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This is a very big topic and because of that I’m going to split it up into two separate articles.  This week I’m going to cover what is known as “short acting contraception” and then in a couple of weeks I will cover the newer “longer acting contraception”.

People have been using contraception for hundreds of years and thankfully things have moved on from the use of beeswax in the vagina as a barrier to sperm or drinking various “poisons” such as mercury containing drinks, as an abortive agent.  However, surprisingly some still think that the “withdrawl method” prior to ejaculation is a reliable form of contraception.  It is thought that this was one of the first birth control methods ever to be used, but it is a very risky method as pre-ejaculation semen does contain sperm and also some men are better at timing this than others, so it should not be used a birth-control method unless you do want to run the risk of getting pregnant!

Therefore what are the options we have left?

In terms of physical barriers, there is of course the male condom.  This can be bought from most chemists, supermarkets, sexual health clinics and family planning clinics.  They come in all colours, flavours, sizes, with or without ribs, and with and with out latex.  In order for these to be successful as a form of contraception it is really important that they are put on before any sexual interaction takes place, to avoid any chance of pregnancy.  As women have been known to get pregnant if ejaculation occurs on the external genitalia and then penetration occurs and semen is pushed up into the vagina.  It is also important that some vaginal pessaries used to treat, for example thrush or some vaginal lubricants (especially oestrogen based lubricants prescribed by the GP), are not used at the same time as using condoms (or female barriers) as they damage them and prevent them being a proper barrier.  Condoms are not reusable, it is really important that the packet is opened correctly to prevent them being torn and that they are put on properly.  A full description on how to put one on properly can be found on leaflets inside condom packets.  It is also worth knowing that in the Brighton and Hove area, people aged between 13-25 years old can become part of the C-Card scheme and get free condoms (just look at www.swish.org.uk for more information on this).

Physical barriers for women include the vaginal condom, diaphragm and the cervical cap.  These are still used by some women but since the production of the contraceptive pills their popularity has gone down.  The cap is the smallest of the female barrier products on the market, and along with the diaphragm needs to be fitted by a health professional and cannot just be bought over the counter.  Unlike the male and female condoms the diaphragm and cap are reusable, but it must be used with some spermacide, which comes in the form of a gel, several hours before intercourse and not removed for several hours after.  Therefore, more planning is needed with these methods than the condom (male or female).

The final form of contraception which I’m going to discuss today is the contraceptive pill.  This is by far the most popular of all contraceptive devices, but through my experience I feel that this might soon change with the newer longer acting contraceptive devices now being more available.  There are two different types of pills; the first is the combined oral contraceptive pill (COCP).  This has both oestrogen and progesterone hormones and is taken for 21 days, one a day, and then you have a 7 day pill free gap before starting another packet of pills.  As this type of pill has oestrogen in it the risks outweigh the benefits in the case of some people.  Such as those who are over 35 years and smoke more than 15 cigarettes a day, have a family history of blood clots/strokes, suffer with migraines with visual symptoms or migraines which worsen with the COCP, are overweight (BMI greater than 35) or if you are over 40 years old.  A lot of studies have been done to look into these risks and because of this health professionals are able to advise whether this form of contraception is best suited to the individual and whether the risks outweigh the benefits and vice-versa.  Therefore it is very important that this is discussed with a health professional at your GP practice, sexual health or family planning clinics.

Conversely the second type of pill is called the progesterone only pill (POP) and this is taken every day with no pill free week.  As the name suggests it does not contain any oestrogen but only progesterone and so can be used by a greater number of women.  This pill is taken everyday with no breaks and for some people they will stop having any periods with it (2 in 10 women).

Here is a small list of some helpful pill rules which you can use as a reference guide:

1 – starting the pill:
 For both the COCP and POP if started up to and including the first 5 days of your period, you are instantly covered in terms of contraception, so you don’t have to wait before having unprotected intercourse. 
 If you start on any other day of your cycle, you have to wait 7 days before being covered with the COCP and 2 days before being covered with the POP.

2 – missed pills:
 For the COCP and the POP you should aim to take them at the same every day.  However, with the COCP you have a 12 hour window (that is, for example between 8AM and 8PM the same day), and for the POP you have a 3 hour window (that is, for example between 8AM and 11AM the same day).  Except for Cerazette which is a certain type of POP and has a 12 hour window.
 If you forget to the pill outside the 12 hour window in the case of the COCP, you need to wait 7 days before you are fully covered again.  You must continue taking the pills as soon as you remember that you have forgotten it (this may mean taking 2 pills on the same day).  The most important pills to take are the pills in the first week of your cycle and the last week, so that the 7 day gap between pill packets, is not extended.  (Newer evidence suggests that according to the oestrogen content in your pill different missed pill rules can apply, but for simplicity sake for this article I have just stated it as above which makes it safe for all COCPs and an easier rule to follow.  For further information on this please consultant your GP.)
 If you forget to take the POP outside the 3 hour window (or 12 hour window in the case of Cerazette), you must continue to take your pill as soon as you remember (this may mean taking 2 pills the same day) and you need to wait 2 days before being fully covered again.
 If you fail to use additional contraception or abstinence for the period after the forgotten pill then you are at risk of getting pregnant and you must use emergency contraception.  This can either be in the form of “morning after pill” which can be taken up to 72 hours after the episode of unprotected sex, but the sooner it is taken the more effective it is, or in the form of a copper coil which can be inserted up to 5 days after.

3 – interaction with medication:
 The COCP interacts with most antibiotics as they stop the pill from being absorbed, therefore you must take additional contraception for the duration of the course of antibiotics and 7 days after.  If in this time there you have the pill free week you should omit the 7 day gap and take two packets back to back.
 The POP interacts with only some antibiotics and medication so it is always best just to highlight to the nurse or GP that you are taking this form of contraception and whether additional protection needs to be used.

4 – severe diarrhoea or vomiting:
If within 2 hours of taking either the COCP or POP you suffer with vomiting or severe diarrhoea then the pill will not be absorbed so you must take another pill or
use additional contraception.

5 – STIs
 Both the COCP and POP only stop you getting pregnant, they do not stop the transmission of sexually transmitted infections, therefore barrier protection should always be used as well, for example a condom, or before starting a new relationship it is advised that both partners should have a sexual health screen.  You can have a sexual health screen at your local sexual health clinic (G.U.M clinic) which you can find details about easily through your GP or by using an Internet search engine. 

Finally, there are a few newer products on the market; one of these is the Nova ring, which is a vaginal ring form of the COCP.  It is a hormonal contraceptive ring of oestrogen and progesterone and it is put into the vagina on the first day of your period (it follows the same principles as the COCP) and stays there for three weeks followed by a 7 day break and then a new one is inserted.  There is also another pill, which has recently been launched in America called Clara.  The pills in each packet have different hormone levels in them, which are intended to mimic your natural hormonal changes in a normal cycle.  As a result, if you thought the pill rules were complicated for COCP and POP, I think you may need to go on a course or be very organised so that you never miss a Clara pill before using it!