As a female functional GP qualified to do insertion and removal of hormone implants, insertion and removal of hormone and copper intrauterine devices as well provide MS2Step prescriptions, a lot of my patients are women seeking effective contraception. If you are one of these patients, I would love for you to have a read of this article and write down any questions you have before coming in to see me.
Fertility Awareness Methods
These methods are widely advocated by the Catholic church and used in countries without access to reliable contraception. The most famous, the Billings method (yes – there is an app!) involves tracking the menstrual cycle to avoid intercourse during the fertile period in a woman. This combined with the withdrawal method that relies upon the man ejaculating outside the vagina is purported to have a failure rate of up to 25%. This equates to almost 25 pregnancies in every 100 couples that use the method every year and I can’t help thinking of a few Monty Python skits every time a patient asks me about this method!
Barrier methods
Condoms available in every Australian grocery store and the much less used diaphragm that requires individual sizing and fitting are not very effective contraceptive alternatives. The failure rate is high at 94-98% effectiveness, however as condoms are the only method of contraception that also prevents sexually transmitted disease, most doctors including myself would advocate their use for this reason alone.
The Vaginal Ring
This is a small soft flexible plastic ring that contains combined hormones, oestrogen and progestogen. 4mm thick and 5mm in diameter it is effective (99.7%) and not noticeable by the woman or her partner during intercourse. It is placed in the vagina on the first day of menstruation and removed after 21 days. A new ring replaces the discarded one 7 days later. This is not available on the PBS but a great option for patients that cannot tolerate the doses involved in the oral combined contraceptive pill and those with gastrointestinal problems such as Crohn’s disease.
The Pill
There are more than 30 brands available of Progestogen only and combined Oestrogen and progestogen pills in Australia. This is because women are individuals and what might suit some may not suit everyone. They are 99.7% effective in providing contraception and there are some options available on the PBS making them very affordable. The functional approach allows for the most appropriate choice of this option and the supplements that can be used to minimise known side effects.
The Morning After Pill
These are used if a woman had sex without contraception or the condom broke to avoid pregnancy. They must be taken within 3 days (72hours) after unprotected intercourse and work best if taken as soon as possible. This can prevent up to 85% of expected pregnancies. These are available from a pharmacy without a script but I advocate going to the GP or family planning clinic for this to provide effective management of side effects, facilitate STI screening and follow up of failures.
The injection
Depot provera, an intramuscular injection that is given every 3 months provides effective (99.8%) contraception and is a cheap and effective. The disadvantage is that if there are side effects, there is no way of removing the hormone from the body and the woman will have to deal with these for 3 months.
Implants
A small plastic rod that releases a progestogen to prevent ovulation inserted under the skin on the upper arm can provide 3 years of contraception (99.95% effective). If there are significant side effects, unlike the depot provera, removal of the implant addresses these issues.
Intra-uterine devices (IUDs)
These are small contraceptive devices that are inserted into the uterus. Copper IUDs last for 5-10years and are 99.4% effective. There are two progestogen containing devices that are available in Australia on the PBS for less than $50 called the Mirena and the Kyleena. They last for 5 years and are 99.8% effective. Compared to taking 1826 oral contraceptive pills for the same period, it provides a great option. Hormone optimisation and minimising possible side effects with the functional approach is still effective with these devices.
Sterilisation
These methods are permanent contraception options. Women considering these need to be completely sure they do not want any children. The tubal ligation and tubal occlusion procedures performed by specialist gynaecologists are 99% effective.
