause headache, nausea and weight gain.

Hormone depot injection

What is it? Progesterone injection lasting 12 weeks.
Reliability: 94-99 percent if renewed in time.
Advantages: Lasts three months.
Disadvantages: Can't be removed if side effects. Must be repeated each three months. No protection from STIs. Periods and fertility may take months to return to normal.
Risks and precautions: Irregular bleeding common. Long-term use may reduce bone density.
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Emergency contraception (Morning after pill)

What is it? Single dose of hormones ideally within 24 hours of (but up to four days after) unprotected sex.
Reliability: 85 percent.
Advantages: Available without prescription.
Disadvantages: Not for "regular" contraception. No protection from STIs.
Risks and precautions: Possible side effects are nausea and breast tenderness.

Ovulation method

What is it? Avoiding sex when you are likely to be fertile.
Reliability: 75-99 percent depending on accuracy and commitment to monitoring.
Advantages: Avoids side effects of medication.
Disadvantages: Unreliable if cycle is irregular. Can be difficult to accurately predict ovulation. No STI protection.
Risks and precautions: Relies on close monitoring of cycle and predictable ovulation.

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