The aim of this book is to help women understand what they want from contraception – this may include control of heavy bleeding, for example, in addition to preventing pregnancy – and which options might meet those needs. The aim is not to be too prescriptive – it is a healthcare professional’s role to discuss underlying medical issues that might influence the choice of an individual brand of pill, for example. We want women to understand their choices and to feel empowered to have a meaningful discussion with healthcare professionals.

These methods prevent fertilisation by creating a physical barrier that prevents sperm from coming into contact with the mature egg (i.e., an ovum capable of being fertilised and developing into a pregnancy). Additional spermicide is recommended with barrier contraception to increase effectiveness by killing sperm. The individual types of barrier contraception are described in more detail below.

Chapter 4 talks about combined hormonal contraceptive methods, which contain both estrogen and a progestogen. However, contraception that contains a progestogen alone may be more suitable for women with an increased risk of deep vein thrombosis or cardiovascular disease; this includes women who smoke over the age of 35 and women with a body mass index of 35 kg/m2 or higher.

The fertility awareness method (FAM) is often called ‘natural family planning’ and is promoted as ‘natural’ and may therefore appeal to women who have reservations about using hormonal contraception. FAM is often used by couples planning a pregnancy but it can also be used to avoid pregnancy by using contraception or avoiding sex during the fertile window. However, it is a challenging way to achieve contraception, requiring motivation, commitment and consistency, all of which influence the popularity of this method. FAM is free and success rates are similar to those seen in women using combined hormonal contraception. Women using FAM should be comfortable with a higher risk of pregnancy than with other methods of contraception. FAM is not suitable for women with irregular cycles or those in whom it is imperative not to become pregnant (e.g., for health reasons or because they are taking medication that might harm a developing fetus). It is important to use barrier methods of contraception (usually condoms) if having sex on fertile days (some couples avoid sex on fertile days).

Long-acting reversible contraception has become increasingly popular in place of methods that are dependent on the user, such as oral contraception (both combined and progestogen-only pills). Long-acting methods are highly effective and are suitable for women of any age who do not want to become pregnant in the short term. As well as providing reliable contraception, the hormonal coil can help with common gynaecological symptoms such as heavy menstrual bleeding. This chapter describes the following long-acting methods.

The aim of emergency contraception is to prevent fertilisation (emergency hormonal contraception) or implantation (copper coil). Emergency hormonal contraception is more widely available and easier to access (for example from pharmacies); however, the copper coil is much more effective at preventing pregnancy after unprotected sex. This is because emergency hormonal contraception is only likely to be effective before ovulation, whereas the coil can be fitted at any time up to 5 days after ovulation, and left in place for ongoing contraception. The copper coil can be obtained through community sexual health services/genitourinary medicine clinics or some general practices.

Every sexual encounter (i.e., vaginal penetration with a penis, regardless of whether ejaculation occurs) carries a risk of an unplanned pregnancy unless contraception is used. Women make decisions about contraception throughout their reproductive life, from first sexual activity, through the child-bearing years and then into the perimenopause until the menopause. Some women may quickly find a method that suits them, whereas others will need to try different methods – and may never be truly satisfied. The Contraceptive Counselling (COCO) study of over 1,000 women found that only one-third were very satisfied with their current contraception. One-third were satisfied but wanted to consider a different method, and another third were somewhat satisfied, but felt there might be a more suitable method for them.

As well as being a valuable form of contraception, hormonal contraception can be used to treat painful periods, heavy periods, premenstrual disorders, acne and polycystic ovary syndrome (PCOS). It can also help to manage symptoms associated with the perimenopause. It is important to consider bleeding patterns and related pain and symptoms when discussing contraceptive choices with healthcare professionals.

In order to understand how to prevent conception, it is helpful to understand when, where and how it happens. Key to this is an understanding of the reproductive system and what happens during the menstrual cycle. This will support understanding of how contraception works. This chapter is a useful overview of the basics, to help with later chapters.

Combined hormonal contraceptives contain two hormones, estrogen and a progestogen, which are similar to the body’s own hormones. Many people are familiar with the combined oral contraceptive – ‘the pill’ – but they may not realise that combined hormonal contraception is also available as a patch, changed weekly, and a vaginal ring, which is changed every 3 weeks.