Contraception - choices

What is contraception?

Contraception (also known as family planning or birth control) protects you from pregnancy. Contraception works so that an egg can’t be fertilised by sperm to conceive a baby.

There are many contraceptive options available in Australia. Their level of effectiveness and the way they work varies.

Types of contraception include:

• implants
• intrauterine devices  (IUDs)
• injections
• oral contraceptive pills (combined pill and progestogen only pill)
• vaginal rings
• barrier methods (external and internal condoms, diaphragms)
• tubal ligation and vasectomy
• emergency contraception
• natural methods (also known as natural family planning or fertility awareness based methods).

Barrier methods of contraception (such as condoms) are highly effective to protect you and your sexual partners from sexually transmissible infections (STIs).

It is important to remember, that no method of contraception is 100% effective against pregnancy.

How to choose contraception to suit your needs

When choosing a method of contraception that is right for you, it is important to have accurate information. If you have a partner/s talk openly about your options.

Issues you may like to consider include:

• how well each method works
• why you need to use contraception – some people use contraception for hormonal benefits (such as for heavy menstrual bleeding, skipping periods, endometriosis or acne)
• possible side effects
• ease of use
• cost
• your general health – such as other health conditions and current medications or treatments
• your lifestyle and relationships
• your safety and risk of getting a sexually transmissible infection (STI)
• whether you want to get pregnant
• whether you can stop the method yourself or need to see a health practitioner
• the effort and time involved.

Some methods require more effort than others. Weigh the pros and cons and think about how each method meets your current and future needs. For example, if you decide on the pill, you need to remember to take it every day. If you choose an implant or IUD, once it has been inserted, it can last for a few years. Unless there are issues, you don’t need to think about it until it needs to be replaced.

Talk about your options with a GP or reproductive health nurse.

Contraceptive protection from STIs

As well as preventing an unintended pregnancy, it is also important to practise safer sex.

Not all methods of contraception give protection from STIs.

The best way to lessen the risk of STIs is to use condoms. Condoms (external or internal) can be used for vaginal, anal and oral sex to help stop infections from spreading.

Long-acting reversible contraception

Long-acting reversible contraception (LARC) gives safe, effective contraception over a number of years.

Their lifespan varies depending on the type of LARC you use.

LARC available in Australia includes:

• contraceptive implant
• copper and hormonal IUDs.

IUDs and implants are the most effective (more than 99%) contraception available to prevent pregnancy. They also require replacement less often than any other method.

LARC methods do not protect you from STIs. Practise safer sex by using condoms.

Contraceptive implants

A contraceptive implant is a LARC method, available in Australia as Implanon NXT™.

It is a small plastic stick (about 4 cm long) that is placed under the skin of your upper arm. It slowly releases a low dose of the hormone progestogen, which stops your ovaries releasing an egg each month.

You will notice a change to your period, or it may stop altogether.

The implant lasts for 3 years and is more than 99% effective at preventing pregnancy.

It can easily be removed and won’t stop you from getting pregnant in the future.

It is safe to use if you are breastfeeding and can be inserted straight after the birth of your baby.

Contraceptive intrauterine devices (IUDs)

An IUD is a small contraceptive device that is placed in your uterus. An IUD is also a LARC method. There are two kinds of IUD:

• copper IUD (Cu-IUD) – lasts 5 to10 years
• hormone-releasing IUD – last 5 years.

An IUD stops sperm from reaching and fertilising an egg. It also changes the lining of your uterus (womb), so a fertilised egg won’t stay in it to start a pregnancy.

The copper IUD can also be used as emergency contraception – as an alternative to the emergency contraceptive pill (morning after pill).

An IUD can easily be removed by a doctor or nurse and won’t stop your chance of getting pregnant in the future.

The copper IUD may make your periods heavier. The hormonal IUD will make your periods lighter or stop them completely.

IUDs are safe during breastfeeding and are not affected by other medications.

Contraceptive injections (Depo)

The contraceptive injection (Depo-Provera™ or Depo-Ralovera™, also known as Depo) is a hormonal injection. It contains the hormone progestogen, which is like the hormone produced by the ovaries.

When given on time, each injection is more than 99% effective at preventing pregnancy. This method stops ovulation and makes the fluid at the opening to the uterus (womb) thicker, stopping sperm from getting through.

The injection lasts 12-14 weeks, so you need to return to a clinic to have further injections by a doctor or nurse.

Injections tend to make periods less painful. You may find you have no vaginal bleeding or very light bleeding.

It can be given if you are taking other medications.

Injections do not protect you and your partners from STIs. To practise safer sex, you will need to use condoms.

Contraceptive injections can be used if you are breastfeeding and after a baby’s birth.

If you stop injections, it may take a while for your fertility to return.

Oral contraceptive pills

Contraceptive pills thicken the fluid around the cervix to block sperm from getting through. Most contraceptive pills stop ovulation by preventing the ovaries from releasing an egg each month.

Oral contraception needs to be taken around the same time each day. It is available on prescription (script) which you take to the pharmacy.

There are 2 types of contraceptive pills available in Australia:

• combined pill (or oral contraceptive pill) – contains 2 hormones similar to those produced by the ovaries – oestrogen and progestogen.
• progestogen only pill  (sometimes called the 'mini pill') – only contains progestogen.

Oral contraceptive pills, if used correctly are very effective (up to 99%) at preventing pregnancy. However, if you make a mistake – such as forgetting or delay taking them their effectiveness reduces to 93%.

Vomiting, severe diarrhoea and some medications can also affect how well the pill works.

The pill does not protect you from STIs so use barrier protection (such as condoms) when having sex.

Some pharmacies may provide a small number of pills without a script if you run out and haven’t seen your doctor for a new prescription.

Combined pill

Combined oral contraception contains synthetic forms of hormones – oestrogen and progesterone. When taken correctly, the combined pill is more than 99.5% effective at preventing pregnancy.

There are many types of combined pills with different doses and hormones. Some brands are more expensive than others and if you have a healthcare card, cheaper brands are available. Ask your pharmacist for more information.

Most combined pills come in a 28-day pack that includes hormone and sugar pills. Sugar pills can be missed if you don’t wish to have your period.

The pill can take up to 12 days to start working if you have never used it before or had a break from taking it. Use another form of contraception if you decide to have sex.

Some medications (including natural remedies) can interfere with the pill and stop it from working.

Combined oral contraception can be used to treat various conditions including heavy menstrual bleeding, polycystic ovary syndrome (PCOS), endometriosis and acne.

The combined pill may not be a good option for some people. This includes people who:

• smoke (35 years and over)
• have a body mass index (BMI) over 35 kg/m2
• are at risk of deep vein thrombosis, heart disease or stroke
• have severe liver disease
• have received treatment for breast cancer.

If you are breastfeeding, do not use the pill until your baby is 6 weeks old. Also, after birth, the combined pill is generally not recommended until your baby is 3-6 weeks old.

Check with your doctor, nurse or pharmacist to find out what options will work for you.

Progestogen only pill

The progestogen only pill contains a synthetic form of only one hormone – progesterone. There are 2 types the:

• traditional low dose progestogen only pill
• new standard dose progestogen only pill.

Both types make the fluid at the opening to the uterus thicker, stopping sperm from getting through.

The traditional low dose progestogen only pill is different to the combined pill as you usually still ovulate (release an egg) each month. It may not be as effective (up to 99%) as the new standard dose progestogen only pill and the combined pill. It needs to be taken strictly every day at the same time.

The new standard dose progestogen only pill also prevents ovulation.

The progestogen only pill usually suits people who have side effects when they take oestrogen or cannot take oestrogen for health reasons.

The progestogen only pill can be used while breastfeeding. It is also safe to start the progestogen only pill after the birth of a baby.

Vaginal ring

The vaginal ring (or NuvaRing™) contains similar hormones to the combined pill – oestrogen and progestogen. It slowly releases hormones that move from the vagina into the bloodstream.

The vaginal ring prevents pregnancy by stopping the ovaries from releasing an egg each month. It is at least 99% effective when used correctly.

Some medications and natural therapies may interfere with their effectiveness.

Vaginal rings come in one size are available on prescription which you take to a pharmacy. They are self-inserted (a bit like inserting a tampon) and usually stay in the vagina for 3 weeks.

After this time, you take the ring out and wait 7 days before inserting a new vaginal ring. You usually get your period after the ring is removed.

You can also skip your period by avoiding the 7-day break and inserting a new vaginal ring straight away.

As well as offering contraception, the vaginal ring can be used to treat some conditions (such as heavy menstrual bleeding, acne, PCOS and endometriosis).

If you are breastfeeding, you cannot use the vaginal ring until your baby is 6 weeks old. Also, after birth, the vaginal ring is generally not recommended until your baby is 3-6 weeks old.

The vaginal ring does not provide protection STIs so use barrier protection (such as condoms) when having sex.

The combined pill may not be a good option for some people. This includes people who:

• smoke (35 years and over)
• have a body mass index (BMI) over 35 kg/m2
• are at risk of deep vein thrombosis, heart disease or stroke
• have severe liver disease
• have received treatment for breast cancer.

Check with your doctor, nurse or pharmacist to find out what options will work for you.

Barrier methods of contraception

Barrier methods of contraception stop sperm from getting into the uterus to to prevent pregnancy. Options include:

• external condom
• internal condom
• diaphragm.

Condoms also lessen the risk of STIs. They are very effective because they block the exchange of body fluids during anal, oral, vaginal, some skin-to-skin contact and sharing of vibrators and sex toys.

Use a new condom each time you have sex and when switching to a different kind of sex (such as from anal to vaginal).

To be effective, all barrier methods need to be used and stored correctly. Follow the instructions on the packet and check the use by date before any sexual contact.

External condom

The external (or male) condom is a is a strong latex (rubber) pouch that is put over the erect penis to stop sperm from getting into the vagina. Non-latex ones are available for people who have a latex allergy.

Condoms come in all shapes and sizes and can be used by anyone who is sexually active.

Condoms are up to 98% effective when used the right way to prevent pregnancy.

Use a new condom each time you have sex. Put it on before there is any contact between the penis and vagina.

Condoms are easy to use. Be gentle when putting them on to avoid accidental tears. Use water or silicone-based lubricants (lube) as oil-based ones can make them break.

Condoms can be used with other forms of contraception.

External condoms are cheap and available without a doctor’s prescription from pharmacies, supermarkets, sexual health clinics and vending machines in some venues.

Internal condom

The internal condom (also known as female condom or femidom) is a loose non-latex pouch with a flexible ring at each end that sits in the vagina, to stop sperm from getting into the uterus.

If the internal condom is used the right way each time you have sex, it is 95 % effective at preventing pregnancy.

Internal condoms come in one size. They are stronger than external condoms and can be put in several hours before having sex. Use a new condom each time you have sex.
Using this method may take some practice.

Internal condoms are more expensive than external condoms. They are available from some retail outlets and sexual health clinics.

Diaphragm

A diaphragm (sold as Caya™ in Australia) is a soft, shallow, silicone dome that fits in the vagina. It is used with a special gel. You need to insert the diaphragm into the vagina so that it covers the cervix (the opening to the uterus) to stop sperm from getting through.

It needs to stay in place for at least 6 hours after sex. Do not leave the diaphragm for any more than 24 hours.

It is available in one size and may not fit everyone (around 1 in 7 people).

If used the right way, this method is 86% effective.

A diaphragm does not protect you or your partners from STIs.

Do not use a diaphragm that is past its use by date or has been used for 2 years or more.

You do not need a script to get a diaphragm – it can be bought from some pharmacies, sexual health and family planning clinics and online.

Diaphragms can be tricky to insert. It is recommended that a doctor or a nurse checks that you are able insert it correctly before it is used as contraception. Check with a doctor or nurse to find out if the diaphragm is a good option for you.

If you have recently had a baby, it is best to wait 6 weeks before using a diaphragm.

Permanent methods of contraception

Sterilisation is a permanent method of contraception that involves having a surgical procedure. It is a very effective (more than 99%) method of contraception.

These forms of contraception will not protect you from STIs, so you will need to practise safer sex by using condoms.

As with any form of surgery, there is a small risk of injury.

Tubal ligation

Tubal sterilisation or ligation (known as ‘having your tubes tied’), is usually performed as a keyhole procedure called a laparoscopy under general anaesthetic.

A surgeon places a clip on each fallopian tube to block the sperm and egg from meeting. In some cases, you may have your fallopian tubes removed rather than clipped.

Your ovaries and periods are not affected.

Vasectomy

Vasectomy (known as sterilisation or ‘the snip’) is a quick and easy procedure usually done under local anaesthetic. It involves cutting the tubes that carry sperm from the testes to the penis.

Although highly effective at preventing pregnancy, it can take around 3 months for a vasectomy to begin working (that is, no sperm is present in the semen). Use another form of contraception during this time and have sperm tests with your doctor.

Natural methods of contraception

Natural family planning (or fertility awareness) methods are overall not as effective as other forms of contraception. They are built on trust between partners and not having sex at times when you could get pregnant.

Some of these methods rely on having a regular menstrual cycle. If you have irregular periods, you have a higher chance of getting pregnant.

Natural methods are based on monitoring your body each day. This may include watching changes to your body’s temperature and vaginal fluid to determine the time you are fertile during your menstrual cycle.

Natural methods include:

• rhythm (or calendar)
• cervical mucus (or Billings)
• temperature and symptothermal.
• fertility apps.

Natural methods do not protect you from STIs.

They are not recommended if you:

• have a fever, vaginal infection or polycystic ovary syndrome (PCOS)
• regularly travel through different time zones
• are under stress.

The effectiveness of natural family planning varies, depending on which method or combination of methods is used.

Withdrawal method

The withdrawal (or pulling out) is where the penis is withdrawn from the vagina before ejaculation (cumming).

This method is not recommended as a form of contraception due to the risks of sperm being present in the pre-ejaculate or not withdrawing the penis in time.

Emergency contraception

Emergency contraception can be used after unprotected sex (such as missing a pill, the condom broke, or you didn’t use any contraception). You need to get it quickly to avoid an accidental pregnancy.

Forms of emergency contraception available in Australia include:

• the copper IUD
• emergency contraceptive pill (or ‘morning after pill’).

Emergency contraception is not an abortion.

Copper IUD

The non-hormonal copper IUD is the most effective method (more than 99%) of emergency contraception. It works by making it difficult for a fertilised egg to stick to the uterus (womb) lining.

It can be inserted within 5 days of unprotected sex.

Once inserted the copper IUD can provide effective contraception for 5 -10 years.

Emergency contraceptive pill

The emergency contraceptive pill (or ‘morning after pill’) prevents or delays the ovaries releasing an egg. It should be taken as soon as possible after unprotected sex.

The emergency contraceptive pill is around 85% effective in preventing pregnancy.

Two types of emergency contraceptive pills are available at pharmacies (chemists) without a prescription:

• ulipristal acetate (sold as EllaOne) – taken up to 5 days (120 hours)
• levonorgestrel (various brands) – taken up to 4 days (96 hours).

Ulipristal has been clinically demonstrated to be more effective than levonorgestrel.

Emergency contraceptive pills are not recommended as your usual method of contraception. Ask your GP or reproductive health nurse for further advice.

Information in community languages

The following is available from Health Translations Directory:

Contraception – your choices (PDF) by Royal Women's Hospital, Victoria

• Arabic
• Chinese (simplified)
• Hindi
• Spanish
• Urdu
• Vietnamese

Contraceptive options – what can I choose (PDF) by Sexual Health Victoria (formerly Family Planning Victoria)

• Easy English

Where to get help

• Your GP (doctor)
• Your school nurse or welfare coordinator. Some secondary schools provide access to an adolescent health trained GP on site
• Your local community health service
• Your pharmacist
• Some public hospitals have clinics including family planning, sexual health and women’s health
• 1800 My Options – Victoria’s sexual and reproductive health information and phone line service Tel. 1800 My Options (1800 696 784)
• Sexual Health Victoria (SHV) – book an appointment online or call Melbourne CBD Clinic: (03) 9660 4700, Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952 (Monday to Friday 9 am – 5 pm). These services are youth friendly
• Melbourne Sexual Health Centre (Monday to Friday 8:30 am – 5 pm) Tel. (03) 9341 6200 or 1800 032 017 or National Relay Service (for people with a hearing impairment) (03) 9341 6200
• Victorian Sexual Health Network – where to get tested – visit Melbourne Sexual Health Centre's GP partner clinics for STI check-ups and treatment
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840 (toll free)
• The Centre Clinic, St Kilda Tel. (03) 9525 5866
• Equinox Gender Diverse Health Centre (Monday to Friday 9 am – 5 pm) Tel. (03) 9416 2889 or email: equinoxadmin@thorneharbour.org
• PRONTO! Clinic for men who have sex with men. Book online or Tel. Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health Clinic – book online or Tel. (03) 5338 4541
• Bendigo Community Health Services Sexual and Reproductive Health Hub - book online Tel. (03) 5406 1200 or (03) 5448 1600
• Gateway Health Sexual and Reproductive Health  – Clinic 35, Wodonga (Monday to Friday 9 am – 5 pm) Tel. (02) 6022 8888 and Wangaratta Tel. (03) 5723 2000 or email: info@gatewayhealth.org.au
• Sunraysia Community Health Services, Mildura (Monday to Friday 8:30 am – 5 pm) Tel. (03) 5022 5444 or email to: schs@schs.com.au
• Barwon Health Sexual Health Clinic (no GP referral, walk-in service Tuesdays 2 pm – 6:30 pm) Tel. (03) 5226 7489
• Victorian Aboriginal Health Service Fitzroy: Tel. (03) 9419 3000 and Preston Tel. (03) 9403 3300 (Monday to Friday 10 am – 4 pm) and after-hours locum service Tel. 132 660 or Epping: Tel. (03) 8592 3920 (Monday to Thursday 9 am-5 pm, Friday 9 am-4 pm)