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well…what?: hormonal contraception part II

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Join Lip’s Cin Peeler for her all new fortnightly column on all things medicine, health and wellbeing!

Last fortnight on Lip, Cin ran us through some types of hormonal contraception, their benefits and side effects. Here are a few more options …

Intra Uterine Device (IUD)

Mirena™ is the only available brand of hormonal IUD currently in Australia, is covered by the PBS, and lasts up to five years. IUDs are inserted by a specially trained medical professional, occasionally under sedation or with a local anaesthetic, but usually neither is necessary. The procedure can be uncomfortable, and sometimes painful, but not for very long. There is a small risk of the IUD slipping out of place after the procedure, which would make the IUD ineffective, but this is more common younger people and if you haven’t had a baby. There is also a very small risk of infection developing within the first three weeks after insertion, or that the IUD will push through the wall of the uterus. Your health care provider can fix both of these straight away, as long as you follow post-op care procedures.

As Mirena™ releases progestogen into the uterus, it works similarly to the Mini Pill and Depo. Once it is removed, conception is possible almost immediately. The hormonal IUD is used to treat Menorrhagia, which is excessive menstrual bleeding. IUDs can also be used as emergency contraception if inserted within 120 hours (five days) of unprotected sex.

Another form of IUD, the copper IUD, a form of contraception which is great for those who don’t do well with hormonal contraceptives, but don’t wish to use condoms, dams, or diaphragms (contraception that protects against STIs). It is similar to the hormonal IUD, but doesn’t use progestogen, so doesn’t lessen the side effects of periods (and can actually make periods heavier and worsen cramps). It lasts up to ten years, but is not covered by the PBS, and is not suitable for people with a copper allergy or Wilson’s Disease. Erika Moen of Oh Joy, Sex Toy (Adults Only!) does a great comic on copper IUDs and why she chose it here.

Vaginal Ring

The vaginal ring is placed into the vagina, where the hormones are absorbed into the body. The ring stays in for three weeks, before being removed for one week, and then being replaced by a new one. The vaginal ring uses the same hormones as the Pill, oestrogen and progestogen, so provides similar benefits, but also has similar possible side effects. When using the ring, you can skip the ring-free week, much like skipping the sugar pills in the Pill blister pack, to avoid getting the lighter, period-like withdrawal bleed. Another advantage of the vaginal ring is that it doesn’t need to be fitted by a medical professional, unlike an implant or an IUD. Unfortunately, it’s not be compatible with some health conditions and medications, such as certain migraines, deep vein thrombosis, and breast cancer. The only available brand in Australia is the NuvaRing®, which is not PBS listed, so the vaginal ring is one of the least cost effective methods of hormonal contraceptives in Australia.

Emergency Contraception (“Morning After Pill”)

Trigger warning: rape.

This is not an abortion. It is a common misconception that emergency contraception is terminating or can terminate a pregnancy, but it is a form of contraception meaning it only prevents pregnancy. Emergency contraception uses progestogen to prevent ovulation, thicken cervix mucus, and prevent the egg “sticking” in the endometrium. If the egg and the sperm have already formed an embryo, emergency contraception will not terminate the pregnancy. There are many reasons someone might need emergency contraception, including failed birth control, unsure if they used birth control or used it correctly, and rape. It is incorrectly called the Morning After Pill, because it can be taken up to five days after unprotected sex, not just following day. The sooner after unprotected sex it is taken, the more likely it will be effective at preventing pregnancy.

If you use emergency contraception, you may find in the weeks following you have light bleeding or “spotting”, your period may come slightly early or late, and you might become nauseous for a few days. However, there are no long-term side effects of taking the emergency contraceptive pill, and you can even take it more than once in one menstrual cycle. If you take emergency contraception and vomit within two hours, you must take it again. In Australia, emergency contraception can be bought over the counter at chemists and costs between $25 and $35.

Always talk to your doctor… 

There is always a risk factor when engaging in sexual activity, and while all of these contraceptives have extremely high success rates, none of them are 100% effective at preventing pregnancy, and none of them protect against sexually transmissible infections (STIs). If one of these looks like it might be the one for you, or you have any other questions, talk to your doctor and get more information.

Other places to find information:

Family Planning NSW

Talkline: 1300 658 886

Family Planning Victoria

Advice Line: Under 25s – 1800 013 952 (free call)

Over 25s – 03 9257 0116

To find a sexual health clinic in your area:

Sexual Health & Family Planning Australia

Cin will be back in a fortnight with the next instalment of ‘Well…What?’: Lip’s guide to health, medicine, healthcare and wellbeing. Stay Tuned, Lipsters!

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