Pregnancy options

Once a woman finds out she is pregnant, she has several options. Obviously, if the pregnancy is planned and there are no problems, the woman is likely to decide to keep the baby.

If the pregnancy is unplanned, a woman may decide to do one of the following:

• proceed with the pregnancy and keep the baby
• proceed with the pregnancy and have the baby adopted (see below for further information)
• have the pregnancy terminated.

The woman should be offered support and counselling to help her come to her decision, and her needs should be supported once she has made her decision. There are a number of organisations that offer counselling and support for a woman in this situation. See the website links for further information.

A woman considering having her baby adopted should be able to discuss the matter if she wishes. She may find it helpful to speak to friends or family, a social worker or the adoption agency she is using. The adoption agency must discuss with the pregnant woman how she wishes her child to be cared and provided for, and it must also provide counselling so that the woman is fully aware of her rights and responsibilities. Private adoption is not allowed in the UK, and, in Britain, a woman has six weeks after the baby’s birth in which she can change her mind. Further information about agencies is available at the Department of Health website.

Websites with information on pregnancy options

The Family Planning Association provides advice on a pregnant woman’s options. It offers pregnancy counselling, information on abortion and information once a woman has made her decision.
www.fpa.org.uk

Marie Stopes International Global Partnership is an organisation that provides sexual and reproductive health information and services. It has a website covering options and services in the UK on abortion, contraception, emergency contraception, female sterilisation, health screening and vasectomies.
www.mariestopes.org.uk

About.com is an American website that was founded in 1997. About.com covers a vast range of topics, with articles written by experts. Within the catalogue is a site dealing with women’s issues where there is an informative article on unplanned pregnancy and a woman’s options, complete with case studies.
http://womensissues.about.com

Unplannedpregnancies.co.uk is a website written by a woman with first-hand experience of unplanned pregnancy. The website contains information on all aspects of unplanned pregnancy, including the options a woman has, and life after the baby is born.
www.unplannedpregnancies.co.uk

Websites on adoption

The Department for Education and Skills has an adoption site, with help and addresses for relevant agencies in a person’s area. There is also a question and answer page on adoption issues.
www.dfes.gov.uk/adoption

Adoption.net is a site dedicated to adoption and fostering in the UK. It lists further contacts and has a FAQ page.
www.adoption-net.co.uk

Adoption UK is a site dedicated to adoption issues, with lots of information about the adoption process.
www.adoptionuk.com

The British Association for Adoption and Fostering is the leading UK charity working for children separated from their birth families. It contains information on adoption, including all the relevant legislation.
www.baaf.org.uk

Abortion service provision

Abortion was made legal in the UK in 1968. Currently, in England, Wales and Scotland, abortion is legal if it is carried out when the woman is less than 24 weeks pregnant and if two doctors agree that it is necessary under the following grounds:

• that having the baby would harm the mental or physical health of the woman more than having the abortion
• that having the baby would harm the mental of physical health of any children she already has.

The stage of pregnancy is calculated from the first day of the woman’s last menstrual period.

Abortion is legal at any stage of the pregnancy if, as agreed by two doctors:

• the abortion is necessary to save the woman’s life or prevent serious permanent harm to her mental or physical health
• there is a high risk that the baby would be severely handicapped.

A woman wishing for an abortion on the NHS should be referred by a doctor, for example her own GP, a doctor at her local family planning clinic, a doctor at BPAS (the British pregnancy advisory service), or a doctor at a Brook centre if she is under 25 years old.

Once she has been referred, the woman should attend a consultation at the clinic, during which her medical history will be taken and a nurse or doctor will explain the procedure.

A woman can also refer herself for a private abortion and there are several clinics that offer this service (see web links for details). Early abortions start from around £350 (termination of pregnancy providers follow guidelines and will supply further information on request).

The method used for an abortion depends on the stage of pregnancy. For example, pregnancies up to nine weeks can be terminated through the use of a pill (mifepristone), with a prostaglandin tablet inserted into the vagina 36 to 48 hours later. Pregnancies up to 13 weeks can be terminated using vacuum aspiration in which the pregnancy is removed by suction through a tube inserted into the vagina. Later abortions can be more invasive and more traumatic, so the earlier the decision is made the better. Women should also be advised that it could take 2 to 4 weeks for an abortion appointment to come through.

A woman who has had an abortion is likely to experience bleeding and some pain similar to normal menstrual pain. She should receive advice on how to reduce the risk of infection and be told that if the pain or bleeding is severe or if she has a high temperature or unusual discharge that this may be a sign of infection and she should seek medical advice. The woman should also be seen by a doctor 1 to 6 weeks after the abortion. It is important that the woman is aware that it is possible to become pregnant as early as seven days after an abortion and that she should think about contraception.

Having an abortion should not affect a woman’s chance of successful pregnancies in the future.
Guidelines on the care of women requesting induced abortion are available from the Royal College of Obstetricians and Gynecologists. Click here for further information.

NHS Quality Improvement Scotland (QIS) was set up as a special health board by the Scottish Parliament in 2003. Its role was to improve the quality of care and treatment delivered by NHS Scotland. As part of its role, NHS QIS investigated the sexual health services within Scotland and recommended how they can best support and improve the services offered around sexual health.

From their investigation, the group came up with five key clinical indicators (KCI) which would be used to monitor the improvement in sexual health care. Abortion procedures performed at gestation of nine weeks or less is one of the KCI set out for 2006.

Click here for more detail on the NHS:QIS Sexual Health Services project preliminary report (June 2006).

Post-abortion counselling

Some women are traumatised after having an abortion and need post-abortion counselling. The following organisations offer counselling after an abortion:

The British Pregnancy Advisory Service (bpas), which is a non-profit making charity, provides a counselling service and NHS-approved abortion facilities. It operates nine clinics and has 32 branches in England, Wales and Scotland.
www.bpas.org

Marie Stopes International Global Partnership is an organisation that provides sexual and reproductive health information and services. It has a website covering options and services in the UK on abortion, contraception, emergency contraception, female sterilisation, health screening and vasectomies. It also offers post-abortion counselling.
www.mariestopes.org.uk

Brook advisory centres offer free advice, information and services to people under 25 on all matters on relationships, contraception and pregnancy (including testing). It also offers abortion referral (to the NHS if possible) and abortion counselling. It has 33 branches in England and Scotland, and one in Belfast, Northern Ireland.
www.brook.org.uk

Web links on abortion services

The British Pregnancy Advisory Service (bpas) is a non-profit making charity that provides a counselling service and NHS-approved abortion facilities. bpas operates nine clinics and 32 branches in England, Wales and Scotland.
www.bpas.org

Marie Stopes International Global Partnership is a globalan organisation that provides sexual and reproductive health information and services. It has a website covering options and services in the UK on abortion, contraception, emergency contraception, female sterilisation, health screening and vasectomies. They also offerIt also offers post-abortion counselling. To visit their site, go to:
www.mariestopes.org.uk

The Abortion Rights Office was formed when the National Abortion Campaign merged with the Abortion Law Reform Association. It campaigns on abortion rights, provides information on abortion and also publishes a newsletter.
www.abortionrights.org.uk

Brook advisory centres offer free advice, information and services to people under 25 on all matters on relationships, contraception and pregnancy (including testing). It also offers abortion referral (to the NHS if possible) and abortion counselling. It has 33 branches in England and Scotland, and one in Belfast, Northern Ireland.
www.brook.org.uk

Combined pill

The combined pill, or ‘the pill’, as it is commonly called, is a tablet that contains the female hormones oestrogen and progestogen (a manufactured version of progesterone). There are currently 23 brands of the pill on the market in Britain. It is important to be clear that the combined pill is not the same as the mini pill, which only contains progestogen. The combined pill is taken at the same time every day for 21 days with a seven-day pill free interval, and works by preventing a woman from ovulating. (It also thickens the secretions around the cervix, making it more difficult for sperm to get through, and it makes the lining of the womb thinner making it less receptive to a fertilised egg.)

The combined pill, when taken correctly, is likely to be 100% effective. Along with this, it can make periods shorter, lighter and less painful. It can also reduce a woman’s chances of certain diseases, such as ovarian cancer. However, there are some disadvantages:

• it can have side-effects (for example headaches, weight gain and nausea) some of which can be serious, such as (rarely) deep vein thrombosis
• a woman has to remember to take it everyday (preferably around the same time)
• its efficacy can be compromised by bouts of vomiting or diarrhoea, some epilepsy drugs and some antibiotics (for example, amoxicillin)
• because a barrier method is not used, it can increase a woman’s chance of contracting some cancers (e.g. cervical cancer)
• it does not protect against sexually transmitted infections.

Whilst it may suit many women, the combined pill is not suitable for every one. For example, some women who suffer a certain form of migraine are at an unreasonably high risk of stroke if they take the pill, and should therefore consider other methods.

There are so many advantages, disadvantages and reasons why it may or may not be suitable for a particular woman that it is important that the decision to prescribe a combined pill is made on an individual basis according to the woman’s needs and medical history.

Click here for further information on the advantages and disadvantages of the combined pill.

Further information on the combined pill can be found in the websites listed in the General web links on hormonal contraception.

Contraceptive injections and patches

Many millions of women worldwide use the contraceptive injection. In the UK, there are two types, both of which contain a manufactured version of the hormone progesterone called progestogen:

• Depo-Provera, which is the most commonly used method and which protects a woman from pregnancy for 12 weeks
• Noristerat, which is not widely used, provides contraceptive protection for eight weeks.

In some other countries, including the USA, there is a contraceptive injection that contains two hormones. It is called Lunelle and is thought to control periods better that Depo-Provera and Noriserat. It is likely to be introduced into the UK in 2006 or 2007.

Contraceptive injections work in a similar way to the combined pill, in that they prevent a woman from ovulating. Like the pill, they also cause the secretions around the cervix to thicken, making it more difficult for sperm to get through, and they make the lining of the womb thinner making it less receptive to a fertilised egg.

These injections are considered to be almost 100% effective. A woman does not have to remember to take a pill (although she does need to remember to go to her next appointment). Other advantages to the injections:

• a woman who has had the contraceptive injection does not need to think about contraception while it lasts
• they do not interfere with intercourse
• they can be used while breast feeding
• they provide some protection against cancer of the uterus and pelvic inflammatory disease
• they can be used by women who cannot take oestrogen.

Disadvantages:

• they can alter a woman’s periods (these can be more irregular, heavier or stop all together. Some women have frequent light bleeding, which can be inconvenient)
• irregular bleeding can continue for several months after a woman stops the injections
• they can cause weight gain
• they can have some side-effects, such as headaches, acne, tender breasts, mood swings and bloating
• the injection cannot be removed from the body, so any side-effects will continue for the duration of the injection
• fertility can return immediately after stopping injections, but it can take up to a year
• there is some concern over whether injectables, when used over a long period of time, they contribute to the development of osteoporosis (bone loss that is sometimes seen in women after the menopause) because of the effects on oestrogen levels – this is still being researched
• they do not protect against sexually transmitted infections.

Further information about contraceptive injections can be found on NetDoctor.

An alternative to injections is the contraceptive patch, Evra. This was introduced in the UK in the early 2000s and is a sticky patch, approximately 5 cm by 5 cm, which you put on your skin. Like the pill, it releases progesterone and oestrogen. It may therefore cause similar side-effects to the pill, although it is too early to know. Each patch lasts a week and should then be replaced. The system is designed so that a woman has three weeks wearing a patch and in the fourth week she has her period. The patch costs nine times as much as the pill and because there are no real advantages over the combined pill, it is not recommended as a first-time choice for most people.

Evra has three main advantages over the combined pill:

• the woman does not have to remember to take a pill each day
• the patch should not cause the feelings of nausea that the combined pill does as the hormones are absorbed through the skin and not the stomach
• its efficacy is not affected by bouts of vomiting and/or diarrhoea.

Disadvantages:

• the patch may fall off without the woman’s knowledge
• it can, in some women, cause skin reactions bad enough for the woman to stop using it
• the patch does not control periods in the same way as the combined pill.

Further information, including changes and timing, about Evra can be found on NetDoctor and in the websites listed in the General web links on hormonal contraception.

Progestogen-only pill

The progestogen-only pill (POP) or mini-pill contains a manufactured hormone that is similar to progesterone. It is less popular than the combined pill (‘the pill’) as it is the less effective option. Newer versions however, are almost as effective as the combined pill. In addition, the health risks associated with the progestogen-only pill are less than with those associated with the combined pill. The progestogen-only pill is therefore suitable for women for whom the combined pill may be unsuitable, for instance women who are breast feeding, have diabetes, suffer migraines. It works by causing the secretions around the cervix to thicken, making it more difficult for sperm to get through, also by making the lining of the womb thinner making it less receptive to a fertilised egg. It also (more commonly with recent versions of the mini-pill) can prevent a woman from ovulating, further reducing the risk of pregnancy.

A woman has to remember to take the mini-pill at the same time every day (which some women find difficult, and is therefore considered a drawback). This may not suit women working in jobs with irregular hours.

Advantages to the progestogen-only pill:

• it has few serious side-effects
• it does not interrupt intercourse
• it can be used during breast feeding
• it can be used by women who cannot take oestrogens
• it can be used by women of any age, including older women who smoke (for whom the combined pill is not recommended)
• it may help with pre-menstrual tension and painful periods.

Disadvantages:

• women on the progestogen-only pill may not have regular periods. These may also become lighter, more frequent or stop all together (which may cause concerns of pregnancy)
• it does not protect against sexually transmitted infections
• to provide effective contraception, women on the POP have to remember to take it at the same time every day
• it can have some temporary side-effects, such as acne, tender breasts, weight gain and headaches.

Further information on the progestogen-only pill can be found on NetDoctor, and in the websites listed in the General web links on hormonal contraception

Implants

In the UK, there is currently one type of implant: Implanon (there used to be another one, Norplant, but that was withdrawn in 2001). It is a rod-shaped implant that is around 3 cm long, which is usually inserted using a needle just under the skin in a woman’s arm up to five days after her period (to ensure she isn’t pregnant). The procedure is carried out under local anaesthetic and is relatively painless. The implant lasts for three years, after which it should be removed and replaced by a specially trained doctor or nurse. An advantage of the implant over the contraceptive injection is that by removing the implant, the contraceptive effects are also removed. This means any side-effects will stop straight away and also enables a woman to begin trying to conceive when she wants to, rather than when her contraceptive has worn off.

The implant should not be fitted in a woman experiencing undiagnosed vaginal bleeding, with severe liver disease, or suffering from thrombosis. It has been linked with ovarian cysts, so women with a history of these should probably not be given the implant.

An important note is that in larger women, the implant may not be as effective.

Advantages to a contraceptive implant:

• a woman with an implant does not need to think about contraception for as long as it in place
• it does not interfere with intercourse
• women with an implant can breast feed
• women who cannot take oestrogens can use the implant
• fertility returns as soon as the implant is removed
  
• it offers some protection against pelvic inflammatory disease.

Disadvantages:

• it can alter a woman’s period – most women have irregular bleeding for the first year. Some women will have heavy bleeding, others, no bleeding at all
• side-effects can include headaches, acne, weight gain, tender breasts and bloating
• it can, on rare occasions, cause an infection in the arm in which it was inserted
• it can sometimes be difficult to remove
• some women can develop small fluid-filled cysts on their ovaries. These are generally without symptoms although they can sometimes cause pelvic pain. They are usually not harmful and disappear without treatment
• it can sometimes cause mood swings
• it offers no protection against sexually transmitted infections.

Further information on contraceptive implants can be found on NetDoctor, and in the websites listed under General web links on hormonal contraception.

Emergency contraception

Emergency contraception should not be used as a form of contraception, but, as the name suggests, in emergencies only (for instance in a case of condom failure). There are two types:

• the emergency (or ‘morning after’) pill Levonelle 2, which comes in a packet of two and can be taken up to 72 hours after unprotected sex (the sooner the better). The pills contain a synthetic version of the hormone progesterone which prevents pregnancy by either preventing or delaying ovulation, or preventing a fertilised egg from implanting in the uterus. Levonelle 2 is only available from a doctor or a nurse and it is free. You can buy Levonelle One Stop from pharmacies: this is just one tablet and there is a charge of about £25.
• the IUD (copper intrauterine device), is a non-hormonal method, which can be fitted in a woman’s uterus up to five days after she has had unprotected sex, or up to five days after the earliest time she could have ovulated.

Emergency contraception is available from GPs, family planning clinics, most genito-urinary clinics and sexual health clinics. Women under the age of 25 can also obtain emergency contraception from their local Brook centre.

Further information on emergency contraception can be found on the Family Planning Association website.
www.fpa.org.uk

Guidance on the use of emergency contraception is available on the NHS PRODIGY website.
www.prodigy.nhs.uk

For information on contraceptive methods, see the websites listed under General web links on hormonal contraception.

General web links on hormonal contraception

Guidance on the use of contraception is available on the NHS PRODIGY website.
www.prodigy.nhs.uk

AVERT is an international AIDS charity that provides information on HIV and AIDS. It has a section on contraception, particularly aimed at teenagers.
www.avert.org/cpills.htm

Contraception.net is a website providing information on all aspects of contraception.
www.contraception.net

Brook provides free and confidential sexual health advice and contraception to people under the age of 25 years.
www.brook.org.uk

RU thinking about it? is a website aimed at teenagers, and has a section on contraception.
www.ruthinking.co.uk

The Family Planning Association provides advice on family planning issues, and has a section on contraception.
www.fpa.org.uk

The NHS Direct on-line health encyclopaedia contains a section on contraception.
www.nhsdirect.nhs.uk/en

The National Library for Health website contains many sections on contraception.
www.library.nhs.uk/womenshealth

Patient UK is a website written by GPs that provides evidence-based information on health, disease and related issues. It contains lots of information about contraception.
www.patient.co.uk

Likeitis.org is a website aimed at teenagers, and contains a section on hormonal contraception.
www.likeitis.org.uk

Male and female condoms

Condoms are sheathes that trap the sperm released when a man ejaculates, thereby reducing the chance of pregnancy. They also provide some protection against sexually transmitted infections such as HIV.

There are two types, the more traditional male condom (also known as a sheath, rubber, Johnny, or prophylactic) made of rubber or polyurethane, which is placed over the erect penis, and the more recently-introduced female condom (tradename Femidom), which is inserted into the vagina before penetration occurs. The effectiveness of condoms is generally associated with how the person uses them (for example how roughly they put the condom on) and when during intercourse they are worn. They are most effective when worn for the duration of penetrative intercourse and when put on correctly. Under these conditions, male condoms are considered to be 98% effective and female condoms 95% effective at preventing pregnancy.

Disadvantages of condoms:

• putting them on can interrupt sex
• a male condom can split (this is more likely if it is a polyurethane one) or slip off
• some people are sensitive to the chemicals in latex condoms
• after intercourse care must be taken when the man pulls out so that semen is not spilt
• care must be taken with the female condom to ensure the penis enters the condom and not between the condom and the vagina.

Male condoms are free from family planning clinics, sexual health clinics, some genito-urinary medicine (GUM) clinics, GPs, and practice nurses. They can also be bought from a pharmacy or by mail order as well as from vending machines, supermarkets, garages and other shops.

Female condoms are free from some family planning clinics, sexual health clinics and GUM clinics. They can also be bought from a pharmacy or by mail order. They are not as widely available as male condoms.

Further information on condoms can be found on NetDoctor.

Websites with information on condoms

Contraception.net is a website providing information on all aspects of contraception.
www.contraception.net

Brook provides free and confidential sexual health advice and contraception to people under the age of 25 years.
www.brook.org.uk

RU thinking about it? is a website aimed at teenagers, and has a section on contraception.
www.ruthinking.co.uk

The Family Planning Association provides advice on family planning issues, and has a section on condoms.
www.fpa.org.uk

AVERT is an international AIDS charity providing information on HIV and AIDS. It has a section on condoms, particularly aimed at teenagers.
www.avert.org

The NHS Direct on-line health encyclopaedia contains a section on condoms.
www.nhsdirect.nhs.uk/en

The National Library for Health (NLH) contains detailed information about contraception.
www.library.nhs.uk

Patient UK is a website that provides evidence-based information on health, disease and related issues. Written by GPs, the site contains detailed information about contraception.
www.patient.co.uk

Likeitis.org is a website aimed at teenagers, and contains a section on male and female condoms.
www.likeitis.org.uk

Natural family planning

Natural family planning is a process by which a woman is aware of the fertile and infertile times in her menstrual cycle. It is achieved through the woman recording her body temperature daily on waking (this rises just after ovulation), observing any cervical secretions and recording how long her menstrual cycle lasts. When used correctly, natural family planning can be up to 98% effective.

Advantages to the method include the following:

• it can be used to both avoid and plan a pregnancy
• it does not involve the use of chemical agents or physical devices
• there are no physical side-effects
• it is effective if used correctly
• a woman becomes more aware of her body and fertility
• it is acceptable to all faiths and cultures.

Disadvantages:

• the method depends heavily on a number of complicated calculations, and, as such, many people regard it as too difficult to be a reliable form of contraception
• it takes three to six cycles to learn effectively
• a woman has to keep daily records
• illness, stress and travel may make fertility indicators difficult to identify
• intercourse should be avoided (or a barrier method used) during the woman’s fertile times
• it takes commitment from the woman and her partner to be effective
• the method provides no protection against sexually transmitted infections.

Further information on this method can be found on the Family Planning Association website.

Other websites associated with natural family planning

NHS Direct has a section on natural family planning.
www.nhsdirect.nhs.uk/en

Patient UK provides evidence-based information on health, disease and related issues, written by GPs. It contains information on natural family planning.
www.patient.co.uk

NetDoctor is an on-line collaboration between doctors, healthcare professionals, information specialists and patients providing, wherever possible, quality-assessed information on the basis of the principles of evidence-based medicine. It contains a section on natural family planning.
www.netdoctor.co.uk

Other general web links on contraception

The NHS Prodigy website produces guidance on the use of contraception.
www.prodigy.nhs.uk

AVERT is an international AIDS charity that provides information on HIV and AIDS. It has a section on contraception, particularly aimed at teenagers.
www.avert.org

Contraception.net is a website providing information on all aspects of contraception.
www.contraception.net

Brook provides free and confidential sexual health advice and contraception to people under the age of 25 years.
www.brook.org.uk

RU thinking about it? is a website aimed at teenagers and has a section on contraception.
www.ruthinking.co.uk

The National Library for Health website contains many sections on contraception.
www.library.nhs.uk/womenshealth

Patient UK provides evidence-based information on health, disease and related issues, written by GPs. It contains lots of information about contraception.
www.patient.co.uk

Male and female sterilisation

Sterilisation is a permanent method of contraception. In females it is achieved by blocking the fallopian tubes (which carry the eggs from the ovary to the uterus) and in males by blocking the vas deferens (the tube that carries the sperm from the testicles to the penis). The technique in males is known as a vasectomy. As it is permanent, this option should only be taken by people who are completely sure that they never want children, or by those that already have children and are completely sure that they do nt want any more.

Sterilisation is more effective in men than women, with about 1 in 2,000 vasectomies failing, compared with 1 in 200 female sterilisations failing. The tubes that carry the sperm in men and the eggs in women can rejoin after sterilisation, either immediately or some years after the operation has been carried out.

Advantages of sterilisation are that:

• it does not interrupt sex, unlike other methods (e.g. condoms)
• after a person has been successfully sterilised, he or she does not need to worry about contraception again.

Disadvantages:

• it can take at least two months for a vasectomy to be successful (a semen sample should be checked for live sperm a few months after the procedure)
• although uncommon, the tubes can sometimes rejoin, restoring the person’s fertility
• sterilisation cannot be easily reversed, and a reversal operation may not be successful
• sterilisation does not protect a person from sexually transmitted infections.

Further information on male and female sterilisation can be obtained from the Family Planning Association website.

The Royal College of Obstetricians and Gynaecologists (RCOG) produced guidelines on male and female sterilisation in 2004.

NHS Quality Improvement Scotland (QIS) was set up as a special health board by the Scottish Parliament in 2003. Its role was to improve the quality of care and treatment delivered by NHS Scotland. As part of its role, NHS QIS investigated the sexual health services within Scotland and recommended how they can best support and improve the services offered around sexual health.

From their investigation, the group came up with five key clinical indicators (KCI) which would be used to monitor the improvement in sexual health care. Male and female sterilisation procedures are one of the KCI set out for 2006.

Click here for more detail on the NHS:QIS Sexual Health Services project preliminary report (June 2006).

Websites associated with male and female sterilisation

Brook provides free and confidential sexual health advice and contraception to people under the age of 25 years and has a small section on sterilisation.
www.brook.org.uk

Marie Stopes International Global Partnership is an organisation that provides sexual and reproductive health information and services. It has a website covering options and services in the UK on abortion, contraception, emergency contraception, female sterilisation, health screening and vasectomies. www.mariestopes.org.uk

NetDoctor has a section on female sterilisation and male sterilisation

Other general web links on contraception

The NHS PRODIGY website produces guidance on the use of contraception.
www.prodigy.nhs.uk

AVERT is an international AIDS charity that provides information on HIV and AIDS. It has a section on contraception, particularly aimed at teenagers.
www.avert.org

Contraception.net is a website providing information on all aspects of contraception.
www.contraception.net

The National Library for Health website contains many sections on contraception.
www.library.nhs.uk/womenshealth

Patient UK provides evidence-based information on health, disease and related issues, written by GPs. It contains lots of information about contraception.
www.patient.co.uk

Diaphragms and caps

Diaphragms and caps are barrier methods of contraception, which fit inside a woman’s vagina and cover her cervix. Vaginal diaphragms are circular domes that are made of thin, soft rubber and have a flexible rim. Cervical caps are smaller than vaginal diaphragms. To be effective they need to be used in combination with a spermicide, which destroys the sperm. If they are used according to instructions, diaphragms and caps are 92 to 96% effective.

Diaphragms and caps work by covering the cervix, thereby preventing the sperm access to the uterus and fallopian tubes, while the spermicide kills the sperm.

There are three types of cap (vault, cervical and vimule) and three types of diaphragm (flat, coil and arcing spring). The best type for a woman should be decided on an individual basis after examination.

Advantages of diaphragms and caps:

• they need only be used during intercourse and left in place for six hours after
• they pose no serious health risks
• they put the woman in control (unlike male condoms)
• they can be inserted any convenient time before sex
• they may provide some protection against cervical cancer and some sexually transmitted infections.

Disadvantages:

• inserting them can interrupt sex
• the spermicide can be messy
• inserting them correctly can be difficult and take time to learn
• they may cause cystitis in some women
• the rubber or spermicide can cause irritation.

Further information on diaphragms and caps can be obtained from the Family Planning Association website.

Web links associated with diaphragms and caps

The BBC Lifestyle web pages include a section on contraception that covers the contraceptive diaphragm.
www.bbc.co.uk

The NHS Direct on-line health encyclopaedia contains a section on diaphragms and caps.
www.nhsdirect.nhs.uk/en

NetDoctor has a section on diaphragms.
www.netdoctor.co.uk

Other general web links on contraception

The NHS PRODIGY website produces guidance on the use of contraception.
www.prodigy.nhs.uk

AVERT is an international AIDS charity that provides information on HIV and AIDS. It has a section on contraception, particularly aimed at teenagers.
www.avert.org

Contraception.net is a website providing information on all aspects of contraception.
www.contraception.net

The National Library for Health website contains many sections on contraception.
www.library.nhs.uk/womenshealth

Patient UK provides evidence-based information on health, disease and related issues, written by GPs. It contains lots of information about contraception.
www.patient.co.uk

Intrauterine devices

An IUD, or coil, as it used to be called, is a small plastic and copper device placed in a woman’s uterus. It has one or two soft threads on the end that hang through the opening at the entrance of the uterus (cervix). Depending on the type, it can stay in place for between 3 and 8 years. When fitted in a woman over 40 years of age it can remain in place until one year after the menopause.

Older IUDs are around 98 to 99% effective, and the newer versions are nearer 100% effective. An IUD works primarily by stopping the sperm from reaching the egg (either by preventing the sperm from surviving in the uterus or fallopian tube, or by making it too difficult for the sperm to get through the cervical mucous. It may also stop a fertilised egg from implanting in the uterus.

Advantages of using IUDs:

• it provides effective contraceptive protection as soon as it is in place
• it works for a long period of time (3 to 8 years)
• the woman does not have to think about contraception while it is in place
• it does not interrupt intercourse
• normal fertility is restored once the IUD is removed.

Disadvantages of using IUDs:

• it may cause periods to be heavier, longer and more painful (although this may improve after a few months)
• it can, on rare occasions, cause an infection within 20 days of being fitted
• it does not protect against sexually transmitted infections and if a woman with an IUD contracts an STI, it can lead to a pelvic infection at any time
• it can be expelled by the uterus or it can become displaced. This is most likely soon after it has been fitted, and women should be shown how to check their IUD threads each month
• it can very occasionally perforate the uterus or cervix whilst being fitted. This can cause pain, but is sometimes asymptomatic). If this occurs, surgery is required to remove the IUD.
• pregnancies that occur in a woman with an IUD have a slightly higher chance of being ectopic (that is, outside the uterus, usually in a fallopian tube) than a woman not fitted with an IUD who is using contraception.

For further information on IUDs, visit the Family Planning Association website.

Slightly different to the IUD, is the IUS, intra-uterine system, for example Mirena, which is a small T-shaped plastic device that contains progestogen. Further information on this method is also available on the Family Planning Association website.

Other web links associated with intrauterine devices

The NHS Direct on-line encyclopaedia has a section on intrauterine devices.
www.nhsdirect.nhs.uk/en

Brook provides free and confidential sexual health advice and contraception to people under the age of 25 years and has a small section on intrauterine devices.
www.brook.org.uk

NetDoctor has a section on Intrauterine devices.
www.netdoctor.co.uk

Marie Stopes International Global Partnership is an organisation that provides sexual and reproductive health information and services. It has a website covering options and services in the UK on abortion, various methods of contraception, emergency contraception, female sterilisation, health screening and vasectomies.
www.mariestopes.org.uk

Patient UK provides evidence-based information on health, disease and related issues, written by GPs. It contains information on natural family planning.
www.patient.co.uk

The BBC Lifestyle web pages include a section on contraception that covers the contraceptive diaphragm.
www.bbc.co.uk

Contraception and breast feeding

Many unplanned pregnancies happen in the first few months after childbirth, so a woman should be informed about her contraceptive options.

Breast feeding a baby under six months can be an effective form of contraception as it can delay the return of ovulation. However it is only effective if the following criteria are met:

• the woman must be breast feeding at regular intervals, day and night
• the baby must be given no other food or drink to ensure no breast feeds are missed
• the woman must not be having periods.

It is generally always recommended, however, that the woman opts for an additional contraceptive. For a breast feeding mother, any form of contraceptive is suitable, except the combined pill.

A breast feeding mother can start to use the progestogen-only pill or an implant as soon as three weeks (21 days) after the birth. A contraceptive injection or patch or diaphragm or cap can be used around six weeks after giving birth. An intrauterine device can usually be fitted around six weeks after giving birth or eight weeks after having a Caesarean section. The woman may choose to opt for natural family planning.

For further information on contraception and breast feeding, visit the Family Planning Association website.

Guidelines on the use of hormonal contraceptives in women who are breast feeding can be found on the Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit website.

Other websites associated with contraception and breast feeding

BabyCentre is a parenting resource offering practical advice from expert sources, such as obstetricians, paediatricians, doctors, midwives and parents. There is a section on contraception and breast feeding.
www.babycentre.co.uk

The BBC Health web pages contain lots of information on breast feeding.
www.bbc.co.uk/health/

Patient UK provides evidence-based information on health, disease and related issues, written by GPs. It contains lots of information about contraception.
www.patient.co.uk

The Breastfeeding Network has an article on taking emergency contraception whilst breast feeding.
www.breastfeedingnetwork.org.uk