Contraception: long-term options for women

Several medicines and devices are available to provide long-term, reversible contraception for women. These options offer from 1 month to 5 years of contraceptive protection, depending on which one is selected.

Long-term contraceptives can only be obtained through your doctor or Family Planning Clinic. Your doctor will usually want you to attend for 2 appointments. The first is to discuss fully the advantages and disadvantages of the various methods. At this time, your doctor will also ask about your general and reproductive health, and will often carry out a pelvic examination and a Pap smear, if you are due for one.

Selecting the most appropriate long-term contraceptive for your needs will depend on your individual preferences and circumstances — for example, when and if you plan to have a pregnancy in the future — as well as your previous and current general and reproductive health.

The second appointment will be at a time in your menstrual cycle when it is appropriate for your doctor to check that you are not pregnant and to administer the long-term contraceptive. Your doctor will also advise you how to recognise side effects of the contraceptive — and what to do about them should they occur — and tell you about any check-ups you may require during the use of the contraceptive.

Implant

The contraceptive implant Implanon NXT is inserted under the skin of the inner, upper arm to provide 3 years of contraceptive protection. The implant is made of plastic containing a progestogen, and is 2 mm wide and 4 cm long — similar in shape and size to a match stick. Your doctor will remove the implant after it has been in place for 3 years, or at any time prior to this if the contraceptive effect is no longer required. Fertility returns soon after removal of the implant. To continue contraception, a new implant must be inserted at the time of removal of the previous one.

How it works

Implanon NXT continuously releases the progestogen hormone called etonogestrel, which prevents ovulation occurring each month. This means no egg is available for fertilisation, so pregnancy is avoided. Implanon NXT also changes the mucus produced by the cervix, which makes it difficult for sperm to enter the uterus.

Precautions and side effects

Even though Implanon NXT is inserted and removed using local anaesthetic, if you plan to use this contraceptive option, you need to be comfortable with the idea of having an implant placed under your skin.

Prolonged, irregular or absent periods, acne, weight gain, headache and breast tenderness are among the side effects that have been reported in some women using Implanon NXT.

How effective is it?

The effectiveness of a contraceptive method can be measured for perfect use and typical use.

  • Perfect use is when instructions are followed precisely. The failure rate for perfect use of hormone implants during the first year of use is 0.05 to 0.3 per cent. So, when used perfectly, less than one woman in every 100 will become pregnant in the first year.
  • Typical use is what tends to happen in reality. Typical use failures include failures due to incorrect use. The failure rates for hormone implants are 0.05 to 3 per cent in the first year of typical use.

Hormone-releasing intrauterine device

Mirena (also called the ‘progestogen IUD’) is a small, T-shaped device made of impregnated plastic that is placed inside the uterus (womb). From here it releases a progestogen called levonorgestrel, which provides continuous contraceptive protection for 5 years.

Mirena has a small string attached that passes out through the cervix — feeling the string high up in the vagina lets you know that the device is still in place. The device is removed by your doctor after 5 years, or earlier if contraception is no longer required. If further contraception is needed, a new Mirena device is inserted at the same time as removal of the previous IUD.

How it works

The progestogen in Mirena (levonorgestrel) changes the mucus produced by the cervix, preventing sperm from entering the uterus. It also inhibits movement of sperm within the female reproductive tract, and acts directly on the lining of the uterus to make it thin and unsuitable for pregnancy. In some women it also stops ovulation occurring.

Precautions and side effects

Cramping can occur in the few days after Mirena is inserted. The most common side effect of Mirena is a change in the pattern of your periods. This can include an increased time between periods or longer periods, but the longer that Mirena is in place, the more likely that periods will become fewer (further apart) or, for some women, absent altogether.

A progestogen IUD very slightly increases your risk of a pelvic infection. Although this is a rare side effect, pelvic infections can reduce your fertility and so reduce your chance of having children in the future. Therefore, it is important to discuss these issues with your doctor.

As with other types of IUD, Mirena may not be suitable for women who have fibroids in the uterus. However, for women who normally experience very heavy periods, it can be a suitable choice. Again, your doctor will be able to discuss your suitability for a progestogen IUD.

How effective is it?

Mirena is more than 99 per cent effective in preventing pregnancy.

Copper intrauterine device

A copper IUD is a small plastic device that has a stem wound with fine copper wire. It looks like a small anchor with 2 side branches. Attached to the base of the stem is a nylon string. The string hangs out from the uterus through the cervix and can be felt with the fingers high in the vagina. Checking for the string each month reassures you that the IUD is still in place.

The copper IUD provides up to 5 years of contraceptive protection, depending on the brand used. After this time, the device is removed and a new copper IUD is inserted to continue the contraceptive effect if required.

How it works

The copper IUD releases very small amounts of copper (about one-hundredth of your average food intake of copper) which creates conditions inside the uterus that are unsuitable for the movement of sperm and eggs, and for the implantation of a fertilised egg.

Precautions and side effects

The presence of a copper IUD slightly increases your risk of a pelvic infection. Pelvic infections can reduce your fertility, which can reduce your chance of having children in the future. It is important to discuss these issues with your doctor.

The copper IUD can cause cramping and pain in the few days after it is inserted. As is the case with the progestogen IUD, the copper IUD may not be suitable for women who have fibroids in the uterus. Your doctor can discuss whether a copper IUD is suitable for you.

Periods can be heavier and longer than previously when a copper IUD is in place, although this usually settles after a few months.

How effective is it?

The copper IUD is more than 99 per cent effective in preventing pregnancy.

Depot injection

Available under the brand names Depo-Provera and Depo-Ralovera, a depot injection for long-term contraception usually involves an injection into the muscle of your buttock, or your upper arm, to provide protection from pregnancy for 3 months. If contraception is needed beyond this time the injection is repeated every 3 months, for as long as needed.

How it works

These injections contain the medicine medroxyprogesterone acetate (sometimes shortened to ‘MPA’). MPA is a progestogen, which is a synthetic substance that mimics the action of the natural hormone progesterone. MPA works by stopping the release of an egg from the ovary (‘ovulation’) each month. If no egg is present for fertilisation by sperm, then a pregnancy cannot occur.

Precautions and side effects

Following one or more depot MPA (DMPA) injections, a return to regular monthly periods and ovulation can be delayed for up to 18 months. For this reason, Depo-Provera or Depo-Ralovera are not recommended if you want to fall pregnant soon after stopping your contraceptive.

DMPA can result in altered vaginal bleeding, such as unpredictable spotting, irregular periods or no periods. Other possible side effects of DMPA include weight gain, and long-term use may be associated with a possible loss of bone density (bone thinning).

How effective is it?

The failure rate for perfect use of DMPA during the first year of use is 0.05 to 0.3 per cent, and the failure rate for DMPA in the first year of typical use is 0.05 to 3 per cent.


 
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