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caps
combined pill
condoms (female)
condoms (male)
contraceptive implant
contraceptive injection
contraceptive patch
diaphragms
intrauterine device (IUD)
intrauterine system (IUS)
natural family planning
progestogen-only pill
vaginal ring

At a glance: the facts about the female condom
If used correctly and consistently, female condoms are 95% effective.This means that five out of 100
women using female condoms as contraception will become pregnant in a year.
Using female condoms protects against both pregnancy and STIs.
A female condom needs to be placed inside the vagina before there is any contact between the vagina
and the penis.
Female condoms need to be stored in places that aren't too hot or too cold, and away from sharp or
rough surfaces that could tear them or wear them away.
Always buy condoms that have the CE mark on the packet. This means they've been tested to European
safety standards. Condoms that don't have the CE mark won't meet these standards, so don't use them.
A female condom can get pushed too far into the vagina, but it's easy to remove it yourself.
Female condoms may not be suitable for women who are not comfortable touching their genital area.
Do not use a female condom more than once. If you have sex again, use a new female condom.
You can get contraception at:
most GP surgeries
community contraception clinics
some GUM clinics
sexual health clinics
some young people's services
How female condoms work
The female condom is worn inside the vagina to stop sperm getting to the womb.
It is important to use condoms correctly, and to make sure the penis doesn't make contact with the
vagina before a condom has been put in. This is because semen can come out of the penis before a man
has fully ejaculated (come). A female condom can be put in up to eight hours before sex.
How to use a female condom
Take the female condom out of the packet, taking care not to tear the condom – do not open the packet
with your teeth.
Squeeze the smaller ring at the closed end of the condom and insert it into the vagina.
Make sure that the large ring at the open end of the female condom covers the area around the vaginal
opening.
Make sure the penis enters into the female condom, not between the condom and the side of the vagina.
Remove the female condom immediately after sex by gently pulling it out – you can twist the large ring
to prevent semen leaking out.
Throw the condom away in a bin, not down the toilet.
Who can use female condoms
Most people can safely use condoms. However, they may not be the most suitable method of
contraception for women who do not feel comfortable touching their genital area.
Advantages and disadvantages of female condoms
It is important to consider which form of contraception is right for you and your partner. Take care to use
condoms correctly, and consider using other forms of contraception for extra protection.

Advantages
By preventing the exchange of bodily fluids (semen and vaginal fluid), female condoms help to protect
against many STIs, including HIV.
When used correctly and consistently, condoms are a reliable method of preventing pregnancy.
You only need to use them when you have sex – they do not need advance preparation and are suitable
for unplanned sex.
In most cases, there are no medical side effects from using condoms.
Female condoms can be inserted up to eight hours before sex, and mean that women share the
responsibility for using condoms with their partner.
Disadvantages
Some couples find that putting a condom in can interrupt sex – to get around this, try making using a
condom part of Foreplay or insert the female condom in advance.
condoms are very strong, but may split or tear if not used properly.
Female condoms are not as widely available as male condoms and are more expensive to buy.
Can anything make condoms less effective?
Sperm can sometimes get into the vagina during sex, even when using a condom. This may happen if:
the
the
the
the

penis touches the area around the vagina before a condom is put in
female condom gets pushed too far into the vagina
man’s penis enters the vagina outside the female condom by mistake
condom gets damaged by sharp fingernails or jewellery

Although female condoms (when used correctly) offer reliable protection against pregnancy, using an
additional method of contraception will protect you against pregnancy if the female condom fails. If a
female condom slips or fails, you can use emergency contraception to help to prevent pregnancy. This is
for emergencies only, and shouldn't be used as a regular form of contraception.
If you've been at risk of unintended pregnancy, you're also at risk of catching an STI, so have a check-up
at:
a GP surgery
a local sexual health clinic or genitourinary medicine (GUM) clinic (Find sexual health services near you)
a young persons' service (call the sexual health line on 0300 123 7123 for details)
Using lubricant
Condoms come ready lubricated, to make them easier to use, but you may also like to use additional
lubricant. This is particularly advised when using male condoms for anal sex to reduce the chance of the
condom splitting.
Any kind of lubricant can be used with female polyurethane condoms. If you are using male latex
condoms, do not use oil-based lubricants, such as body oil, petroleum jelly or creams (like Vaseline), as
they can damage the latex and make the condom more likely to split.
Risks
There are no serious risks associated with using female condoms.
Where to get female condoms
Everyone can get condoms for free, even if they are under 16. They are available from the following
places in your local area:



contraception (or family planning) clinics
sexual health or GUM (genitourinary medicine) clinics
some GP surgeries
Brook Advisory Centres (for under-25s only)

Find your nearest sexual health service.
Some places might only offer male condoms – you can ask the staff whether they provide free female
condoms.
You can also buy male and female condoms from:

pharmacies





supermarkets
websites
mail-order catalogues
vending machines in some public toilets
some petrol stations

If you buy condoms online, make sure you buy them from a pharmacist or other legitimate retailer.
Always choose condoms that carry the European CE mark or British BSI Kitemark as a sign of quality
assurance.
Contraception services are free and confidential, including for people under the age of 16.
If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or
carer) as long as they believe you fully understand the information you're given, and your decisions.
Doctors and nurses work under strict guidelines when dealing with young people under 16. They'll
encourage you to consider telling your parents, but they won't make you. The only time that a
professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The
risk would need to be serious, and they would usually discuss this with you first.

At a glance: facts about the cap

• When used correctly with spermicide, the cap is 92-96% effective at preventing pregnancy. This





means that between four and eight women out of every 100 who use a cap as contraception will
become pregnant in a year.
There are no serious health risks.
You only have to think about it when you have sex.
You can put a cap in several hours before you have sex.
It can take time to learn how to use a cap.
If you lose or gain more than 3kg (7lbs) in weight, or have a baby, miscarriage or abortion, you
may need to be fitted with a new cap.
By using condoms as well as a cap, you will help to protect yourself against sexually transmitted
infections (STIs).

How the cap works
Inserting a cap
Removing a cap
A cap, like a diaphragm, is a barrier method of contraception. It fits inside your vagina and prevents
sperm from passing through the entrance of your womb (the cervix). Caps are soft, thin domes made of
silicone, and come in different shapes and sizes.
You can get contraception at:




most GP surgeries
community contraception clinics
some GUM clinics
sexual health clinics
some young people's services

Find a clinic near you
To be effective in preventing pregnancy, a cap needs to be used in combination with spermicide, which is
a chemical that kills sperm.
You only have to use a cap when you have sex, but you must leave it in for at least six hours after the
last time you had sex. You can leave it in for longer than this, but do not take it out before.
When you first start using a cap, a doctor or nurse will examine you and advise on the correct size or
shape. They will show you how to put in and take out the cap, and also how to use the spermicide, which
must be applied every time you use a cap.
A cap provides only limited protection against STIs. If you're at a high risk of getting an STI – for
example, you or your partner has more than one sexual partner – you may be advised to use another
form of contraception.

You can insert a cap up to three hours before you have sex – after this time. During this time. Most women can use the same cap for a year before they need to replace it. This is for you to practise with at home. or if you have a baby. such as the urethra. when you have sex. or if you cannot reach your cervix have weakened vaginal muscles (possibly as a result of giving birth) that cannot hold a cap in place have a sensitivity or an allergy to the chemicals in spermicide (or latex. if you have a latex cap) have ever had toxic shock syndrome (a rare. However. Some women squat while they put their cap in. It gives you the chance to learn how to use it properly. but life-threatening bacterial infection) have repeated urinary tract infections (an infection of the urinary system. they may not be suitable for you if you: • • • • • • • • have an unusually shaped or positioned cervix (entrance to the womb). while others lie down or stand with one foot up on a chair – use the position that's easiest for you. then leave to dry. Always check your cap for any signs of damage before using it. • • • • Never boil a cap. Removing a cap A cap can be easily removed by gently hooking your finger under its rim. You may need to get a different sized cap if you gain or lose more than 3kg (7lb) in weight. such as condoms. but do not leave them in for longer than the recommended maximum time of 48 hours (including the minimum six). Do not use disinfectant. You may be fitted with a temporary cap by your doctor or nurse. Caps come with instructions and are all inserted in a similar way: • • • • • • • • With clean hands. bladder or kidneys) currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap) are not comfortable touching your vagina have a high risk of getting an STI – for example. miscarriage or abortion. The cap must fit neatly over your cervix – it stays in place by suction. The silicone cap has a groove between the dome and the rim – some spermicide should also be placed there. you will need to take it out and put some more spermicide on it. but do not put any spermicide around the rim. which you should keep in a cool. wear the cap so they can check that it is the right size and you have put it in properly. upwards. but this does not make it less effective. see how it feels and find out if the method is suitable for you. they will give you one to use as contraception. Rinse it thoroughly. You must leave all types of cap in place for at least six hours after the last time you had sex. You can leave them in for longer than this. you can wash your cap with warm water and mild. dry place. fill one-third of the cap with spermicide. When you go back for a follow-up appointment with your doctor or nurse. Squeeze the sides of the cap together and hold it between your thumb and first two fingers. Your cap may become discoloured over time. Who can use the cap Most women are able to use contraceptive caps. unperfumed soap. Slide the cap into your vagina. A latex cap should not be left in for more than 30 hours. Looking after your cap After use. you are not protected against pregnancy and need to use additional contraception. You will be given a small container for it. loop or strap and pulling it downwards and out. detergent. Depending on the type of cap. you may need to add extra spermicide after it has been put in. You can visit your GP or nurse when you want to replace your cap. as these products can damage it. oil-based products or talcum powder to keep it clean. When they are happy that you can use a cap properly. as this will stop the cap staying in place. if you have multiple sexual partners .Inserting a contraceptive cap Your doctor or nurse will show you how to put in a cap.

. and they would usually discuss this with you first. If you're under 16 and want contraception. They'll encourage you to consider telling your parents. the doctor. Places where you can get contraception include: • • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services some young people's services (call the Sexual Health Line on 0300 123 7123 for more information) Find your nearest sexual health clinic by searching by postcode or town. It is recommended that you wait at least six weeks after giving birth before using a contraceptive cap. Contraception services are free and confidential. and your decisions. moisturiser or some vaginal medicines (for example. the pill is over 99% effective at preventing pregnancy. bath oils. but you may need a different size. nurse or pharmacists won't tell your parents (or carer) as long as they believe you fully understand the information you're given. but you may need a different size. such as abuse. You can use a cap after having a baby. or you have had sex without contraception. At a glance: the combined pill • When taken correctly. You can use a cap after a miscarriage or abortion. pessaries) with a latex cap – these can damage the latex If any of these things happen. Advantages and disadvantages of the cap A cap has the following advantages: • • • you only need to use it when you want to have sex you can put it in at a convenient time before having sex (do not forget to use extra spermicide if you have it in for more than three hours) there are no serious associated health risks or side effects A cap has the following disadvantages: • • • • • • it is not as effective as other types of contraception it only provides limited protection against STIs it can take time to learn how to use a cap putting a cap in can interrupt sex cystitis (bladder infection) can be a problem for some women who use a cap latex and spermicide can cause irritation in some women and their sexual partners Risks There are no serious health risks associated with using a contraceptive cap. it is torn or has holes it is not the right size for you you use it without spermicide you do not use extra spermicide with your cap every time you have more sex you remove it too soon (less than six hours after the last time you had sex) you use oil-based products. you may need emergency contraception. A cap may be less effective if: • • • • • • it is damaged – for example. such as baby lotion. The risk would need to be serious. Where you can get it Most types of contraception are free in the UK. The only time that a professional might want to tell someone else is if they believe you're at risk of harm. Doctors and nurses work under strict guidelines when dealing with people under 16.Research shows that spermicides which contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an STI. including for people under the age of 16. but they won't make you. Contraception is free to all women and men through the NHS. This means that fewer than one woman in 100 who use the combined pill as contraception will get pregnant in one year.

or women with certain medical conditions. One pill is taken each day for 21 days and then no pills are taken for the next seven days.• • • • • • • • You need to take the pill every day for 21 days. so using a condom as well will help to protect you against STIs. You could get pregnant if you don't do this. Binovum and Logynon are examples of this type of pill. It also: • • thickens the mucus in the neck of the womb. or if you miss a pill. . breast tenderness and headaches. Minor side effects include mood swings. Every day (ED) pills You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you There are 21 active pills and seven inactive (dummy) pills in a pack. Brevinor and Cilest are examples of this type of pill. such as blood clots and cervical cancer. There's a very low risk of serious side effects. the combined pill can help. Microgynon. then stop for seven days. The combined pill is not suitable for women over 35 who smoke. or vomit or have severe diarrhoea. Every day pills need to be taken in the right order. One pill is taken each day for 28 days with no break between packets of pills. There is no evidence that the pill makes women gain weight. The pill does not protect against sexually transmitted infections (STIs). Each pill has the same amount of hormone in it. Phasic 21-day pills Phasic pills contain two or three sections of different coloured pills in a pack. Phasic pills need to be taken in the right order. If you have heavy periods or painful periods. Each section contains a different amount of hormones. there are three main types: Monophasic 21-day pills This is the most common type. You start taking the pill again after seven days. so there is less chance of a fertilised egg implanting into the womb and being able to grow Although there are many different brands of pill. and during this week you have a period-type bleed. so it is harder for sperm to penetrate the womb and reach an egg thins the lining of the womb. The two types of pill look different. How the combined pill works How it prevents pregnancy Monophasic 21-day pills Phasic 21-day pills Every day (ED) pills How to take 21-day pills How to take every day pills Starting the combined pill Taking pill packs back-to-back How it prevents pregnancy The pill prevents the ovaries from releasing an egg each month (ovulation). One pill is taken each day for 21 days and then no pills are taken for the next seven days. Microgynon ED and Logynon ED are examples of this type of pill. You need to take the pill at the same time every day.

Taking pill packs back-to-back For monophasic combined pills (pills all the same colour and with the same level of hormones). and seek advice as soon as possible. What to do if you miss a pill If you miss a pill or pills. You will not need additional contraception. Missing one pill anywhere in your pack or starting the new pack one day late isn’t a problem. This should be the same day of the week as when you took your first pill. If you start the pill on any other day of your cycle. missing two or more pills. continue to take your pill and use another method of contraception. However. this can make the pill less effective at preventing pregnancy. How to take every day pills • • • • Take the first pill from the section of the packet marked "start". such as condoms. Starting the combined pill Most women can start the pill at any time in their menstrual cycle. it is normally fine to start a new pack of pills straight after your last one – for example. practice nurse or pharmacist. whether you are still bleeding or not. If you miss a pill. During the seven days of taking the inactive pills. if you make the seven-day pill-free break longer by forgetting two or more pills.Follow the instructions that come with your packet. How to take 21-day pills • • • • Take your first pill from the packet marked with the correct day of the week. If you are not sure what to do. Some women find they feel bloated if they run several packs of the pill together. Continue to take a pill at the same time each day until the pack is finished. as you will still be protected against pregnancy (known as having contraceptive cover). If you have a short menstrual cycle. Start your next pack of pills after you have finished the first. you will still be protected from pregnancy straight away. . This will be an active pill. such as condoms. Start your next pack of pills on the eighth day. abortion or miscarriage. avoid taking more than two packs together unless advised to by a doctor or nurse. in the correct order and preferably at the same time each day. or you start a pack late. This is because your ovaries are not getting any effect from the pill during the seven-day break. until the pack is finished (28 days). If you have any questions about how to take the pill. follow the advice below. If you start the pill on the fifth day of your period or before. The chance of getting pregnant after missing a pill or pills depends on: • • when the pills are missed how many pills are missed A pill is late when you have forgotten to take it at your usual time. because missing pills or taking them at the same time as certain medicines may make them less effective. if you want to delay your period for a holiday. or the first pill of the first colour (phasic pills). or starting the pack two or more days late (more than 48 hours late) may affect your contraceptive cover. unless you have a short menstrual cycle (your period is every 23 days or less). In particular. It's important to take the pills as instructed. you will need additional contraception. your ovaries might release an egg and there is a risk of getting pregnant. ask your GP. If you start the combined pill on the first day of your period (day one of your menstrual cycle) you will be protected from pregnancy straight away. There is special guidance if you have just had a baby. Stop taking pills for seven days (during these seven days you will get a bleed). You have missed a pill when it is more than 24 hours since the time you should have taken it. This is because you may have breakthrough bleeding as the womb lining sheds slightly. you will get a bleed. you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for seven days. However. You may need to use additional contraception during your first days on the pill – this depends on when in your menstrual cycle you start taking it. Continue to take a pill every day. until you have taken the pill for seven days. whether you are still bleeding or not.

talk to your GP. practice nurse or pharmacist. Get advice from your contraception clinic. even if it means taking two pills in one day leave any earlier missed pills continue taking the rest of the pack as usual and use an extra method of contraception for the next seven days you may need emergency contraception you may need to start the next pack of pills without a break (see Starting the next pack after missing two or more pills) You may need emergency contraception if you have had unprotected sex in the previous seven days and have missed two or more pills (you are taking your pill more than 48 hours late) in the first week of a pack. Who can use the combined pill If there are no medical reasons why you cannot take the pill and you do not smoke. such as condoms. even if it means taking two pills in one day continue taking the rest of the pack as usual you don’t need to use additional contraception. If you continue to be sick. it may not have been fully absorbed into your bloodstream. but use additional contraception. without having a break Vomiting and diarrhoea If you vomit within two hours of taking the combined pill. anywhere in the pack: • • • • take the last pill you missed now. the pill is not suitable for all women. Keep taking your pill as normal. You should not take the pill if you: • • • • • are pregnant smoke and are 35 or older stopped smoking less than a year ago and are 35 or older are very overweight take certain medicines (ask your GP about this) You should also not take the pill if you have (or have had): • thrombosis (a blood clot) • • • a heart abnormality or heart disease. keep using another form of contraception while you're ill and for two days after recovering. To find out whether the pill is right for you. especially with aura (warning symptoms) breast cancer . such as condoms take your seven-day pill-free break as normal If you have missed two or more pills (you are taking your pill more than 48 hours late) anywhere in the pack: • • • • • take the last pill you missed now. You can also call NHS 111 or the Sexual Health Line on 0300 123 7123.If you have missed one pill. Take another pill straight away and the next pill at your usual time. while you have diarrhoea and for two days after recovering. Starting the next pack after missing two or more pills If there are seven or more pills left in the pack after the last missed pill: • • finish the pack have the usual seven-day break If there are fewer than seven pills left in the pack after the last missed pill: • finish the pack and start the new one the next day. or if your sickness or diarrhoea continues. Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn't work properly. doctor or pharmacist about this. you can take the pill until your menopause. including high blood pressure severe migraines. However. Speak to your GP or contraception nurse or call NHS 111 for more information.

Some interactions are listed on this page. oxcarbazepine. Advantages and disadvantages Some advantages of the pill include: • • • • • • • it it it it it it it does not interrupt sex usually makes your bleeds regular. but it is not a complete list. practice nurse or pharmacist read the patient information leaflet that comes with your medicine Antibiotics The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the combined pill. After a miscarriage or abortion If you have had a miscarriage or abortion. and St John's wort The combined pill can interact with medicines called enzyme inducers. lighter and less painful reduces your risk of cancer of the ovaries. phenytoin. If you start the pill later than 21 days after giving birth. you may need additional contraception (such as condoms) while taking the antibiotic. primidone and topiramate St John's wort (a herbal remedy) antiretroviral medicines used to treat HIV (research suggests that interactions between these . Other antibiotics do not have this effect. If you want to check your medicines are safe to take with the combined pill. womb and colon can reduce symptoms of PMS can sometimes reduce acne may protect against pelvic inflammatory disease may reduce the risk of fibroids. such as headaches. you'll need to use additional contraception until you have taken the pill for seven days. It is recommended that you use a different method of contraception until you stop breastfeeding. such as thrombosis (blood clots) and breast cancer The combined pill with other medicines Some medicines interact with the combined pill and it doesn't work properly. If you are prescribed rifampicin or rifabutin. you will need additional contraception (such as condoms) for the next seven days. Speak to your doctor or nurse for advice. breast tenderness and mood swings – if these do not go after a few months. you can start the pill up to five days after this and you will be protected from pregnancy straight away. Examples of enzyme inducers are: • • • the epilepsy drugs carbamazepine. nausea. reducing the effectiveness of the pill. you can start the pill on day 21 after the birth. Epilepsy and HIV medicines. you can: • • ask your GP. phenobarbital. If you are breastfeeding a baby less than six months old. it may help to change to a different pill it can increase your blood pressure it does not protect you against sexually transmitted infections breakthrough bleeding and spotting is common in the first few months of using the pill it has been linked to an increased risk of some serious health conditions. taking the pill can reduce your flow of milk.• • disease of the gallbladder or liver diabetes with complications or diabetes for the past 20 years After having a baby If you have just had a baby and are not breastfeeding. You will be protected against pregnancy straight away. ovarian cysts and non-cancerous breast disease Some disadvantages of the pill include: • • • • • it can cause temporary side effects at first. These speed up the breakdown of progestogen by your liver. If you start the pill more than five days after the miscarriage or abortion.

However. and bleeding will probably be lighter and less painful. but you can rinse it in warm water and put it back in as soon as possible. the risks of using the pill usually outweigh the benefits) having migraines (you should not take the pill if you have severe or regular migraine attacks. Some women have temporary side effects. Places where you can get contraception include: • • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services some young people's services (call the Sexual Health Line on 0300 123 7123 for more information) If used correctly. pulmonary embolus (clot in your lung). in a wheelchair or with a leg in plaster Cancer Research is ongoing into the link between breast cancer and the pill. • • • • • • • One ring will provide contraception for a month. the vaginal ring is more than 99% effective. the ring is still effective if you have vomiting or diarrhoea. However. The pill can be taken with caution if you have one of the risk factors below. because you can have sex with the ring in place. However. but your doctor will check if you have certain risk factors that make you more vulnerable before prescribing the pill. Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. If a blood clot develops. It doesn’t interrupt sex. Contraception is free to all women and men through the NHS. for most women. but you should not take it if you have two or more risk factors. so you don’t have to think about it every day. Where you can get the combined pill Most types of contraception are available for free in the UK. stroke or heart attack. This means that fewer than one woman out of every 100 who use the vaginal ring as contraception will become pregnant in one year.medicines and the progestogen-only pill can affect the safety and effectiveness of both) Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines. A few women develop a blood clot (thrombosis) when using the ring. You might need emergency contraception. Unlike the pill. Blood clots The oestrogen in the pill may cause your blood to clot more readily. these risks are small and. The ring may ease premenstrual symptoms. the benefits of the pill outweigh the risks. the pill does offer some protection against developing endometrium (lining of the womb) cancer. especially if you get aura or a warning sign before an attack) having high blood pressure having had a blood clot or stroke in the past having a close relative who had a blood clot when they were younger than 45 being immobile for a long time – for example. depending on how long it has been out. it could cause deep vein thrombosis (clot in your leg). . but this is rare. breast tenderness and headaches. your risk of breast cancer goes back to normal. The risk of getting a blood clot is very small. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. including more vaginal discharge. Risks of taking the combined pill There are some risks associated with using the combined contraceptive pill. The ring can sometimes come out on its own. These include: • • • • • • • • being 35 years old or over being a smoker or having quit smoking in the past year being very overweight (in women with a BMI of 35 or over. 10 years after you stop taking the pill. ovarian cancer and colon cancer.

squeeze the ring between your thumb and finger. put a finger into your vagina and hook it around the edge of the ring gently pull the ring out . then remove it and have a seven-day ring-free break. advising that the ring will protect against pregnancy straight away if you start it up to day five of your menstrual cycle. and gently insert the tip into your vagina gently push the ring up into your vagina until it feels comfortable Unlike a diaphragm or cap. You leave it in for 21 days. see your doctor or nurse. as long as it isn’t uncomfortable. If you can feel the ring and it is uncomfortable. you remove it. To remove the ring: • • with clean hands. By using condoms as well as the ring. There isn’t a right or wrong place for it to be. You should be able to check that the ring is still there using your fingers. This: • • • reduces ovulation (the release of an egg) thickens vaginal mucus. To insert the ring: • • with clean hands. If you can’t feel it. This is because a study found that ovulation was suppressed in women who started using the vaginal ring on day five of their cycle. After the ring has been in your vagina for 21 days (three weeks). the ring does not need to cover your cervix (the entrance to your womb) to work. push it a bit further into your vagina. You’re protected against pregnancy during the ring-free break. you’ll protect yourself against STIs. and you'll need to use additional contraception (such as condoms) for the first seven days However. How the ring works Using the vaginal ring If you forget to take the ring out If you forget to put a new ring in If the ring comes out by itself The ring continually releases oestrogen and progestogen. but you’re sure it’s there. which are synthetic versions of the hormones that are naturally released by the ovaries. You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you The licence for the vaginal ring states that: • • you will be protected against pregnancy straight away if you insert it on the first day of your period (the first day of your menstrual cycle) you won't be protected from pregnancy if you start using it at any other time in your menstrual cycle. guidance from The Faculty of Sexual and Reproductive Healthcare (FSRH) differs slightly. which makes it more difficult for sperm to get through thins the lining of the womb so that an egg is less likely to implant there Using the vaginal ring You can start using the vaginal ring at any time during your menstrual cycle. You then put a new ring in for another 21 days.• The vaginal ring doesn’t protect against sexually transmitted infections (STIs). This should be on the same day of the week that you put it in. You can discuss this with your doctor or nurse to decide when might be the best time for you to start using the ring. The ring cannot get "lost" inside you.

If you have any bleeding or pain. You and your partner may feel the ring during sex. and you should OR . The FSRH advice is different. Talk to your doctor or nurse about whether you'll be protected against pregnancy or not. If you forget to take the ring out If you forget to take the ring out after 21 days. or when you're constipated. and you don’t need to use additional contraception If the ring has been in for more than seven extra days (more than four weeks in total): • • take the ring out as soon as you remember put a new ring in straight away The licence for the vaginal ring states that you should use additional contraception (such as condoms) until the new ring has been in for seven days. then repeat the cycle. and use additional contraception. You might have a period-type bleed during this time. second or third week of using it. Dispose of it in the normal way. Put the new ring in even if you’re still bleeding. The licence for the vaginal ring states that if the ring is out for more than three hours. If this is the case. The FSRH advises that you'll be protected for longer – up to 48 hours if the ring was in for seven continuous days before it came out. Talk to your doctor or nurse. you will not be protected against pregnancy. You may need emergency contraception if you have had sex in the last few days – talk to your doctor or nurse. You now have two options: • You can put a new ring in straight away. what you should do depends on how much extra time the ring has been left in. tell your doctor or nurse immediately. rinse it and put it back in. You may not have a period-type bleed. you don’t put a new one in for seven days (one week). but you may have spotting. You’ll have a period-type bleed. The information below is based on the licence information on what to do if the ring comes out. Talk to your doctor or nurse about when you should use additional contraception. don’t put it back in.• put it in the special bag provided and throw it in the bin – don’t flush it down the toilet Removing the ring should be painless. If the ring is out for more than three hours in the third week of using it. What you should do depends on how long the ring is out for. If you forget to put a new ring in Put in a new ring as soon as you remember. such as condoms. If the ring comes out by itself Sometimes the ring may come out on its own (this is called expulsion). and the ring-free interval was 48 hours or more longer than it should have been (nine days or more in total). When you’ve taken the ring out. • Don’t put a ring in and have a seven-day interval. If the ring has been in for up to seven days after the end of week three: • • • • take the ring out as soon as you remember don’t put a new ring in – start your seven-day interval as normal begin your new ring after your seven-day interval as normal you’re still protected against pregnancy. You may need emergency contraception if you had sex in the days before changing the rings over. This is most likely to happen after or during sex. or you can’t pull it out. You may need emergency contraception if you had sex before you remembered to put the new ring in. If the ring is out for more than three hours in the first or second week of using it. This is the ringfree interval. Leave this ring in for 21 days. You can have sex and use tampons while the ring is in your vagina. talk to your doctor or nurse. you need to insert a new one. You need to use additional contraception for seven days. After seven days without a ring in. for seven days. and whether you’re in the first. but this isn’t harmful.

breast tenderness and mood changes the ring does not protect against STIs The vaginal ring with other medicines Some medicines may interact with the vaginal ring. such as increased vaginal discharge. nausea. If you start the ring more than 21 days after giving birth. and it will work straight away. you need to use additional contraception for seven days after you insert the ring. Whichever option you choose. After miscarriage or abortion You can start using the ring immediately after a miscarriage or abortion. to see whether the ring is suitable for you.put a new ring in seven days after the old one came out (you can only choose this option if the ring was in continuously for the previous seven days). as you may need emergency contraception. If you want to check that your medicines are safe to take with the vaginal ring. meaning it doesn’t work properly. more regular and less painful it may reduce the risk of cancer of the ovary. The vaginal ring may reduce your flow of milk if you’re breastfeeding a baby under six months old. The ring may not be suitable if you: • have had a blood clot in a vein or artery • have had heart or circulatory problems. You don’t need to use additional contraception. You should also talk to your doctor or nurse if you’ve had sex in the last few days. you need to use additional contraception until the ring has been in for seven days in a row. Advantages and disadvantages Some of the advantages of the vaginal ring include: • • • • • • • • it doesn’t interrupt sex it’s easy to put in and remove you don’t have to think about it every day or each time you have sex the ring is not affected if you vomit or have diarrhoea it may help with premenstrual symptoms period-type bleeding usually becomes lighter. uterus and colon it may reduce the risk of fibroids. including high blood pressure • are 35 or older and smoke. and you will be protected against pregnancy straight away. ovarian cysts and non-cancerous breast disease Some of the disadvantages of the vaginal ring include: • • • • it may not be suitable if you don’t feel comfortable inserting or removing it from your vagina spotting and bleeding while the ring is in your vagina can occur in the first few months it may cause temporary side effects. Your doctor or nurse will ask about your medical history and your family's medical history. After giving birth You can start using the vaginal ring 21 days after giving birth. you can: . Who can use the vaginal ring? Some women cannot use the vaginal ring. It’s usually recommended that you use a different method. you can use it until you are 50 years old. headaches. or stopped smoking in the past year • have severe migraine with aura (warning symptoms) • have had breast cancer in the past five years • have diabetes with complications • • • are overweight take certain medicines have vaginal muscles that can’t hold a vaginal ring If you don’t smoke and there are no medical reasons why you can’t use the ring.

sexual health clinics and some GP surgeries. but these are not common. phenytoin. Risks There are some serious side effects. Some research suggests a link between oestrogen and progestogen hormonal contraception and a very rare liver cancer. available in pharmacies and sexual health clinics. primidone and topiramate St John’s Wort (a herbal remedy) some antiretroviral medicines used to treat HIV antibiotics called rifampicin and rifabutin. • Condoms need to be stored in places that aren't too hot or cold. such as moisturiser. lotion and Vaseline. This means that they've been tested to high safety standards. and away from sharp or rough surfaces that could tear them or wear them away. . • Putting on a condom can be an enjoyable part of sex. and doesn't have to feel like an interruption. Research suggests there is a small increase in the risk of developing cervical cancer with longer use of oestrogen and progestogen hormonal contraception. They include: • • developing a blood clot in a vein or artery having a heart attack or stroke Research into the risk of breast cancer and hormonal contraception is complex and contradictory. practice nurse or pharmacist read the patient information leaflet that comes with your medicine The vaginal ring can interact with medicines called enzyme inducers. • You can get free condoms from contraception clinics. • Always buy condoms that have the BSI kite mark and the CE mark on the packet. is safe to use with all condoms. It suggests that all women who use hormonal contraception appear to have a small increased risk of being diagnosed with breast cancer. and to get checked for STIs.• • ask your GP. These speed up breakdown of progestogen by your liver. compared with women who don’t use hormonal contraception. male condoms are 98% effective. which can be used to treat illnesses including tuberculosis (TB) and meningitis Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines. Contraception is free to all women and men through the NHS. Don't use out-of-date condoms. Examples of enzyme inducers are: • • • • the epilepsy drugs carbamazepine. phenobarbital. • Water-based lubricant. Use a new one each time you have sex. Places where you can get contraception include: • • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services some young people’s services (call 0300 123 7123 for more information) At a glance: condoms • If used correctly every time you have sex. you may need emergency contraception. If this happens. so don't use them. oxcarbazepine. Where you can get the vaginal ring Most types of contraception are available for free in the UK. This means that two out of 100 women using male condoms as contraception will become pregnant in one year. • If you're sensitive to latex. • Oil-based products. reducing the effectiveness of the ring. but they are safe to use with condoms made from polyurethane. Condoms that don't have the BSI kite mark and CE mark won't meet these standards. • Condoms have a use-by date on the packaging. can make latex and polyisoprene condoms less effective. you can use polyurethane or polyisoprene condoms instead. • A condom must not be used more than once. • It's possible for a condom to slip off during sex.

• Men who have difficulty keeping an erection may not be able to use male condoms. • Place the condom over the tip of the erect penis. withdraw the penis while it's still erect – hold the condom onto the base of the penis while you do this. • Remove the condom from the penis. How to use a condom • Take the condom out of the packet. They stop sperm from reaching an egg by creating a physical barrier between them. If this happens. taking care not to tear it with jewellery or fingernails – do not open the packet with your teeth. Condoms can also protect against STIs if used correctly during vaginal. or the condom slipping off. • They help to protect both partners from STIs. • You only need to use them when you have sex – they do not need advance preparation and are suitable .How a condom works Condoms are a barrier method of contraception. There are many different varieties and brands of male condom. as research has found that a spermicide called nonoxynol 9 does not protect against STIs such as chlamydia and HIV. You should also consider having an STI test. use your thumb and forefinger to squeeze the air out of it. throw the condom away because it may have sperm on it. or spermicide as an additional lubricant. • Gently roll the condom down to the base of the penis. seek advice about emergency contraception from your GP or contraception clinic. condoms are a reliable method of preventing pregnancy. • After sex. you're probably holding it the wrong way round – if this happens. • If you have sex again. or if semen leaks into the vagina while using a condom. It's important that the man's penis does not make contact with the woman's vagina before a condom has been put on. anal and oral sex. being careful not to spill any semen. and it's up to you and your partner which type of condom you use. If this is a problem. • Throw the condom away in a bin. • Some men and women are sensitive to the chemicals in latex condoms. polyurethane or polyisoprene condoms have a lower risk of causing an allergic reaction. • Make sure the man's penis does not touch his partner's genital area again. • If there's a teat on the end of the condom. Spermicide is a chemical that kills sperm. Advantages and disadvantages of condoms It is important to consider which form of contraception is right for you and your partner. However. condoms may not be the most suitable method of contraception for everyone. Condoms with spermicide Some male condoms come with spermicide on them. not down the toilet. as the penis must be erect to prevent semen leaking from the condom. • If the condom won't roll down. and consider using other forms of contraception for extra protection. Who can use condoms Most people can safely use condoms. This is because semen can come out of the penis before a man has fully ejaculated (come). gonorrhoea and HIV. and may even increase the risk of infection. Advantages • When used correctly and consistently. including chlamydia. Take care to use condoms correctly. It is best to avoid using spermicide-lubricated condoms. and try again with a new one. use a new condom. These condoms are slowly being phased out.

This may happen if: the penis touches the area around the vagina before a condom is put on the condom splits or comes off the condom gets damaged by sharp fingernails or jewellery you use oil-based lubricants. pessaries or suppositories – this can damage latex and polyisoprene condoms and stop them working properly • • • • If you think that sperm has entered the vagina. to reduce the chance of the condom splitting. plastic or spermicides – you can get condoms that are less likely to cause an allergic reaction. you have also been at risk of STIs. baby oil or petroleum jelly. practise putting them on so that you get used to using them properly. This is for emergencies only and shouldn't be used as a regular form of contraception. Any kind of lubricant can be used with condoms that are not made of latex. If male condoms aren't used properly. holding the condom firmly in place. with latex or polyisoprene condoms – this damages the condom • you are using medication for conditions like thrush. for extra protection against pregnancy. • When using a male condom. Disadvantages • Some couples find that using condoms interrupts sex – to get around this. they can slip off or split. you need to take the emergency contraceptive pill up to 72 hours or up to 120 hours (five days) after unprotected sex. As well as condoms. If this happens.for unplanned sex. but may split or tear if not used properly. • In most cases. sizes and flavours. This is particularly advised for anal sex. the man has to pull out after he has ejaculated and before the penis goes soft. such as: • body oil or lotion • petroleum jelly or creams (such as Vaseline) This is because they can damage the condom and make it more likely to split. you can use emergency contraception to help prevent pregnancy. • Condoms are very strong. You should have a check-up at: • a GP surgery . such as the contraceptive pill. try to make using a condom part of foreplay. • Male condoms are easy to get hold of and come in a variety of shapes. You will still be at risk of STIs if the condom breaks. Depending on the type of pill. If a condom splits or comes off If the condom splits or comes off. other forms of contraception will not protect you against STIs. However. but you may also like to use additional lubricant. Can anything make condoms less effective? Sperm can sometimes get into the vagina during sex. Using lubricant Condoms come ready lubricated to make them easier to use. there are no medical side effects from using condoms. The intrauterine device (IUD) can be used as emergency contraception up to five days after sex. If you have been at risk of pregnancy. even when using a condom. do not use oil-based lubricants. However. • Some people may be allergic to latex. if you are using latex or polyisoprene condoms. such as creams. you can use other forms of contraception. talk to your GP or staff at a contraception clinic about emergency contraception and the risk of STIs. such as lotion. or lube.

there are no serious risks associated with using condoms. although some people are allergic to latex condoms. • It's very useful for women who find it difficult to take a pill at the same time every day. • The implant does not protect against sexually transmitted infections (STIs). • It's very useful for women who know they don't want to get pregnant for a while. you'll help to protect yourself against STIs. the implant can be taken out. tenderness or swelling around the implant. heavier or longer. lighter. it's more than 99% effective. • It can be useful for women who can't use contraception that contains oestrogen. At a glance: the implant • If implanted correctly. It's not harmful. you don't have to think about contraception for three years.000 who have the implant as contraception for three years will get pregnant. your periods may become irregular. but you may want to consider this before deciding to have an implant. • When it's first put in. Once the implant is in place. Fewer than one woman in 1. This usually settles down after the first year. • Some medications can make the implant less effective. You can have the implant removed at any time. By using condoms as well as the implant. This means they have been tested to the required safety standards.• a contraception clinic • a sexual health clinic or genitourinary medicine (GUM) clinic • a young person's clinic Risks For most people. You can get condoms that are less likely to cause an allergic reaction. • A common side effect of the implant is that your periods stop (amenorrhoea). and additional contraceptive precautions need to be followed when you are taking these medications (see Will other medicines affect the implant?). Always choose condoms that carry the BSI kite mark and the European CE mark as a sign of quality assurance. and your natural fertility will return very quickly. • In the first year after the implant is fitted. make sure that you buy them from a pharmacist or other legitimate retailer. They are available from: • • • • contraception clinics sexual health or GUM (genitourinary medicine) clinics some GP surgeries some young people's services Find sexual health services near you You can also buy condoms from: • • • • • • pharmacies supermarkets websites mail-order catalogues vending machines in some public toilets some petrol stations If you buy condoms online. How the implant works The implant steadily releases the hormone progestogen into your bloodstream. you may feel some bruising. • If you have side effects. even if they are under 16. Progestogen is similar to the . Where to get condoms Everyone can get condoms for free.

you will be immediately protected against becoming pregnant. Since October 2010. and Nexplanon has become the most commonly used implant. you will need to use additional contraception. Both types of implant work in the same way. using a local anaesthetic. . such as condoms. for the following seven days. flexible tube about 4cm long. you will no longer be protected against pregnancy. It is implanted under the skin of your upper arm by a doctor or nurse. Nexplanon works for up to three years before it needs to be replaced. as long as you and your doctor are reasonably sure you are not pregnant. The small wound made in your arm is closed with a dressing and does not need stitches. You can continue to use it until you reach the menopause. If it is fitted on any other day of your menstrual cycle. when a woman’s monthly periods stop (at around 52 years of age). It only takes a few minutes to remove. such as condoms. The implant can be removed at any time by a specially trained doctor or nurse. After a miscarriage or abortion The implant can be fitted immediately after a miscarriage or an abortion. There is no need for existing Implanon users to have their implant removed and replaced by Nexplanon ahead of its usual replacement time. Nexplanon is the main contraceptive implant currently in use. Nexplanon is a small. and should use another method. and you will be protected against pregnancy straight away. A local anaesthetic is used to numb the area. making it difficult for sperm to pass through to the womb and reach an unfertilised egg • makes the lining of the womb thinner so that it is unable to support a fertilised egg You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you The implant can be put in at any time during your menstrual cycle. insertion of Implanon has decreased as stocks are used up. • If it is fitted after day 21. After giving birth You can have the contraceptive implant fitted after you have given birth. you will be immediately protected against becoming pregnant. which is released by a woman's ovaries during her period. The continuous release of progestogen: • stops a woman releasing an egg every month (ovulation) • thickens the mucus from the cervix (entrance to the womb). • If it is fitted on or before day 21 after the birth. you will not be protected against pregnancy for up to seven days. but Nexplanon is designed to reduce the risk of insertion errors and is visible on an X-ray or CT (computerised tomography) scan. thin. In the UK. As soon as the implant has been removed.natural hormone progesterone. usually after three weeks. It is safe to use the implant while you are breastfeeding. When it starts to work If the implant is fitted during the first five days of your menstrual cycle. Implants inserted before October 2010 were called Implanon.

If you have prolonged or severe headaches or other side effects. contraceptive patch or vaginal ring • you do not have to remember to take a pill every day • the implant is safe to use while you are breastfeeding • your fertility should return to normal as soon as the implant is removed • implants offer some protection against pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb • the implant may reduce heavy periods or painful periods after the first year of use • after the contraceptive implant has been inserted. Around 20% of women using the implant will have no bleeding. tell your doctor. These include: Disrupted periods Your periods may change significantly while using a contraceptive implant. although they may settle down after the first year. Other side effects that some women report are: • • • • • • headaches acne nausea breast tenderness changes in mood loss of sex drive These side effects usually stop after the first few months. they may not be acceptable for some women. and almost 50% will have infrequent or prolonged bleeding. you should be able to carry out normal activities Using a contraceptive implant may have some disadvantages. which you should consider carefully before deciding on the right method of contraception for you. Your GP may be able to help by providing additional medication if you have prolonged bleeding. Although these changes are not harmful. Some women put on weight while using the implant. but there is no evidence to show that the implant causes weight gain.Who can use the implant Most women can be fitted with the contraceptive implant. Bleeding patterns are likely to remain irregular. such as the combined contraceptive pill. . It may not be suitable if you: • • • • • • • • • • • think you might be pregnant want to keep having regular periods have bleeding in between periods or after sex have arterial disease or a history of heart disease or stroke have a blood clot in a blood vessel (thrombosis) have liver disease have migraines have breast cancer or have had it in the past have diabetes with complications have cirrhosis or liver tumours are at risk of osteoporosis Advantages and disadvantages of the implant The main advantages of the contraceptive implant are: • it works for three years • the implant does not interrupt sex • it is an option if you cannot use oestrogen-based contraception.

If this happens. or stop altogether (amenorrhoea). so you don't have to think about contraception every day or every time you have sex. headaches. • It can be useful for women who can't use contraception that contains oestrogen. the contraceptive injection is more than 99% effective. • It can take up to one year for your fertility to return to normal after the injection wears off. The injection can't be removed from your body. such as St John's Wort an antibiotic called rifabutin (which can be used to treat tuberculosis) an antibiotic called rifampicin (which can be used to treat several conditions. Always tell your doctor that you are using an implant if you are prescribed any medicines. Contraception is free to all women and men through the NHS. so it may not be suitable if you want to have a baby in the near future. which can cause thinning of the bones. • Using Depo-Provera affects your natural oestrogen levels. This means that less than one woman in 100 who use the injection will become pregnant in a year. breast tenderness and irregular bleeding. If you are using these medicines for a short while (for example. Risks of the implant In rare cases. or a single dose of the contraceptive injection. • It can be useful for women who might forget to take the contraceptive pill every day. including tuberculosis and meningitis) These are called enzyme-inducing drugs. • The contraceptive injection may provide some protection against cancer of the womb and pelvic inflammatory disease. • Side effects can include weight gain. By using condoms as . the area will be cleaned and may be treated with antibiotics. Ask your doctor or nurse for more details about the implant and other medication. • Your periods may become more irregular or longer. the area of skin where the implant has been fitted can become infected. mood swings. Places where you can get contraception include: • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services At a glance: the contraceptive injection • If used correctly. so if you have side effects they'll last as long as the injection and for some time afterwards. The additional contraception could be condoms. rifampicin to protect against meningitis). The implant can remain in place if you have the injection. it is recommended that you use additional contraception during the course of treatment and for 28 days afterwards.Will other medicines affect the implant? Some medicines can reduce the implant's effectiveness. Treatment is available if your bleeding is heavy or longer than normal – talk to your doctor or nurse about this. Where you can get the contraceptive implant Most types of contraception are available for free in the UK. • The injection lasts for eight. Women taking enzyme-inducing drugs in the long term may wish to consider using a method of contraception that isn't affected by their medication. These include: • • • • • medication for HIV medication for epilepsy complementary remedies. 12 or 13 weeks (depending on the type). • It's not affected by medication. • The injection does not protect against sexually transmitted infections (STIs).

you will be immediately protected against becoming pregnant. After giving birth You can have the contraceptive injection at any time after you have given birth. which is released by a woman's ovaries during her period. How the injection works You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you The contraceptive injections Depo-Provera and Noristerat are usually given into a muscle in your bottom. the injection will usually be given after six weeks. If you are breastfeeding. you'll need to use additional contraception for seven days. • If you start injections after day 21. you'll help to protect yourself against STIs. although sometimes may be given in a muscle in your upper arm. so that it is unable to support a fertilised egg The injection can be given at any time during your menstrual cycle. It is safe to use contraceptive injections while you are breastfeeding. you will not be protected against pregnancy for up to seven days. When it starts to work If you have the injection during the first five days of your cycle. If you have the injection more than five days after a miscarriage or abortion. Use condoms or another method of contraception during this time. The contraceptive injection works in the same way as the implant. If you have the injection on any other day of your cycle. you will be immediately protected against becoming pregnant. The continuous release of progestogen: • stops a woman releasing an egg every month (ovulation) • thickens the mucus from the cervix (neck of the womb). Sayana Press is given under the skin (subcutaneously) rather than into a muscle. After a miscarriage or abortion You can have the injection immediately after a miscarriage or abortion. in the abdomen or thigh.well as the injection. . and you will be protected against pregnancy straight away. Progestogen is similar to the natural hormone progesterone. Heavy and irregular bleeding is more likely to occur if you have the contraceptive injection during the first few weeks after giving birth. It steadily releases the hormone progestogen into your bloodstream. if you are not breastfeeding. as long as you and your doctor are reasonably sure you are not pregnant. although it may be given earlier if necessary. you will need to use additional contraception for the following seven days. • If you start injections on or before day 21 after giving birth. making it difficult for sperm to pass through to the womb and reach an unfertilised egg • makes the lining of the womb thinner.

It may not be suitable if you: • • • • • • • • • • • think you might be pregnant want to keep having regular periods have bleeding in between periods or after sex have arterial disease or a history of heart disease or stroke have a blood clot in a blood vessel (thrombosis) have liver disease have migraines have breast cancer or have had it in the past have diabetes with complications have cirrhosis or liver tumours are at risk of osteoporosis Advantages and disadvantages of the injection The main advantages of the contraceptive injection are: • each injection lasts for either eight. They will usually become irregular and may be very heavy. This may settle down after the first year. It takes around eight to 12 weeks for injected progestogen to leave the body. or shorter and lighter. or stop altogether. such as the combined pill. Weight gain You may put on weight when you use the contraceptive injection. It can take a while for your periods and natural fertility to return after you stop using the injection. painful periods and help with premenstrual symptoms for some women • the injection offers some protection from pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb Using the contraceptive injection may have some disadvantages. Until you are ovulating regularly each month. 12 or 13 weeks • the injection does not interrupt sex • the injection is an option if you cannot use oestrogen-based contraception. particulaly if you are under 18 years old and are overweight with a BMI (body mass index) of 30 or over. which you should consider carefully before deciding on the right method of contraception for you. it can be difficult to work out when you are at your most fertile. These are as follows: Disrupted periods Your periods may change significantly during the first year of using the injection. Other side effects that some women report are: • headaches • acne • tender breasts . but you may have to wait longer for your periods to return to normal if you are trying to get pregnant. but may continue as long as the injected progestogen remains in your body. In some cases. it can take three months to a year for your periods to return to normal.Who can use the injection? Most women can be given the contraceptive injection. contraceptive patch or vaginal ring • you do not have to remember to take a pill every day • the injection is safe to use while you are breastfeeding • the injection is not affected by other medicines • the injection may reduce heavy.

and some women get temporary side effects. or a family history of osteoporosis). the patch can help. and it doesn't appear to cause any long-term problems. Contraception is free to all women and men through the NHS. • The patch can increase blood pressure. • The patch may protect against ovarian cancer. the patch is more than 99% effective at preventing pregnancy. womb cancer and colon cancer.• changes in mood • loss of sex drive Depo-Provera. In very rare cases. How it works How you use the patch When the patch starts to work . such as headaches. but it does not increase your risk of breaking a bone. in the swimming pool and while playing sports. Thinning of the bones may be a problem for women who already have an increased risk of developing osteoporosis (for example. • You can wear the patch in the bath. which can cause thinning of the bones. because they have low oestrogen. Where you can get it Most types of contraception are available free in the UK. then have a week off without a patch. You can get contraception at: • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services At a glance: facts about the patch • When used correctly. so using a condom as well will help to protect you against STIs. • Some women develop a blood clot when using the patch. • If you have heavy or painful periods. or who weigh 90kg (14 stone) or more. Will other medicines affect the injection? No – the contraceptive injection is not affected by other medication. Women under 18 may use Depo-Provera. • The patch does not protect against sexually transmitted infections (STIs). It may also be a concern for women under 18. You change the patch every week for three weeks. Risks There is a small risk of infection at the site of the injection. some people may have an allergic reaction to the injection. oestrogen and bone risk Using Depo-Provera affects your natural oestrogen levels. This isn't a problem for most women. because the bone replaces itself when you stop the injection. • The patch may not be suitable for women who smoke and who are 35 or over. • You don't need to think about it every day. because the body is still making bone at this age. • Each patch lasts for one week. but only after careful evaluation by a doctor. but this is rare. and it's still effective if you vomit or have diarrhoea.

such as condoms. you can vary the position every time you use a new patch to reduce your risk of irritation. as long as the skin is clean. You can talk to your doctor or nurse for more information about when the patch will start to work. like a period. If the patch has been off for 48 hours or more. It should not come off after a shower. you need to use an additional form of contraception. and how many days you had a patch on before it came off. You apply a new patch once a week (every seven days) for three weeks. such as condoms. This means you can have sex without getting pregnant. it starts working straight away. This is known as your patch-free week. although this may not always happen. What to do if the patch falls off The contraceptive patch is very sticky and should stay on. If you have had a patch on for six days or less before it falls off. you do not need to use additional contraception. or after exercise. If the patch does fall off. When the patch starts to work The licence for the patch states that if you start using the patch on the first day of your period. If the patch has been off for less than 48 hours: • stick your patch back on as soon as possible (if it is still sticky) • if it is not sticky. for the first seven days. After seven patch-free days. or you're not sure how long it has been off: . hot tub. You should not stick the patch on: • sore or irritated skin • anywhere it may get rubbed off by tight clothing • your breasts When you first start using the patch. sauna or swim. If this is the case. Start your new cycle even if you are still bleeding. what you need to do depends on how long it has been off. you will be protected and won't need to use additional contraception. you may not be protected against pregnancy and should use additional contraception.What to do if the patch falls off What to do if you forget to take the patch off Bleeding in the patch-free week How you use the patch You can use the contraceptive patch on most areas of your body. and then stop using the patch for seven days. dry and not very hairy. bath. replace it with a new patch (do not try to hold the old patch in place with a plaster or bandage) • continue to use your patch as normal and change your patch on your normal change day If the patch has been off for less than 48 hours before you replace it. If you start using it on any other day. for seven days. you apply a new patch and start the four-week cycle again. and whether you need to use additional contraception. During your patch-free week you will get a withdrawal bleed. you will still be protected against pregnancy as long as the patch was on properly for seven days before the patch came off. The Faculty of Sexual and Reproductive Healthcare guidance states that if you start using the patch in the first five days of your menstrual cycle.

You may or may not bleed on the patch-free days. and advice for extending the patch-free week is based on what is known about the vaginal ring and combined pill. Who can use the patch You can get contraception at: • most GP surgeries • community contraception clinics • some GUM clinics . If you put the patch on 48 hours late or less (so the patch-free interval has been nine days or less). You don’t need to use any additional contraception and you are protected against pregnancy. as you may need emergency contraception. put a new one on as soon as you remember. This is nothing to worry about if you have used the patch properly and have not taken any medication that could affect it. you may need emergency contraception. such as condoms. even if you are bleeding. Bleeding in the patch-free week Some women do not always have a bleed in their patch-free week. take the patch off as soon as possible and start your patchfree break. If you forget to put on a patch at the end of the patch-free week. get medical advice.• apply a new patch as soon as possible and start a new patch cycle (this will now be day one of your new cycle) • use another form of contraception. • 48 hours or more longer than it should have been (10 days or more in total) – start a whole new patch cycle by applying a new patch as soon as possible. nurse or local sexual health (GUM) clinic if you are concerned. Ask your doctor or nurse for advice if you have had sex in the previous few days and were not using a condom. See your GP or nurse for advice if you are worried. The patch works in a similar way to the vaginal ring and the combined pill. such as condoms. so the interval has been 10 days or more. changing it on your normal change day. as long as you wore the patch correctly before the patch-free interval. If you miss more than two bleeds. Start a new patch on your usual start day. as you may need emergency contraception. What to do if you forget to take the patch off If you forget to take the patch off after week one or two. If you put the patch on more than 48 hours late. you may not be protected against pregnancy and need to use additional contraception. See your GP. such as condoms. If you forget to take the patch off after week three. Continue to use your patch as normal. you will still be protected against pregnancy. This is now week one of the patch cycle and you will have a new day of the week as your start day and change day. what you need to do depends on how long you have forgotten it. or do a pregnancy test to check if you are pregnant. Ask your doctor or nurse for advice if you have had sex in the patch-free interval. What to do if you forget to put a patch on after the patch-free week There is no specific research on what happens if the patch-free week is longer than seven days. If it has been on for: • Less than 48 hours longer than it should have been (eight or nine days in total) – take off the old patch and put on a new one. You will be protected against pregnancy and do not need to use any additional contraception. for the next seven days. This means that you will not have a full week of patch-free days. for the next seven days If you had unprotected sex in the previous few days. Use another method of contraception. for seven days.

your doctor or nurse will need to ask you about your health and your family’s medical history. irregular bleeding) is common in the first few cycles of using the patch. this is nothing to worry about if you are using the patch properly. tuberculosis (TB) or HIV You will also not be able to use the patch if you have (or have had) any of the following conditions: • • • • • • thrombosis (blood clots) in a vein or artery a heart problem or a disease affecting your blood circulatory system (including high blood pressure) migraine with aura (warning signs) breast cancer disease of the liver or gallbladder diabetes with complications. to make sure the patch is suitable for you. so you may need to use condoms as well some women get mild temporary side effects when they first start using the patch. or diabetes for more than 20 years Advantages and disadvantages of the patch If it is used properly. nausea (sickness). so it is just as effective even if you vomit or have diarrhoea • like the pill. it tends to make your periods more regular. It is very important to tell them about any illnesses or operations you have had. womb and bowel cancer • it may reduce the risk of fibroids. itching and soreness it does not protect you against STIs. If you are thinking of using it. such as some antibiotics. Some potential disadvantages of the patch are that: it may be visible it can cause skin irritation. or medications you are currently taking. and you will still be protected against pregnancy • • • • . the contraceptive patch is more than 99% effective in stopping you from getting pregnant. This means that if 100 women use the patch according to the instructions. such as headaches. these side effects usually settle down after a few months • bleeding between periods (breakthrough bleeding) and spotting (very light.• sexual health clinics • some young people's services Find a clinic near you The contraceptive patch is not suitable for everyone. ovarian cysts and non-cancerous breast disease Some women may find that the contraceptive patch has some disadvantages and may wish to use a different form of contraception. you do not have to think about it every day – you only have to remember to change the patch once a week • the hormones from the contraceptive patch do not need to be absorbed by the stomach. Conditions and circumstances that may mean you should not use the patch include: • • • • • • you are pregnant or think you may be pregnant you are breastfeeding you smoke and are 35 or over you are 35 or over and stopped smoking less than a year ago you are very overweight you take certain medicines. breast tenderness and mood changes. St John’s Wort or medicines used to treat epilepsy. Other advantages of the patch are: • it is very easy to use and does not interrupt sex • unlike the combined oral contraceptive pill. fewer than one will get pregnant in a year. lighter and less painful • it can help with premenstrual symptoms • it may reduce the risk of ovarian.

which can block a vein (venous thrombosis) or an artery (arterial thrombosis. Your risk is also higher if: • • • • • you smoke you are very overweight you are immobile (unable to move) or use a wheelchair you have severe varicose veins a close family member had a venous thrombosis before they were 45 years old The risk of arterial thrombosis is greatest if: • • • • • • you smoke you are diabetic you have high blood pressure (hypertension) you are very overweight you regularly have migraines with aura (warning signs) a close family member had a heart attack or stroke before they were 45 Cancer Current research suggests that people who use hormonal contraception. Contraception is free to all women and men through the NHS. such as the contraceptive patch. Research also suggests there is a small increase in your risk of developing cervical cancer with the long-term use of oestrogen and progestogen hormonal contraception. Blood clots The patch slightly increases your chance of developing a blood clot. such as the contraceptive patch or combined pill. If you are prescribed new medicine or are buying an overthe-counter medicine. discuss all risks and benefits with your GP or nurse before starting to use the patch. the benefits of the patch outweigh the risks. If you have had a blood clot before. do not use the patch. and for 28 days afterwards. If there are no problems. ask the doctor or pharmacist for advice. to see how you get on with it. you can be prescribed the patch for six months to a year. which may lead to a heart attack or stroke). You will not be allowed to use the patch if you are considered to be at a higher risk of serious side effects. are at a slightly increased risk of being diagnosed with breast cancer compared with people who do not use hormonal contraception. However.Some medicines can make the patch less effective. You may need to use an extra form of contraception while you are taking the medicine. For most women. Risks of using the patch There is a very small risk of some serious side effects when you use a hormonal contraceptive. Where you can get it Most types of contraception are available for free in the UK. When you first get the contraceptive patch you will be given a three-month supply. However. Places where you can get contraception include: • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services . Your risk of blood clots is higher during the first year of using the patch. further research is needed to provide more definitive evidence.

but you must leave it in for at least six hours after the last time you had sex. but do not take it out before. • You can put a diaphragm in several hours before you have sex. • You only have to think about it when you have sex. you'll help to protect yourself against sexually transmitted infections (STIs). upwards. Diaphragms come with instructions and are all inserted in a similar way: • With clean hands. If you're at a high risk of getting an STI – for example. and come in different shapes and sizes. To be effective in preventing pregnancy. • By using condoms as well as a diaphragm. • It can take time to learn how to use it. which is a chemical that kills sperm. How the contraceptive diaphragm works Inserting a diaphragm Removing a diaphragm Looking after your diaphragm You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you A diaphragm (like a cap) is a barrier method of contraception. • There are no serious health risks. A diaphragm provides only limited protection against sexually transmitted infections (STIs). • Some women develop cystitis (a bladder infection) when they use a diaphragm. a diaphragm is 92-96% effective at preventing pregnancy – this means that between four and eight women out of every 100 who use a diaphragm as contraception will become pregnant within a year. • If you lose or gain more than 3kg (7lbs) in weight. a doctor or nurse will examine you and advise on the correct size or shape to suit you. • Slide the diaphragm into your vagina. you or your partner has more than one sexual partner – you may be advised to use another form of contraception. You only have to use a diaphragm when you have sex. Diaphragms are soft. miscarriage or abortion. which must be applied every time you use the diaphragm. • Put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers. put a small amount of spermicide on each side of the diaphragm (also putting a little spermicide on the rim may make the diaphragm easier to put in). Your doctor or nurse can check the size – switching to a smaller size may help. Inserting a diaphragm Your doctor or nurse will show you how to put in a diaphragm.At a glance: contraceptive diaphragm • When used correctly with spermicide. They will show you how to put in and take out a diaphragm. you may need to be fitted with a new diaphragm. When you first start using a diaphragm. It fits inside your vagina and prevents sperm from passing through the cervix (the entrance of your womb). thin domes made of latex (rubber) or silicone. This should ensure that the diaphragm covers your . or have a baby. You can leave it in for longer than this. and also how to use the spermicide. diaphragms need to be used in combination with spermicide.

cervix. • If your cervix is not covered. • Never boil a diaphragm. as these products can damage it. You can visit your GP or nurse when you want to replace your diaphragm. Rinse it thoroughly. then try again. This is for you to practise with at home. then leave it to dry. take the diaphragm out by hooking your finger under the rim or loop (if there is one) and pulling downwards. detergent. such as the urethra. see how it feels and find out if the method is suitable for you. • Do not use disinfectant. but this does not make it less effective. bladder or kidneys) • currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap) • are not comfortable touching your vagina • have a high risk of getting an STI – for example. loop or strap and pulling it downwards and out. During this time. Looking after your diaphragm After using. they will give you one to use as contraception. you can wash your diaphragm with warm water and mild unperfumed soap. Removing a diaphragm A diaphragm can be easily removed by gently hooking your finger under its rim. or if you cannot reach your cervix • have weakened vaginal muscles (possibly as a result of giving birth) that cannot hold a diaphragm in place • have a sensitivity or an allergy to latex or the chemicals in spermicide • have ever had toxic shock syndrome (a rare but life-threatening bacterial infection) • have repeated urinary tract infections (infection of the urinary system. Most women can use the same diaphragm for a year before they need to replace it. dry place. they may not be suitable for you if you: • have an unusually shaped or positioned cervix (entrance to the womb). • Your diaphragm may become discoloured over time. • Some women squat while they put their diaphragm in. However. When they are happy that you can use a diaphragm properly. You will be given a small container for it. if you have multiple sexual partners . or if you have a baby. • Always check your diaphragm or cap for any signs of damage before using it. Who can use a diaphragm? Most women are able to use a diaphragm. a bit like the end of your nose. When you go back for a follow-up appointment with your doctor or nurse. wear the diaphragm so they can check that it is the right size and you have put it in properly. others lie down or stand with one foot up on a chair – use the position that's easiest for you. You can leave them in for longer than this. You may need to get a different size diaphragm if you gain or lose more than 3kg (7lb) in weight. but do not leave them in for longer than the recommended time of 30 hours (including the minimum six). which you should keep in a cool. you will need to take it out and put some more spermicide on it. you are not protected against pregnancy and need to use additional contraception. when you have sex. It allows you to learn how to use it properly. • Always check that your cervix is covered – it feels like a lump. such as condoms. You may be fitted with a temporary diaphragm by your doctor or nurse. • You can insert a diaphragm up to three hours before you have sex – after this time. miscarriage or abortion. You must leave all types of diaphragm in place for at least six hours after the last time you had sex. oil-based products or talcum powder to keep it clean.

It can take time to learn how to use it. Advantages and disadvantages A diaphragm has the following advantages: • You only need to use a diaphragm when you want to have sex. Where you can get a diaphragm Most types of contraception are free in the UK. bath oils. or you have had sex without contraception. A diaphragm has the following disadvantages: • • • • • • It is not as effective as other types of contraception. moisturiser or some vaginal medicines (for example. Putting it in can interrupt sex. some with more copper than others. You can use a diaphragm after having a baby. but you may need a different size.Research shows that spermicides which contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an infection. Risks There are no health risks associated with using a contraceptive diaphragm. IUDs with less copper will be less effective. • There are no serious associated health risks or side effects. . Latex and spermicide can cause irritation in some women and their sexual partners. • You can put it in at a convenient time before having sex (but do not forget to use extra spermicide if you have it in for more than three hours). It only provides limited protection against STIs. You can use a diaphragm after a miscarriage or abortion. IUDs with more copper are more than 99% effective. but you may need a different size. A diaphragm may be less effective if: • • • • • • it is damaged – for example. This means that fewer than one in 100 women who use an IUD will get pregnant in one year. Cystitis (bladder infection) can be a problem for some women who use a diaphragm. it is torn or has holes it is not the right size for you you use it without spermicide you do not use extra spermicide with your diaphragm every time you have more sex you remove it too soon (less than six hours after the last time you had sex) you use oil-based products. Places where you can get contraception include: • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services At a glance: facts about the IUD • There are different types of IUD. such as baby lotion. It is recommended that you wait at least six weeks after giving birth before using a diaphragm. you may need to use emergency contraception. pessaries) with latex diaphragms – these can damage the latex If any of these things happen. Contraception is free to all women and men through the NHS. • You are in control of your contraception.

Before you have an IUD fitted. you'll help to protect yourself against STIs. An IUD can stay in the womb for five to 10 years. IUDs need to be fitted by a trained doctor or nurse at your GP surgery. Ask the doctor or nurse about pain relief. • Having the IUD put in can be uncomfortable. stopping sperm surviving there. • If you get pregnant. Sometimes. the overall risk of ectopic pregnancy is lower than in women who don't use contraception. as long as you're not pregnant. • Changes to your periods (for example. IUDs may also stop fertilised eggs from implanting in the womb. as long as you are not pregnant. Having an IUD fitted An IUD can be fitted at any time during your menstrual cycle. such as STIs. But because you're unlikely to get pregnant. • There's a risk that your body may expel the IUD. there's an increased risk of ectopic pregnancy (when the egg implants outside the womb). the IUD releases copper. It's best to do this before an IUD is fitted so that you can have treatment (if you need it) before the IUD is put in. you may be given antibiotics at the same . local contraception clinic or sexual health clinic. You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you You may also be tested for infections. Instead of releasing the hormone progestogen like the IUS. but they're likely to settle down after this. Copper changes the make-up of the fluids in the womb and fallopian tubes. • An IUD may not be suitable for you if you've had previous pelvic infections. You might get spotting or bleeding between periods. How the IUD works How it prevents pregnancy Having an IUD fitted How to tell whether an IUD is still in place Removing an IUD How it prevents pregnancy The IUD is similar to the IUS (intrauterine system) but works in a different way. By using condoms as well as the IUD. There are types and sizes of IUD to suit different women. • It can be removed at any time by a specially trained doctor or nurse and you'll quickly return to normal levels of fertility. being heavier. • It can be put in at any time during your menstrual cycle. • The IUD does not protect against sexually transmitted infections (STIs). and lasts for five to 10 years. This is to make sure that the IUD can be put in the correct place. you will have an internal examination to find out the size and position of your womb. If you're 40 or over when you have an IUD fitted.• An IUD works as soon as it's put in. You'll be protected against pregnancy straight away. longer or more painful) are common in the first three to six months after an IUD is put in. depending on the type. • There's a very small chance of infection within 20 days of the IUD being fitted. depending on the type. it can be left in until you reach the menopause or until you no longer need contraception.

You may get cramps afterwards. As soon as an IUD is taken out. you may not be fully protected against getting pregnant. You should not use an IUD if you have: • an untreated STI or a pelvic infection • problems with your womb or cervix • any unexplained bleeding from your vagina – for example. and the IUD is inserted through the cervix and into the womb. If he can feel the threads. If you're not going to have another IUD put in and you don't want to get pregnant. Discuss this with your GP or nurse beforehand. Your partner shouldn't be able to feel your IUD during sex. See your GP or go back to the clinic where your IUD was fitted as soon as you can if you: • have pain in your lower abdomen • have a high temperature • have a smelly discharge These may mean you have an infection. Removing an IUD An IUD can be removed at any time by a trained doctor or nurse. Speak to your doctor or nurse if you have any problems before or after this first check or if you want the IUD removed. between periods or after sex . Sperm can live for up to seven days in the body and could make you pregnant once the IUD is removed. You may get pain and bleeding for a few days after having an IUD fitted. so many women have the procedure without. use another method (such as condoms) for seven days before you have the IUD removed. like it is during a cervical screening (smear) test. Who can use an IUD Most women can use an IUD.time as the IUD is fitted. If you feel any pain during sex. you may need to use emergency contraception. This includes women who have never been pregnant and those who are HIV positive. your normal fertility should return. such as condoms. You can ask for a local anaesthetic or painkillers before having the IUD fitted. How to tell whether an IUD is still in place An IUD has two thin threads that hang down a little way from your womb into the top of your vagina. It takes about 15 to 20 minutes to insert an IUD. The fitting process can be uncomfortable and sometimes painful. If you've had sex recently. The doctor or nurse who fits your IUD will teach you how to feel for these threads and check that it is still in place. but if you can't feel the threads. It's very unlikely that your IUD will come out. and then after each period or at regular intervals. Check your IUD is in place a few times in the first month. This is because STIs can lead to an infection in the pelvis. Your doctor or nurse will ask about your medical history to check if an IUD is the most suitable form of contraception for you. The vagina is held open. or if you think the IUD has moved. until your IUD has been checked. An anaesthetic injection itself can be painful. get your doctor or nurse to check that your IUD is in place. They may be able to cut the threads to a shorter length. See your doctor or nurse straight away and use an extra method of contraception. Speak to your doctor or nurse if you or your partner are at risk of getting an STI. This is to stop sperm getting into your body. go for a check-up. The IUD needs to be checked by a doctor after three to six weeks.

Most will appear within the first year after fitting. so you may have to use condoms as well. it works straight away and lasts for up to 10 years or until it's removed. the risk of this is very low. An IUD is safe to use when you're breastfeeding and it won't affect your milk supply. Your normal fertility returns as soon as the IUD is taken out It's not affected by other medicines.Women who have had an ectopic pregnancy or recent abortion. it could lead to a pelvic infection if not treated. If you or your partner are unsure. or who have an artificial heart valve. Advantages and disadvantages of the IUD Although an IUD is an effective method of contraception. an IUD can be fitted within 48 hours of giving birth. but these changes are very small. It doesn't interrupt sex. There is no evidence that the IUD affects weight. In some cases.000 cases. there are some things to consider before having one fitted. go to your GP or a sexual health clinic to be tested. Using an IUD after giving birth An IUD can usually be fitted four to six weeks after giving birth (vaginal or caesarean). You'll need to use alternative contraception from three weeks (21 days) after the birth until the IUD is fitted. If the doctor or nurse fitting your IUD is experienced. you may need surgery to remove the IUD. endometrial cancer (cancer of the lining of the womb) or ovarian cancer. • The most common reasons that women stop using an IUD are vaginal bleeding and pain. longer or more painful. There's no evidence that having an IUD fitted will increase the risk of cancer of the cervix. Once an IUD is fitted. If perforation occurs. It can be used if you're breastfeeding. though this may improve after a few months. Risks of the IUD Complications after having an IUD fitted are rare. Contact your GP straight away if you feel a . but doesn't usually cause any other symptoms. must consult their GP or clinician before having an IUD fitted. Disadvantages of the IUD • Your periods may become heavier. as long as you were pregnant for less than 24 weeks. Advantages of the IUD • • • • • • Most women can use an IUD. you may have to wait a few weeks before having an IUD fitted. Some women experience changes in mood and libido. This can cause pain in the lower abdomen. including women who have never been pregnant. If you get an STI while you have an IUD. • An IUD doesn't protect against STIs. You should not be fitted with an IUD if there's a chance that you are already pregnant or if you or your partner are at risk of catching STIs. If you were pregnant for more than 24 weeks. Damage to the womb In fewer than one in 1. Using an IUD after a miscarriage or abortion An IUD can be fitted straight away or within 48 hours after an abortion or miscarriage by an experienced doctor or nurse. an IUD can perforate (make a hole in) the womb or neck of the womb (cervix) when it's put in.

lot of pain after having an IUD fitted as perforations should be treated immediately. • The progestogen-only pill doesn’t protect against sexually transmitted infections (STIs). such as Cerazette) it may not be effective. This is more likely to happen soon after it has been fitted. although this is uncommon. Pelvic infections Pelvic infections can occur in the first 20 days after the IUD is fitted. it can be more than 99% effective. • Your periods may stop or become lighter. • You can take the progestogen-only pill if you're over 35 and you smoke. Ectopic pregnancy If the IUD fails and you become pregnant. with no break between packs of pills. Places where you can get contraception include: • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – these offer contraceptive and STI testing services At a glance: facts about the progestogen-only pill • If taken correctly. The risk of infection is very small. Fewer than one in 100 women who are at low risk of STIs will get a pelvic infection. Where to get an IUD Most types of contraception are available free in the UK. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUD. • If you’re sick (vomit) or have severe diarrhoea. Your doctor or nurse will teach you how to check that your IUD is in place. previous blood clots or are overweight. By using condoms as well as the progestogen-only pill. • You must take the progestogen-only pill at the same time each day – if you take it more than three hours late (or 12 hours late if you take a desogestrel pill. • Some medicines may affect the progestogen-only pill's effectiveness – ask your doctor for details. because they have high blood pressure. the progestogen-only pill may not work. the IUD is rejected (expelled) by the womb or can move (this is called displacement). • You take a pill every day. irregular or more frequent. Contraception is free to all women and men through the NHS. How the progestogen-only pill works How it prevents pregnancy Using the progestogen-only pill Starting the first pack of pills . Rejection Occasionally. • The progestogen-only pill can be used by women who can't use contraception that contains oestrogen – for example. you'll help to protect yourself against STIs. your IUD should be removed as soon as possible if you're going to continue with the pregnancy. • Side effects may include spotty skin and breast tenderness – these should clear up within a few months. This means that fewer than one woman in 100 who use the progestogen-only pill as contraception will get pregnant in one year.

you start the next one the next day. because missing pills or taking the pill alongside other medicines can reduce its effectiveness. If you start the progestogen-only pill on any other day of your cycle. If you start the progestogen-only pill more than 21 days after giving birth. • Start your next pack of pills the following day. If you start it on day one of your menstrual cycle (the first day of your period) it will work straight away and you will be protected against pregnancy. The desogestrel pill (12-hour pill. It is important to follow the instructions that come with your pill packet. within either three or 12 hours of the same time each day. You won’t need additional contraception. • Continue to take a pill at the same time each day until the pack is finished. such as condoms. until you have taken the pill for two days. Sometimes. After having a baby If you have just had a baby. Norgeston and Noriday. such as Cerazette) must be taken within 12 hours of the same time each day. you can start the progestogen-only pill on day 21 after the birth. Starting the first pack of pills • Choose a convenient time in the day to take your first pill. There are 28 pills in a pack of progestogen-only pills. Using the progestogen-only pill There are two different types of progestogen-only pill: • The three-hour progestogen-only pill must be taken within three hours of the same time each day. Examples are Femulen. You will be protected against pregnancy straight away. • The 12-hour progestogen-only pill (desogestrel pill. If you start the progestogen-only pill on day five of your menstrual cycle or earlier (the fifth day after the start of your period or before) you will be protected from pregnancy straight away unless you have a short menstrual cycle (your period is every 23 days or less). you won't release an egg in 97 cycles out of 100. you will need additional contraception. depending on the type of progestogen-only pill. You can get contraception at: • • • • • most GP surgeries community contraception clinics some GUM clinics sexual health clinics some young people's services Find a clinic near you You can start the progestogen-only pill at any time in your menstrual cycle. . This means that if you're using a 12-hour progestogen-only pill. If you have a short menstrual cycle. depending on which type you are taking. so it is harder for sperm to penetrate into the womb and reach an egg. Micronor. you will need additional contraception (such as condoms) until you have taken the pill for two days. There is no break between packs of pills. You need to take one pill every day. There’s no break between packs of pills – when you finish one pack. it may also prevent ovulation (the release of an egg from your ovaries each month). you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for two days.How it prevents pregnancy The progestogen-only pill works by thickening the mucus in the neck of the womb. such as Cerazette) stops ovulation in 97% of menstrual cycles.

Norgeston or Noriday) you will need to use additional contraception for two days after missing the pill. use additional contraception until you have taken the pill for two days. you may need emergency contraception. or are taking the 12-hour progestogen-only pill and are more than 12 hours late you will not be protected against pregnancy. such as Cerazette). and • take the remaining pills as normal. How long you need to use additional contraception such as condoms depends on the type of pill you are taking: • If you are taking a three-hour pill (such as Femulen. such as condoms for two or seven days (depending on what pill you are taking) after missing a pill. and one at the regular time). • If you are taking a 12-hour pill that stops ovulation (a desogestrel pill. Don’t worry if you have had sex without using another form of contraception. This is because it takes seven days for the pill's effect on ovulation to be re-established after a missed pill. What to do if you miss a pill If you forget to take a progestogen-only pill. Seek advice straight away from your GP or local sexual health clinic. Emergency contraception If you have recently had unprotected sex. It takes two days for the pill's contraceptive effect on cervical mucus to be re-established after missing a pill. take only one) • take your next pill at the normal time Depending on when you remember. You can also call NHS 111 or the Sexual Health Line on 0300 123 7123. you will need additional contraception for seven days. you can start the progestogen-only pill up to five days afterwards and you will be protected from pregnancy straight away. If you are more than three or more than 12 hours late taking the pill If you are taking a three-hour progestogen-only pill and are more than three hours late taking it.After a miscarriage or abortion If you have had a miscarriage or abortion. what you should do depends on: • the type of pill you are taking • how long ago you missed the pill and how many pills you have forgotten to take • whether you have had sex without using another form of contraception during the previous seven days If you are less than three or less than 12 hours late taking the pill If you are taking a three-hour progestogen-only pill and are less than three hours late taking it. and you’ll be protected against pregnancy – you do not need to use additional contraception. You do not need emergency contraception. . You will need to use additional contraception. Micronor. You should: • take the last pill you missed straightaway (if you have missed more than one. it may mean taking two pills on the same day (one at the time of remembering. or even at the same time. If you start the pill more than five days after a miscarriage or abortion. or if you are taking the 12-hour progestogen-only pill and are less than 12 hours late: • take the late pill as soon as you remember. even if that means taking two pills on the same day The pill will still work.

although this is rare. there is no evidence that the pill will harm your unborn baby. or if your period is much shorter or lighter than usual. If you don’t take the replacement within three hours (or 12 hours for the 12-hour pill) of your normal time. If you continue to be sick. If this happens. use additional contraception. or if your sickness or diarrhoea continues. Breastfeeding The progestogen-only pill is safe to use if you are breastfeeding. Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn’t work properly. but use additional contraception. Get medical advice if you have a sudden or unusual pain in your abdomen (tummy). contraceptive patch and vaginal ring • you can use it at any age – even if you smoke and are over 35 • it can reduce the symptoms of premenstrual syndrome (PMS) and painful periods Some disadvantages of the progestogen-only pill include: • you may not have regular periods while taking it – your periods may be lighter. it may not have been fully absorbed into your bloodstream. for two days (seven days for the 12-hour pill). Advantages and disadvantages Some advantages of the progestogen-only pill include: • it does not interrupt sex • you can use it when breastfeeding • it is useful if you cannot take the hormone oestrogen. more frequent or may . Take another pill straight away and the next pill at your usual time. You may not be able to use it if you have had: • • • • • heart disease liver disease breast cancer cysts on your ovaries unexplained vaginal bleeding If you are healthy and there are no medical reasons why you should not take the progestogen-only pill. which is in the combined pill. If you think you may be pregnant. there is a very small chance that you could become pregnant while taking the progestogen-only pill. Who can use the progestogen-only pill? Most women can use the progestogen-only pill. such as condoms. while you have diarrhoea and for two days after recovering (seven days if you are taking a 12-hour pill). Keep taking your pill as normal. Small amounts of progestogen may pass into your breast milk.Vomiting and diarrhoea If you vomit within two hours of taking a progestogen-only pill. Pregnancy Although it is very unlikely. It is possible that these are warning signs of an ectopic pregnancy. keep using another form of contraception while you’re ill and for two days after recovering. you can take it until your menopause or until you are 55. such as condoms. speak to your GP or visit your local contraception clinic. Speak to your GP or contraception nurse or call NHS 111 or the Sexual Health Line on 0300123 7123 if you are unsure whether you are protected against pregnancy. The progestogen-only pill does not affect the way your breast milk is produced. but this is not harmful to your baby.

the effects of one medicine can be changed by the other. see your GP or practice nurse. These speed up the breakdown of progestogen by your liver. Some side effects can include: acne breast tenderness and breast enlargement an increased or decreased sex drive mood changes headache and migraine nausea or vomiting cysts (small fluid-filled sacs) on your ovaries (these are usually harmless and disappear without treatment) • stomach upset • weight gain • • • • • • • These side effects are most likely to occur during the first few months of taking the progestogen-only pill. They may advise you to change to another pill or a different form of contraception. can make it less effective The progestogen-only pill is generally well tolerated and side effects are rare. and St John’s wort The progestogen-only pill can interact with medicines called enzyme inducers. primidone and topiramate • St John’s wort (a herbal remedy) • some antiretroviral medicines used to treat HIV (research suggests interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both) Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines. If you are prescribed rifampicin or rifabutin. Other antibiotics do not have this effect. you can: • ask your GP. Epilepsy and HIV medicines.stop altogether. The progestogen-only pill with other medicines When you take two or more medicines at the same time. including certain types of antibiotic. phenobarbital. Speak to your doctor or nurse for advice. oxcarbazepine. Examples of enzyme inducers are: • the epilepsy drugs carbamazepine. you may need additional contraception (such as condoms) while taking the antibiotic and for 28 days after. practice nurse or pharmacist • read the patient information leaflet that comes with your medicine Antibiotics The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the progestogen-only pill. but they generally improve over time and should stop within a few months. reducing the effectiveness of the progestogen-only pill. and you may get spotting between periods • it does not protect you against STIs • you need to remember to take it at or around the same time every day • some medications. This is known as an interaction. . If you have any concerns about your contraceptive pill. Some medicines interact with the progestogen-only pill and it doesn’t work properly. Some interactions are listed on this page but it is not a complete list – if you want to check your medicines are safe to take with the progestogen-only pill. phenytoin.

Where you can get the progestogen-only pill Most types of contraception are available for free in the UK. there are certain risks. However. If you have a family history of breast cancer. Breast cancer Research is continuing into the link between breast cancer and the progestogen-only pill. Research suggests that women who use any type of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with people who don’t use hormonal contraception. However. For most women. These risks are small. However. In many cases. your risk of breast cancer goes back to normal. the cysts do not cause symptoms. 10 years after you stop taking the pill. Places where you can get contraception include: • • • • most GP surgeries – talk to your GP or practice nurse community contraception clinics some genitourinary medicine (GUM) clinics sexual health clinics – they also offer contraceptive and STI testing services . benefits of the progestogen-only pill outweigh the risks. These are not dangerous and do not usually need to be removed. although some women experience pelvic pain.Risks of taking the progestogen-only pill The progestogen-only pill is very safe to take. as with the combined contraceptive pill. Ovarian cysts Some women can develop fluid-filled cysts on their ovaries. Contraception is free to all women and men through the NHS. These cysts usually disappear without treatment. doctors do not think that using the contraceptive pill is likely to increase the risk in women who already have close relatives with breast cancer. you may feel that this increase in risk (however small it is) is not worth taking.