As a health care professional, you play a crucial role in patient education. One area where your advice can be particularly valuable is in helping pre-menopausal women understand their contraception options. Here’s a guide you can use when discussing this topic with your patients:
Hormonal Contraceptives: These contraceptives work by releasing hormones into the body to prevent ovulation, thicken cervical mucus making it harder for sperm to reach the egg, and thin the lining of the womb to prevent a fertilised egg from implanting. They come in various forms such as pills, patches, vaginal rings, and implants. However, they may have potential health risks associated with each type. For instance, they can increase the risk of certain medical conditions such as blood clots, heart attack, stroke, or breast cancer. They can also cause or worsen symptoms of hormonal imbalance like fluid retention, headaches, loss of sexual desire, breast tenderness, irregular bleeding, depression, and hair loss.
Intrauterine Devices (IUDs): An IUD is a small T-shaped device that’s put into your womb (uterus) by a doctor or nurse. It releases copper to stop you getting pregnant and protects against pregnancy for between 5 and 10 years. However, IUDs carry a small risk of complications including perforation (approximately 2/1000), infection during the first 20 days (<1/300), failure (<1/100), and expulsion (5%).
Intrauterine System (IUS): The IUS is similar to the IUD, but instead of releasing copper, it releases the hormone progestogen into the womb. It thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the lining of the womb so an egg is less likely to be able to implant itself. The IUS can cause side effects such as mood swings, skin problems or breast tenderness. There’s a small risk of getting an infection after it’s been fitted.
Barrier Methods: Barrier methods work by preventing sperm from reaching an egg. They include male condoms, female condoms, diaphragms and cervical caps. There are no age restrictions for the use of barrier methods. They are crucial for women in newer relationships and/or where there is any risk of a sexually transmitted infection. The risks of using barrier methods include allergic reactions, urinary tract infections (UTIs), vaginal irritation or burning, and toxic shock syndrome (rare).
Long-Acting Reversible Contraceptives (LARCs): LARCs include hormonal IUDs, copper IUDs, contraceptive implants, and contraceptive injections. They provide highly effective ‘set-and-forget’ contraception. LARCs are generally safe but there can be side effects such as irregular bleeding for the first three to six months. There’s also a small risk of getting an infection after it’s been fitted.
Sterilisation: Sterilisation is a permanent method of contraception that involves blocking or sealing the fallopian tubes. This prevents eggs from reaching the womb. Female sterilisation does not alter or eliminate periods therefore most women opt for long acting contraceptive options as they provide additional benefits to your periods. Sterilisation carries a low risk of side effects such as internal bleeding or infection from the surgery. There is also a small risk of ectopic pregnancy if the surgery hasn’t worked properly.
Remember to advise patients to consult with their healthcare provider to discuss these risks and choose the contraceptive method that best suits their health condition and lifestyle.
For healthcare professionals seeking more information on contraceptive options, I recommend reading the article titled “Understanding The Contraceptive Cap: The Advantages and Disadvantages” available on the PDUK website. It provides a comprehensive overview of the contraceptive cap, including its benefits and drawbacks. There are also links to PDUK women’s health courses.
References:
NHS (2021) ‘Your contraception guide’, NHS, Available at: https://www.nhs.uk/conditions/contraception/ (Accessed: 13 October 2023).
Faculty of Sexual & Reproductive Healthcare (2020) ‘UK MEC: summary of recommendations’, FSRH, Available at: https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets/ (Accessed: 13 October 2023).
Royal College of Obstetricians and Gynaecologists (2019) ‘Menopause and women’s health in later life’, RCOG, Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_14.pdf (Accessed: 13 October 2023).
