Guide To Contraception

Guide to Contraception: Combined pill

There are two main types of Pill which vary in hormone content and the way they work. The most widely used are the combined pills which combine two hormones, oestrogen and progestogen. There are also pills which have progestogen only and no oestrogen.

How effective is it?
Tests show that for every 100 women who take the pill correctly for one year, less than one will get pregnant. But with less careful use three or more in 100 will get pregnant. To make the pill as effective as it can be, remember:

• To take it regularly.
• To use another contraceptive method as well: if you miss a pill, vomit within 2-3 hours of taking the pill, have diarrhoea or are taking other medicines that may interfere with the pill.

What are the advantages?
- It is a very effective method of contraception.
- It does not interfere with intercourse.
- It helps to reduce heavy or painful periods.
- It may prevent pre-menstrual syndrome.
- It reduces the incidence of noncancerous breast lumps and ovarian cysts.
- It protects against cancer of the ovary and cancer of the body of the uterus (womb).
- Its contraceptive effects are totally reversible.

Are there any side-effects?
When starting the pill some women may experience: breast tenderness, a mild headache, a bloated feeling, or have some bleeding while taking the pill.

Although these can be a nuisance they are not dangerous and should disappear within the first few months on the pill.

However, a woman should see her doctor immediately if while taking the pill she develops:
- Pain or swelling in her legs.
- Severe chest pain.
- Breathlessness or coughing up blood.
- A bad fainting attack or collapse.
- Unusual headaches or difficulty with speech or sight.
- Numbness or weakness of a limb.

Some women develop high blood pressure on the pill, so regular checkups are required.

There is some evidence that young women who start the pill early and stay on it for a long time may be at a small increased risk of breast cancer.

Cancer of the cervix may also be more common in women on the pill so regular smear tests are advised.

What if you smoke?

• Smoking increases some of the risks of the pill.
• If you do not smoke and are healthy you can stay on the pill until 50.
• If you do smoke you will have to stop the combined pill at 35.

If you are a very heavy smoker you may not be suitable for the pill at any age.

What about antibiotics?
Antibiotics can interfere with the absorption of the pill. Therefore, it is important that you use condoms as well as the pill while taking antibiotics and for 7 days afterwards.

If you miss a period?
If you have taken all your pills properly it is most unlikely you are pregnant. Take your next packet as normal. If you think you might have put yourself at risk of pregnancy or if you miss a second period, see your doctor at once.

If you are changing pill brands?
Sometimes you need extra contraceptive protection when you change pills. Ask your doctor.

What if you want to have a baby?
If you plan to become pregnant you may like to stop the pill and use condoms for a few months before trying to conceive. However, this is not essential.

You should of course take folic acid for three months before starting a baby and for the first three months of the pregnancy.

Special precautions?
Ask your doctor for advice about your pill taking if you are planning to have surgery, are immobilised for a prolonged time, are taking a high altitude holiday or a long-haul flight.

A final word
This fact sheet can only outline basic information about the combined pill based on evidence available and current medical opinion at the time of publication. Most pill manufacturers produce their own instruction leaflets and, in some cases, these give conflicting advice on certain points. If in doubt, seek your doctor's advice in your individual case.

Don't forget Ring or visit the clinic or your doctor if you are worried or unsure about anything.

Guide to Contraception: Progestogen-only Pill

There are two main types of Pill which vary in hormone content and the way they work. The most widely used are the combined pills which have two hormones, oestrogen and progestogen. There are also pills which have progestogen only and no oestrogen. This fact sheet is about the progestogen-only pill.
How effective is it?
Tests show that for every 100 women who take the progestogen-only pill very carefully and consistently, one will get pregnant in a year. But with less careful and consistent use, four or more women in 100 will get pregnant. This pill is even more effective in women over 40 years of age. To make the pill as effective as it can be, remember:

• To take it regularly, and at the same time each day.
• Use another contraceptive method as well if you miss a pill or are sick, have severe diarrhoea, or are taking medicines which may interfere with the pill.

How does it work?
The progestogen-only pill does not always stop the ovary releasing an egg each month (ovulation). The main action of this pill is to thicken the fluid (mucus) at the neck of the womb (cervix) which makes it hard for sperm to travel through. It also makes the lining of the womb less Iikely to accept a fertilised egg.

Where do you get it?
Only a doctor can give you the pill. Family planning centres and most doctors prescribe it. You will be asked your medical history to make sure the pill is suitable for you. Your blood pressure should also be taken.

Who is it suitable for?
The pill has the great advantage that it does not interfere with intercourse. As long as you remember to take your pill every single day without a break, you can have intercourse as often as you like, without having to take any other contraceptive precautions. The progestogen-only pill is a possible alternative for older women or others who cannot use the combined pill. It is suitable for women who are breastfeeding as it does not reduce the milk flow. A small amount of hormone enters the milk, but research suggests this will not harm the baby.

Remember, the pill does not prevent transmission of Sexually Transmitted Infections so condoms should also be used.

What if you smoke?
Smoking increases the risks to your health and increases some of the risks of the combined pill. While it is best to stop smoking anyway, these risks do not seem to apply to the progestogen-only pill so it is suitable for women over 35 who smoke.

If you forget a pill?
Take it as soon as you remember, and take the next one at the right time.

This may mean taking two pills in one day. If you take the progestogen-only pill more than three hours late, you are not protected. Continue to take your pills normally but you must also use another method, such as the condom, for the next 7 days.

If you have a stomach upset?
If you have vomiting or severe diarrhoea while taking the pill it may not work. Continue to take it, but you may not be protected from the first day of vomiting or diarrhoea. Use another method such as a condom, for any intercourse during the stomach upset and for the next 7 days.

If you have to take other medicines?
Several medicines may interfere with the way the pill works. These include some drugs that treat epilepsy and tuberculosis. Other medicines, such as sedatives and tranquillisers, might also have this effect. You may have to use another method as well, such as the condom, while you are taking the medicines, and for a further 7 days. Your doctor may advise extra precautions for longer.

Always mention you are on the progestogen-only pill if you are prescribed any medicines.

Are there any problems?
Taking the progestogen-only pill may cause irregular bleeding. Some women find that their periods are much lighter, others have no periods at all. Bleeding at odd times often happens. This is called breakthrough bleeding. Some women have repeated breakthrough bleeding throughout the month. A change of pill may help. If your period is more than two weeks late, consult your doctor or clinic.

One risk of any pregnancy is that occasionally it develops outside the womb, usually in a fallopian tube. This is called an ectopic pregnancy. Although it is rare, it can be dangerous. You should see your doctor straightaway if you have sudden unexplained lower abdominal pain. Be sure to mention to the doctor if you have had a previous pregnancy in the tube, since this may mean it would be better for you to use another method.

Cysts on the ovary may occur in progestogen-only pill users, but are not dangerous. These may cause pain, but sometimes there are no symptoms. These cysts usually disappear when you stop taking the pill.

If you miss a period?
This can happen with this pill. If you have taken all your pills at the right time it is most unlikely that you are pregnant. Continue with your pills as normal. If your period is more than two weeks late, consult your doctor or clinic. If you think you might be pregnant see your doctor sooner. If you have any sudden lower abdominal pain as well as a light or delayed period, see the doctor immediately. These might be the warning signs of an ectopic pregnancy.

If you are changing pill brands?
If you are starting the progestogenonly pill after any brand of combined pill: take the first pill the day after the last of your old kind. Do not leave any break at all, and use condoms for seven days.

If you have side-effects?
Any side effects should be discussed with your doctor.

Suppose you want to have a baby?
If you want to have a baby it is helpful to stop the pill and then have two periods before you try to get pregnant. You can use another method such as a condom for that time. Once you have had two natural periods it is easier to work out when the baby is due. However, if you do get pregnant immediately after stopping the pill, research to date has shown this is not harmful.

What else do you need to know?
It is important that you see your doctor at regular intervals. This will probably be every six months once you are settled on the pill. If you have any worries at all talk to the doctor or nurse sooner.

A final word.
This page can only outline basic information about the progestogen-only pill based on evidence available and current medical opinion at the time of publication. Most pill manufacturers produce their own instruction leaflets and, in some cases, these give conflicting advice on certain points. If in doubt, seek your doctor’s advice in your individual case.

Don't forget Ring or visit the clinic or your doctor if you are worried or unsure about anything.

Guide to Contraception: Injectable Contraceptive

This page gives you some information about injectable contraception, also known as the jab. Only one type is available in Ireland, it is called Depo-Provera. This contains a similar hormone to that in the progestogenonly pill. It can be used by women who cannot use other methods of hormonal contraception. One injection gives 12 weeks protection.

How effective is it?
Tests show that for every 100 women using it, less than one will get pregnant in a year. It is very effective.

Who is it suitable for?
Once you have a regular injection the contraception cannot be forgotten, this makes it useful for women who find daily pill taking hard to remember, those who must avoid pregnancy and those unable to use other methods. It does not interfere with intercourse.

How is it used?
The hormone is injected into a muscle, usually during the first five days of a period, and is released very slowly into the body. Further injections are needed every 12 weeks.

Discuss with your doctor the best time to have your first injection. If you have just had a baby it is believed that delaying the injection for six weeks often makes irregular bleeding less likely. It does not affect your milk supply. A small amount of hormone enters the milk, but is thought to be harmless for the baby.


How does it work?
While similar in many ways to the hormone in the progestogen-only pill, the injectable hormone stops the body releasing an egg each month (ovulation).

Are there any problems?

• The most common side-effect of injectable contraception, like the progestogen-only pill, is that it may alter your periods. Some women find they have fewer or no periods, especially after one or more injections. A few women experience more frequent light bleeding which may be a nuisance. Lack of periods or irregular periods in relation to this method are not harmful to your health. However, frequent and/or heavy bleeds which might occur can, in a woman with a poor diet (low iron content), lead to anaemia.
• Some women gain weight when using this method, and some experience depression which may or may not be related to Depo-Provera. You should seek your doctor’s advice on these, and other less common sideeffects.
• As the injection lasts three months, you can only reconsider whether or not to use it when the next injection becomes due. In the meantime it cannot be removed from the body and any side-effects may continue.
• Some women find that when they stop injections of Depo-Provera there is a delay of many months before their periods come back again. Return of regular periods and fertility may be delayed for up to a year after the last injection.
• The findings with regard to cancer of the breast and cancer of the uterus (womb) in humans are reassuring. The question of a very small increase in the risk of cancer of the cervix (neck of the womb) remains uncertain. Regular smear tests are advised.

Where do you get it?
Only a doctor can prescribe an injectable. You will be asked your medical history to make sure that the method suits you. If you are offered this method, you should discuss any possible side-effects before you have the injection. Don’t be afraid to ask questions. It is your choice whether to have it or not. You are under no obligation to accept it if you do not want to. If you find it does not suit you, you don’t have to have a repeat injection.

A final word
This page can only outline basic information about injectable contraception based on evidence available and current medical opinion at the time of publication. You may come across conflicting advice on certain points concerned with the use of injectable contraception. If in doubt, seek your doctor’s advice in your individual case.

Guide to Contraception: Intrauterine System (IUS)

The letters IUS stand for Interuterine System. This means it is placed inside a woman’s uterus (womb). The IUS is a small T-shaped plastic device with a sleeve, which releases the hormone progestogen into the cavity of the womb. It thickens the mucus at the neck of the womb making it difficult for sperms to reach the egg. It inhibits the function of the sperm within the womb. It makes the lining of the womb thin making periods lighter and shorter. There is only one IUS available at this time. It is called Mirena.

How reliable is it?
It is as reliable as female sterilisation but is a reversible method of contraception. Failure rate is 1-2 per 1000.

How effective is it?
It is as reliable as female sterilisation but is a reversible method of contraception. Failure rate is 1-2 per 1000.

Who is it suitable for?
Many women like the IUS because it does not interrupt intercourse. It works as soon as it is in place. The method is most suitable for women who have had children and for older women who may be advised to stop the pill. Not everyone can use an IUS and your doctor or nurse will need to ask you about your own and your familyís medical history. Do mention any illnesses or operations you have had. Some of the conditions which may mean you should not use an IUS are

• If you think you might already be pregnant.
• You have now or have had in the past:
  - Cancer of the womb or ovary.
  - Active liver disease.
  - Unexplained bleeding from your vagina (for example between periods or after sex).
  - A heart attack or stroke (severe arterial disease).
  - An unrelated sexually transmitted infection.
  - An artificial heart valve ‚ this will require specialist advice.
  - Any problems with your womb or cervix.

When and how is it fitted?
The IUS is fitted during your period to ensure you are not already pregnant. You will be examined internally to find the position and size of your womb before the IUS is fitted. It can be uncomfortable having an IUS fitted and you will be given a painkiller to take before insertion. You may get a period-type pain and some bleeding for a few days after the IUS is fitted. Painkillers can help with this.

Removal of your IUS
A trained doctor or nurse can take out the IUS at any time. If you are not going to have another IUS put in, and you don’t want to become pregnant, you will need to use an extra contraceptive method, such as condoms, for seven days before the IUS is taken out. This is because sperm can live up
to seven days inside your body, and could fertilise an egg once the IUS is removed. Your usual period and fertility returns quickly after removing the IUS.

How will you know if it is still in place?
You can check to see if your IUS is still in place by putting your finger in the vagina and feeling the threads coming through the cervix. The best time to do this is regularly in the first month and then after each period if you have one. If you cannot feel the threads or if you feel a hard end rather like a matchstick, you should see your doctor straight away. If your partner says he can feel the threads and it is uncomfortable during intercourse you should have them checked. They may need trimming or the IUS may be coming out.

Check-ups
It is important that you have a checkup regularly with the doctor - about six weeks after fitting and then at least once a year. The Mirena is effective for five years but can be removed any
time.

How does the Mirena work?
The Mirena works in several different ways, both as an IUCD and hormonally due to the slow release of progestogen which acts locally on the lining of the womb. Its main action is to stop sperm reaching the egg to fertilise it by thickening the mucus in your cervix. It inhibits normal sperm function inside the womb and tubes.

It also makes the lining of the womb thin, making periods lighter, shorter and often stopping.

Are there any problems?
Very rarely, the womb can push the Mirena out (expulsion). This is most likely soon after insertion and you may not know it has happened, so the use of an additional method of contraception until your check-up is advised.

If you get pregnant with a Mirena in place, there is a possibility of this being an ectopic pregnancy. This is when a fertilised egg settles outside the womb, usually in a fallopian tube, and starts to grow. This is rare but serious. Consult your doctor straight away if you have any sudden lower abdominal pain or feel you may be pregnant.

The warning signs of pelvic infection are pain during or after intercourse, pain in your lower abdomen or unusual vaginal discharge, especially if you have a fever. Infection can be easily treated, but if left it can be serious. See your doctor.

The Mirena is usually removed, if possible, if you become pregnant while using it. This reduces the risk of miscarriage though that may still happen.

Rarely when the Mirena is fitted it might perforate the womb tissue or cervix. The Mirena may then have to be removed.

Final word
This page can only outline basic information about the Mirena based on evidence available and current medical opinion at the time of publication. You may come across conflicting advice on certain points with the use of the Mirena. If in doubt, seek your doctor's advice in your individual case.

Guide to Contraception: iucd

The letters IUCD stand for Intrauterine Contraceptive Device. This means it is placed inside a woman’s uterus (womb). It is also known as the IUD, loop or coil, but these terms are now inaccurate and are no longer widely used. IUCDs are made of plastic with a coating of thin copper wire. Different IUCDs suit different women; the doctor will choose the best one after learning the woman’s medical history and examining her.

How effective is it?
Tests show that for every 100 women using it, one to two will get pregnant in a year. If you want to reduce this risk, use a spermicidal cream, jelly, pessary, film or foam in the vagina, especially around ovulation (the fertile time).

Who is it suitable for?
Many women like the IUCD because it does not interrupt intercourse. It works as soon as it is in place. The method is most suitable for women who have had children and for older women who may be advised to stop the pill.

IUCD users may be more likely to get an infection in the womb and fallopian tubes. This is sometimes called salpingitis or PID (pelvic inflammatory disease). Infection is most common in young IUCD users who may have new sexual partners, or whose partner has more than one sexual partner. For this reason it is not a first choice method for young women.

How does it work?
The IUCD is thought to work in several different ways, and through a combination of factors. Its main action is to stop sperm reaching the egg to fertilise it. It may also delay the egg coming down the fallopian tube, as well as preventing the egg settling in the womb.


When and how is it fitted?

• The IUCD must be fitted and removed by a specially trained doctor. It is fitted during your period to make sure you are not pregnant. It also may be easier to fit during a period as the cervix is a little softer at this time. IUCDs are fitted at special sessions in the clinic. Please phone for an appointment.
• If you have just had a baby, an IUCD is usually fitted about 6-8 weeks after the birth. You will need to use another contraceptive method until then.
• The fitting of the IUCD can cause some discomfort. Some discomfort may be felt for a few hours afterwards, which may feel like period pain. You may get some bleeding afterwards.

How will I know if it’s still in place?
You can check to see if your IUCD is still in place by putting your finger in the vagina so that you can feel the threads coming through the cervix. The best time to do this is regularly in the first month and then after each period.

If you cannot feel the threads, or if you feel a hard end rather like a matchstick, you should see your doctor straightaway. If your partner says he can feel the threads and it is uncomfortable during intercourse you should have them checked. They may need trimming, or the IUCD may be coming out. You can use tampons as usual.

Check-ups
It is important that you have a checkup regularly with the doctor – within 6-12 weeks of fitting and then at least once a year. IUCDs are usually replaced every 5 or more years depending on which type is fitted. It’s important to know what sort you have. Then you’ll know when to have it changed.

When else should I see my doctor?
You should talk to your doctor if you have any problems, worries or points that you wish to discuss. Make sure to seek an appointment if:

• You think the device has come out.
• You have pain with intercourse or abdominal pain.
• You have unusual vaginal discharge and fever.
• Your period is more than l4 days Iate.

Are there any problems?
It is important that you are aware of possible problems with your IUCD.

• IUCDs may cause heavier or longer periods in some women, especially in the first few months. May be slight bleeding between the first few periods. This should settle down.
• The womb can push the IUCD out (expulsion). This is most likely soon after insertion and you may not know it has happened, so the use of an additional method of contraception until your check-up is advised.
• If you get pregnant with an IUCD in place, there is a possibility of this being an ectopic pregnancy. This is when a fertilised egg settles outside the womb, usually in a fallopian tube, and starts to grow. This is rare but serious. Consult your doctor straight away if you have any sudden lower abdominal pain, as well as a light or delayed period.
• The warning signs of pelvic infection are pain during or after intercourse, pain in your lower abdomen or unusual vaginal discharge, especially if you have a fever. Infection can be easily treated, but if left it can be serious. See your doctor.
• The IUCD is usually removed, if possible, if you become pregnant while using it. This reduces the risk of miscarriage though that may still happen.
• Rarely when the IUCD is fitted it might perforate the womb tissue or cervix. The IUCD may then have to be removed surgically.

Removal of your IUCD

• If you want to become pregnant, ask your Doctor to remove the IUCD (you must never try to remove it yourself).
• If you do not want to become pregnant, but want your IUCD removed, it is best done during a period and you should immediately start using another method of contraception.

A final word
This leaflet can only outline basic information about the IUCD based on evidence available and current medical opinion at the time of publication. You may come across conflicting advice on certain points concerned with the use of an IUCD. If in doubt, seek your doctor’s advice in your individual case.

These are barrier methods of family planning which fit inside the woman’s vagina. They form a barrier at the entrance to the womb (cervix) which stop the man’s sperm getting through to join an egg.

Vaginal diaphragms are circular domes made of thin rubber. They are kept in shape by a pliable metal rim covered in rubber. Cervical caps are smaller devices which are designed to fit neatly over the cervix. A spermicide is used as well. Diaphragms and caps work in a similar way so the same information applies to both.

How effective are barrier methods?
Tests show that for every 100 women who use the diaphragm or cap very carefully and consistently two will get pregnant in a year. With less careful and consistent use, 2 to 15 will get pregnant. Spermicide must he used with the diaphragm and cap to make them effective. Spermicide on its own is not effective as a method of family planning.

Advantages?
Many women like this method because it is only used when it is needed. It does not interfere with lovemaking as neither you nor your partner should be aware that it is there. It may protect against cancer of the cervix and may also help protect against sexually transmitted diseases. The method works as soon as it is in place.

Are there different types of diaphragm and cap?
Yes - But they all work in a similar way. If you decide to use a diaphragm the doctor will fit you with the correct size and you will be taught by a nurse how to use it properly. Once you have your diaphragm or cervical cap you can use it over and over again provided you treat it carefully (see below).

How to use your diaphragm

1. Always use a spermicide cream or jelly with the diaphragm. Apply two ribbons of cream on each side of the dome, and smear a little around the rim before you put the cap in. The clinic nurse will show you how.
2. The diaphragm/cap and spermicide can be put in at any convenient time before intercourse, so need not interfere with spontaneity. (More than three hours between insertion and intercourse just means using additional spermicide).
3. Check the position of the diaphragm with a finger. It should cover the little knob (cervix) which is at the entrance to your womb. If it is in the right place you will feel the cervix through the diaphragm.
4. If you have intercourse more than 3 hours after inserting the diaphragm, use a pessary or more spermicide without removing the diaphragm.
5. Do not remove the diaphragm for at least 6 hours after intercourse. You can leave it in longer but not more than 24 hours without removing and cleaning it.
6. Do not worry if your period starts while the diaphragm is in place. The blood will collect inside and eventually run over. You can safely remove the cap at any time and then wear a pad or use internal tampons.
7. You can do all the usual things you do while the diaphragm is in place without feeling its presence. You can go to the toilet as usual.

How to care for your diaphragm

1. After use, clean it by washing gently in warm water with unscented toilet soap. Rinse and dry thoroughly.
2. Never boil the diaphragm, avoid disinfectants, detergents, carbolic and strongly perfumed soap, vaseline and any other oil based lubricant. These spoil the rubber.
3. Inspect your diaphragm regularly for defects by holding it up to the light. Never stretch it with sharp fingernails.
4. It is important that the diaphragm gently to restore.

How do you insert your cervical cap?
These caps stay in place by suction. Make sure you understand the nurses instructions as it is vital your cap is correctly in place. It must fit neatly over your cervix. Put a teaspoon of spermicide in the cap but none round the rim as this might stop the suction. Once inserted, add some spermicide.

How to take out and clean your cap?
All types of cap must be left in place for at least six hours after the last time you have intercourse. You can leave it longer, but ideally not more than 24 hours. Then hook your cap out gently

Are there any problems?

• For some people putting the diaphragm or cervical cap in place can interrupt lovemaking. But you can insert it well in advance and, nearer the time, just top it up with spermicide.
• Cystitis can be a problem for some diaphragm users. A change to a slightly smaller or softer-rimmed diaphragm or to one of the cervical caps may help. It may also help to empty your bladder before and after intercourse.

What is a practice diaphragm/ cap?
You may be given at your first visit to the family planning centre a diaphragm or cap to try for a week or so. Practise inserting and removing as told in the centre but do not use the practise diaphragm/cap as a contraceptive. Leave your practise diaphragm in overnight and also wear it during the day to make sure it stays in place and is comfortable.

What else do you need to know?

• You should return every 12 months for a check that your cap still fits. You may need a different size diaphragm if you put on or lose more than 3 kilos (7 pounds) in weight. This is because your internal measurements may change when your weight does. Similarly a new size may be required after having a baby, miscarriage or abortion.
• Always put in your diaphragm before coming to the doctor for a return visit. If a smear test is to be done do not use spermicide.
• Only use products with your barrier method that are recommended by the family planning centre.
• If you have any difficulty with th method always come back to the doctor. In any case come back for a check visit as advised.

A final word.
This leaflet can only outline basic information about the diaphragm based on evidence available and current medical opinion at the time of publication. You may come across conflicting advice on certain points. If in doubt, seek your doctor's advice in your individual case.

Natural family planning is about understanding fertility and finding out those days in the month when a woman can become pregnant. By observing and recording the various natural signs and symptoms that occur during the menstrual cycle you and your partner can learn to identify the fertile time. Then, unless you plan to have a baby, you should avoid sexual intercourse at that time. If you want to avoid pregnancy you must make sure that the sperm and the egg do not meet.

A woman releases an egg (ovulates) every cycle about 12-16 days before her next period is due. An egg can last up to three days, however sperm can survive up to five days. Therefore the fertile time could extend to seven days. If you can learn to recognise your fertile time you can only use infertile days for intercourse. A couple wanting a baby would use the fertile time to have sexual intercourse. Remember to have a Rubella (German Measles) test well before you try for a baby.

Note: The Irish Family Planning Association strongly recommends that should you decide to use natural family planning, you attend an instruction course by a teacher in natural methods. Such instruction is now available from family planning centres and other organisations countrywide.

How effective are natural methods?
There are various ways a woman can learn to recognise the fertile time and using a combination of indicators can increase confidence. Many studies have been carried out on natural methods which show a range of effectiveness from 2 pregnancies for every 100 couples using the method for a year to 20 pregnancies per 100 couples using the method for a year. Much depends on your reasons for using the method and the importance to you of success.

Perhaps more than for any other method, motivation, commitment, careful observance of the rules and good instruction are the keynotes of success.

Who are they suitable for?
Natural family planning methods are suitable for all couples at all stages of a woman’s fertile life, but whichever of them you use you will need to learn more about them, preferably by personal instruction from a qualified teacher - only an outline of the methods can be given here.

A teacher can help you with your charts. This help is most important if you are coming off the pill, have just had a baby, are breastfeeding or approaching the menopause. There are no known harmful side-effects. Some couples have said it benefits their sex life and relationship.

Are there any problems?

• Charts can be difficult to interpret and you will need expert help.
• The time of ovulation can vary. Illness, shock, stress, even a holiday, can change a woman’s cycle.
• You have to avoid having intercourse for a part of each month if you wish to avoid pregnancy. Some couples find that they can use a condom occasionally as a backup to Natural Methods, especially during the fertile time.

How do you use natural methods?

• Temperature Method
  A woman’s body temperature goes up after ovulation. You can chart this by taking your temperature every day as soon as you wake up. It is important to do this before getting up or having anything to eat or drink. The temperature of the body at rest is called basal body temperature (BBT). Ideally it should be taken each day at the same time to give the most accurate record. A special thermometer (fertility thermometer) should be used. This shows the small temperature changes more easily. These thermometers and special charts to record the readings are available by post or by calling at a family planning centre. When you have recorded a temperature for three days in a row which is higher than all the previous six days it may indicate the fertile time is over. The difference will be about 0.20c - 0.40c (0.40f - 0.80f). Your temperature can change, however, for reasons other than ovulation. If you are ill with a fever it can go up. If you are taking painkilling drugs (even aspirin) it can go down. You will then need expert help to interpret your charts. This method by itself does not help you to find out which are the infertile days before ovulation
• Cervical Mucus Method
  This method (also referred to as ‘the ovulation method’) relies on the fact that the fluid (mucus) produced at the entrance of the womb (cervix) changes in texture and increases in amount about five days before ovulation. At first it is thick, sticky and opaque, then it becomes clearer, wetter and slippery so that sperm can travel through it more easily. This slippery wetness signals the most fertile days. Intercourse should be avoided from the first sensation or observation of mucus until four or five days after the slippery wet sensation has gone. Days of no mucus (‘dry’ days) are infertile. Many women can learn the different feelings of ‘wetness’ and ‘dryness’ quite easily but the method should be learned from a properly trained natural family planning teacher. Intercourse should also be avoided during periods, as this can mask mucus changes.
• Sympto-Thermal Method (combination of methods)
  This method uses a combination of basal body temperature and cervical mucus with other signs. The most important of the other signs is the position, softness/ firmness of the cervix, and whether the entrance is slightly open or tightly closed. Other signs include pain in the back or lower abdomen and breast discomfort. It can take time to recognise some of the signs which are linked to ovulation. You should have a properly trained teacher to help you. You are very much more likely to avoid conceiving if you have intercourse only in the time after ovulation up to the next period than if you use the time after a period and before ovulation.

NOTE: The Calendar Methods of trying to pinpoint the fertile time in the cycle based on dates of previous periods and cycle lengths is so unreliable that it is not recommended as a method of family planning on its own. It may however provide a useful cross-check with other natural methods.

A final word
This leaflet can only outline basic information about natural methods based on evidence available and current medical opinion at the time of publication. Some natural family planning organisations produce their own instruction leaflets and, in some cases, these give conflicting advice on certain points. If in doubt, seek your doctor’s or natural family planning teacher’s advice in your individual case.

This is a good method for people who have completed their families, or who are sure they never want to have children. Either the man or the woman can be sterilised, through a minor operation. Anyone having a sterilisation must see it as a permanent step. Reversal operations are difficult to do and there is no guarantee of success. In other words, do not have the operation if you think you may come to regret it.

How effective is sterilisation?
There is a slight risk that the operation will not work. Although it is rare for fertility to return, the tubes do sometimes rejoin. The failure rate is about one in 1,000 for vasectomy (male sterilisation). The failure rate for female sterilisation is about two to four in 1,000 depending on the procedure used.

Who is it suitable for?
Sterilisation is for people who have completed their families. Generally the operation is offered as a means of contraception to men and women over 35 years of age or under 35 if every other avenue of contraception has been explored and failed, so long as no more children are desired. You may be sure what you want now but people can change their minds. That is why there is always counselling if you want to be sterilised. It is important to talk over any worries and doubts with the doctor. If one partner is unsure, you should not go ahead.

Will sterilisation affect my sex life?
The operation makes no physical difference whatsoever to your health or sex life. On the contrary, by removing the fear of pregnancy it often makes for a happier sex life.

In the case of male sterilisation the testicles continue to produce hormones, and fluid comes out in intercourse as before. Sperm are still produced but they are reabsorbed and do not get into the semen (fluid). The operation in no way affects a man’s masculinity.

In the case of female sterilisation the ovaries continue to produce female hormones which enter the bloodstream as before. Periods continue normally. Orgasm and sexual enjoyment are not affected.

MALE STERILISATION/ VASECTOMY

What is a vasectomy?
Both the tubes (each one is called a vas deferens) that carry the sperm up from the testicles to where they are mixed to form the semen, are cut or blocked. You will still climax and produce fluid. The difference is that there are no sperm in the semen.

What is the operation like?
You will be given an anaesthetic, probably a local one. This is an injection which numbs the area being operated on. A small cut is made in the skin, either in the middle or on each side of the scrotum, which is the bag that holds the testicles. The sperm-carrying tubes can be reached easily as they are only just below the skin. The tubes are cut, a piece removed and the two ends sealed. The skin is usually closed with dissolvable stitches or may be so small that these may not be needed. The operation usually takes about 15 minutes to complete.

What happens next?
You should rest for a few days after the operation. Wearing tight fitting underpants will help to avoid bruising which could be uncomfortable. Take no heavy exercise for a week or so. Occasionally there may be bleeding or major swelling, so see the doctor if anything worries you.

When can you have intercourse?
You can have intercourse as soon as it is comfortable, but at first you must use another method of family planning. This is because sperm are left in the tubes that lead to the penis. The rate at which these sperm are used up varies from man to man. After 16-18 weeks, you will have semen tests to see if the sperm have gone. Vasectomy is only reliable as a family planning method after two clear semen tests (no sperm seen). Your testes will produce male hormone as before.

Your sex drive, ability to have an erection and climax won’t be effected. The only difference will be that there are no sperm in the semen when you climax. The appearance of the fluid, and feelings of climaxing should be the same.

Are there any problems?
Some reports have suggested that men who have had a vasectomy might be at an increased risk of developing kidney stones, prostate cancer or testicular cancer. However, these reports have not been confirmed. There are scientific reasons and outside factors which mean that for all these reports, the link may be coincidental rather than due to cause and effect. Research is ongoing, but medical opinion remains unchanged that vasectomy is a recommended choice of family planning.

FEMALE STERILISATION

What is female sterilisation?
This involves an operation on the fallopian tubes, so that the egg cannot travel down them to meet the sperm. The body’s natural cycle continues. An egg, which is smaller than a pencil dot, will still be released each month, so you will not feel different.

What is the operation like?
There are several ways in which the operation can be done. The two main methods are by mini-laparotomy and laparoscopy.

• Mini-laparotomy usually involves a general anaesthetic and a couple of days in hospital. A small cut is made in the abdomen, usually just below the bikini line. The fallopian tubes are reached and blocked, either by tying (ligation) and removing a small piece (excision) or sealing (cauterisation), or by applying clips or rings.
• The most common method used is laparoscopy. This means reaching the fallopian tubes via one or two tiny cuts, one just below the navel, the other in the bikini line. A laparoscope is then inserted. This is a thin, telescope-like instrument, the size of a pencil, with magnifying lenses which let the surgeon see the reproductive organs clearly. The fallopian tubes are sealed or blocked, usually with rings or clips. Sometimes this may be done under local anaesthetic.
• Occasionally the tubes are reached through a cut in the vagina. The operation is done in a specialist hospital or clinic.

What happens next?
If you have a general anaesthetic you may feel unwell for a couple of days. The cut in your abdomen may feel uncomfortable. This is all quite normal but you may have to take things easy for a week or so. Slight bleeding or pain may occur. If they are severe, see the doctor.

When can you have intercourse?
You will certainly be advised to continue using your present method of family planning until your operation. In some cases you may also be advised to continue this method until your next period. You can have intercourse as soon as it is comfortable after the operation. However, if it was done through a cut in the vagina, you must not have intercourse until you have healed. Female sterilisation is effective at once. Your periods should continue as normal since the ovaries, womb and cervix are left in place. Occasionally, some women find that their periods get heavier. This may be related to your previous family planning method, and your age. Your sex drive and climax should not be affected.

Are there any problems?
If a woman gets pregnant after being sterilised, there is a possibility of this being an ectopic pregnancy. This is when a fertilised egg settles outside the womb, usually in a fallopian tube, and starts to grow. This is rare but serious. You should see your doctor straight away if you have any sudden lower abdominal pain in conjunction with a light or delayed period.

A final word
This page can only outline basic information about male and female sterilisation based on evidence available and current medical opinion at the time of publication. You may come across conflicting
advice on certain points concerned with sterilisation. If in doubt, seek your doctor's advice in your individual case.

This page gives you some information about the two types of condom: the male condom and the female condom. Both are barrier methods of contraception. They work by preventing the man's sperm from meeting and fertilising the woman's egg.

A male condom is a narrow tube, made from very thin, natural latex rubber which is soft and stretchy. It is closed at one end, and fits over a man's erect penis. Most male condoms have a 'teat' at the closed end, to hold the man's semen once he has ejaculated (or come). Male condoms come in a variety of types - for example plain, coloured, ribbed, shaped, flavoured and lubricated.

A female condom is a tube made of very thin polyurethane plastic or rubber. The only female condom currently available is 'Femidom', which is made of polyurethane. It is closed at one end, and designed to form a loose lining to a woman's vagina with two flexible rings, one at each end, to keep it in place. The loose ring in the closed end fits inside the vagina, just behind the pubic bone. The fixed ring at the open end stays outside, lying flat against the area around the entrance to the woman's vagina - the vulva. Other types of female condom are expected on the market in the future.

Are condoms effective contraceptives?
Male Condom: Tests show that for every 100 couples who use the male condom very carefully and consistently, two women will get pregnant in a year. But with less careful and consistent use, up to 15 could get pregnant. It is important to use a quality condom - carefully - every time you have sex, whatever your contraceptive method. Look for the BSI Kitemark until the introduction of a new European Standard for condoms. Condoms meeting this new standard will display the CE Mark or the Kitemark.

Female Condom: There have been no large-scale studies showing how effective the female condom is. But research to date suggests that it should be as effective as the male condom. Currently there is no British Standard for the female condom.

Male and female condoms should always be used carefully, to make sure that no sperm comes into contact with the woman's genital area.

Can condoms help protect your sexual health?
Anyone, male or female, can get a sexually transmitted infection (STI), including HIV, from vaginal or anal intercourse.

Using condoms - carefully - every time - helps protect against STIs and HIV infection, whatever your family planning method.

And do you know that regular checks of breasts, cervix (smear test), and testes can save life?

Who are they suitable for?
Male and female condoms are suitable for most couples. Many couples choose condoms because they offer effective contraception and the best protection against sexually transmitted infections, when used carefully and consistently. Male condoms have been shown to protect against herpes, genital warts, chlamydia and HIV - the virus that causes AIDS. For this reason, many couples choose to use a condom in addition to some other form of contraception, such as the pill. Research to date suggests that the female condom should provide similar protection.

Many couples choose condoms because, unlike most other kinds of contraception, you do not need medical advice before starting to use them.

Male condoms are not generally suitable for men who do not always keep their erection during intercourse.

Female condoms are not suitable for women who have an infection in their vagina or cervix, or for those who do not feel comfortable touching their genital area.

The male condom or female condom?
It’s up to you and your partner to choose the condom which suits you best. Why not try both before making up your mind? You may decide to use a male condom on some occasions and a female condom on others.

Some couples choose male condoms to help the man share the responsibility of family planning and safer sex. (Male condoms are the only form of contraception for men, apart from vasectomy - which is male sterilisation).

Some women, who want to take direct responsibility for family planning and safer sex, may prefer the female condom.

Some couples prefer the female condom because you can insert it any time before intercourse, and remove it any time later, after the man has ejaculated and withdrawn.

Are there any problems?
There are no known side-effects from using either the male or female condom, but a few men and women are sensitive to the latex or spermicides used in male condoms. Special male condoms are available if this is a problem.

Both kinds of condoms are easy to use. But if you are using them for the first time, it is a good idea to practise first, either on your own or with your partner.

About spermicides and lubricants
Both male and female condoms are lubricated to make them easier to use. Some male condoms are lubricated with a spermicide - a chemical that kills sperm, so there is really no advantage in using extra spermicide. The female condom currently available contains a spermicide-free lubricant, because spermicide is not needed.

Some people choose to use extra spermicide because it offers some additional protection against sexually transmitted infections. Others use a spermicide as an additional lubricant, though many find a water-based lubricant, such as KY Jelly, suitable for use during sex. If a spermicide causes discomfort or irritation, stop using the product and seek medical advice.

If you are using a male condom, remember that you should never use oil-based products - such as body oils, creams, lotions or petroleum jelly - as a lubricant; as these can damage the latex and make the condom more likely to split. Some ointments can also damage latex. If you are using medication in the genital area - for example pessaries or suppositories - ask your doctor or pharmacist if it will affect the male condom. You should be able to use any of these products with female condoms made of polyurethane, as research to date suggests they are not affected by oil-based products.

How do you use a male condom?
If you get your male condoms from your family doctor or a family planning clinic, you may be told how to use them or you can ask. Instructions are also given on the pack or in a leaflet inside the pack. The man can put the condom on himself, or his partner can do it.

How do you use a female condom?
If you get your female condoms from a family planning clinic, the nurse or doctor will explain how to use them or you can ask. The pack also contains an instruction leaflet. The female condom can be put in by the woman or her partner.

Where should you keep the condoms?
Always keep your condoms where they cannot be damaged by heat, light or damp. Do not keep condoms in your body (eg. in a wallet) as your body heat may weaken them.

How do you dispose of them?
Dispose of your condoms carefully. Never flush them down the toilet as they cannot be broken down in the sewage system. Wrap them in a tissue and put them in a bin.

Can anything go wrong?
Occasionally sperm can get into the vagina during intercourse, even if you are using a condom. This may happen:
- if the male or female condom splits
- if the male condom slips off
- if the female condom gets pushed too far into the vagina
- if the man's penis enters the vagina outside the female condom by mistake.

If an accident does happen, or if you did not use a condom for any reason, you should get immediate advice about emergency contraception. It is advisable not to use a condom for longer than 20 minutes to avoid accidental breakage. Never re-use a condom.

At the IFPA ...
The IFPA supplies a range of male and female condoms, as well as spermicides and lubrificants. Many of these products are also available at most pharmacies and other shops.

Don't forget
This page can only outline basic information based on evidence available and current medical opinion at the time of publication. Ring or visit your doctor if you are worried or unsure about anything.

This is a flexible, transparent, plastic ring that is inserted by the woman herself into her vagina for three weeks of every month.

How does it work?
It is the equivalent of a very low dose pill which is absorbed directly into the blood stream through the vaginal wall. There is only one ring available at this time it is called NuvaRing.

How is it used?

• NuvaRing is a small, clear, flexible plastic ring that also serves as a low dose hormonal contraceptive when placed into a woman's vagina.
• The ring is fitted and removed by the woman herself, not by a doctor or nurse.
• Compressing the ring between the thumb and forefinger and placing into a comfortable position in the vagina will insert it. The exact position of the NuvaRing is not important for its contraceptive effect. One size fits all and it will not fall out.
• After insertion it should stay in place for three weeks after which time it is removed for seven days, during which the woman should have her period.
• After seven days a new ring is inserted into the vagina for another three weeks and so on.

How reliable is it?
It has the same failure rate as the combined pill taken orally. That is with careful use less than one woman in one hundred will get pregnant in a year.
Pregnancy can happen if an error is made in using the NuvaRing – especially if

• the unopened package is exposed to very high temperatures or direct sunlight.
• it slips out of the vagina and is not replaced within three hours.
• it does not stay in the vagina for three weeks in a row.
• it is left in the vagina for more than three weeks.

Always remember to check the expiration date of each ring package before insertion.

What are the advantages?

• Suitable for women who forget to take the pill regularly as requires no daily administration.
• Does not have to be fitted by nurse or doctor and can easily be inserted and removed by the woman herself.
• Suitable for women who have difficulty swallowing pills.
• Suitable for women who suffer from vomiting or diarrhoea.
• Neutral effect on weight gain.
• Does not interrupt sex.

What are the disadvantages?

• May not be suitable for women who for medical reasons cannot take the pill.
• Woman using it must be comfortable about inserting a ring into her vagina.
• May sometimes be felt by her partner during sex.
• May cause increased vaginal discharge.
• Does not protect against sexually transmitted infections.
• Is more expensive then taking the combined pill orally.

Accidental removal?
Should a ring accidentally be removed from the vagina it should be washed in warm water and reinserted. If out of the vagina for more than 3 hours it should be reinserted and a barrier method of contraception used for 7 days.

Are there any side-effects?
You may get some temporary side-effects when you first start using the ring, these should stop within a few months. These side-effects include:
- Headaches.
- Nausea.
- Breast tenderness.
- Bleeding between periods.
- Mood changes.
- Weight gain or loss.
Side-effects are similar to those seen with combined oral contraceptive pill.

Antibiotics?
If on antibiotics the woman needs to use a barrier method of contraception while on the antibiotics and for an additional 7 days.

Where do you get the vaginal ring?
You need a prescription from your family doctor or family planning centre. It isavailable on the GMS (Medical Card Scheme).