Choose Your Contraception

Whether you have completed your family, or are looking to start one, family planning can seem like a daunting discussion. There is a wide variety of contraceptive options available and it is important to find one which works for your individual situation. Let’s take a brief look at the latest recommendations for effective contraception.

Condoms are always recommended as they protect against sexually transmitted diseases (STI’s). STI’s such as chlamydia and gonorrhoea often have no symptoms and are picked up on routine screening tests.

The combined oral contraceptive pill comes in a variety of strengths and formulations, containing both an oestrogen and progesterone component. This helps to prevent ovulation, thicken the cervical mucus and change the uterus wall lining to prevent pregnancy. Taken regularly, this is an effective contraceptive option and can help with control of acne and heavy menstrual bleeding. However, if a pill is missed by greater than 24 hours, you can be at risk of pregnancy and this is reflected in the real-world efficacy rate of 91%. As with any other medication, there are risks and side effects to watch out for: a change in vaginal bleeding patterns, fluid retention, nausea and breast tenderness. Serious side effects include the risk of clots leading to visual loss and deep vein thrombosis. In addition, some breast cancers have oestrogen and progesterone markers. Therefore, it is important to tell your doctor if you have a history of migraines with visual changes, are smoking, or have a family history of breast cancer, pulmonary embolism or deep vein thrombosis.

The mini-pill, or progesterone only pill operates in a similar way but does not contain the oestrogen component. It is favoured for women who are breast-feeding or who have contraindications to the combined oral contraceptive pill. The main downfall to this pill is the risk of pregnancy is a pill is missed by more than 3 hours.

Long-acting reversible contraceptives (LARCs) include the progesterone subcutaneous implant, which is effective for 3 years, and the progesterone intrauterine device, which is effective for 5 years. As they do not contain oestrogen, both can be used in women who have a contraindication to, or experience side effects from oestrogen contraceptives. They have a real-world efficacy of more than 99% since compliance is not an issue, but do require a clinic procedure.

  • The subcutaneous implant is inserted into the fat layer of the upper arm with some local anaesthetic, and will be palpable as a small, flexible “match-stick”. Main side effects include a change in menstrual cycle with some women having no period, some having a usual period, and others getting heavier, irregular vaginal bleeding.
  • The intrauterine device is inserted through the cervix into the uterus. It is also a first-line therapy for heavy menstrual bleeding, can be fitted for women who have never been pregnant, and can be used as part of hormone replacement therapy during menopause. The strings of the intrauterine device usually curl up behind the cervix and are not felt during intercourse. Most women have no periods, light periods or light vaginal spotting with it. If you have fibroids or an abnormal uterine cavity shape, you may need to have the device inserted with a specialist.

Other contraceptive options include the following:

  • Vaginal contraceptive ring contains oestrogen and progesterone and to is placed into the vagina, removed after 3 weeks for a 1 week period, and a new ring reinserted after this (i.e. ring needs to be changed once/month)
  • Depot progesterone injections – these are given as an intramuscular injection once every 3 months. Unlike other contraceptives, it can take up to 1 year to fall pregnant again once the injections are stopped.
  • Copper intra-uterine device – this device also provides contraception for 5 years, but tends to have the side effect of heavier menstrual bleeding.
  • Permanent options include vasectomy, tubal ligation and hysterectomy, which require a specialist referral.

There are many things to think about when considering your options for contraception. Please make an appointment with your local general practitioner for further advice and to discuss a plan that suits you.

Pro Medical SA, Dr Kristen Tee, GP

References and Resources

  • Contraception: an Australian clinical practice handbook. Family Planning NSW, Family Planning Queensland, Family Planning Victoria, Available from:
  • Shine SA on Contraception. Available from:

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