Contraception

• Monophasic 21-day pills
  This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. Microgynon, Marvelon and Yasmin are examples of this type of pill.
• Phasic 21-day pills
  Phasic pills contain 2 or 3 sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. Phasic pills need to be taken in the right order. Logynon is an example of this type of pill.
• Every day (ED) pills
  There are 21 active pills and 7 inactive (dummy) pills in a pack. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED is an example of this type of pill.

Follow the instructions that come with your packet. If you have any questions, ask a doctor, nurse or pharmacist.

It’s important to take the pills as instructed, because missing pills or taking them at the same time as certain medicines may make them less effective.

The pill may not be right for you 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

The pill may also not be right for you if you have (or have had):

• blood clots in a vein, for example in your leg or lungs
• stroke or any other disease that narrows the arteries
• anyone in your close family having a blood clot under the age of 45
• a heart abnormality or heart disease, including high blood pressure
• severe migraines, especially with aura (warning symptoms)
• breast cancer
• disease of the gallbladder or liver
• diabetes with complications, or diabetes for the past 20 years.

Blood clots

The oestrogen in the pill may cause your blood to clot more readily. If a blood clot develops, it could cause:

• deep vein thrombosis (clot in your leg)
• pulmonary embolus (clot in your lung)
• stroke
• heart attack

The risk of getting a blood clot is very small, but your doctor will check if you have certain risk factors before prescribing the pill.

Cancer

The pill can slightly increase the risk of developing breast cancer and cervical cancer. It can also decrease the risk of developing womb (uterus) cancer, ovarian cancer and bowel cancer.

However, 10 years after you stop taking the pill, your risk of breast cancer and cervical cancer goes back to normal.

• sexual health clinics – they also offer contraceptive and STI testing services
• community contraception clinics
• GP surgeries – talk to a GP or nurse
• some young people’s services (call the Sexual Health Line on 0300 123 7123 for more information)

• Starting on the first day of your period
  If you start the combined pill on the first day of your period (day 1 of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.
• Starting on the 5th day of your cycle or before
  If you start the pill on the 5th day of your period or before, you will still be protected from pregnancy straight away.
• Starting after the 5th day of your cycle
  You will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for 7 days.
  If you start the pill after the 5th day of your cycle, make sure you have not put yourself at risk of pregnancy since your last period. If you’re worried you’re pregnant when you start the pill, take a pregnancy test 3 weeks after the last time you had unprotected sex.

• when the pills are missed
• how many pills are missed

Find out what to do if you miss a combined pill.

If you continue to be sick, keep using another form of contraception until you’ve taken the pill again for 7 days without vomiting.

Very severe diarrhoea (6 to 8 watery poos in 24 hours) may also mean that the pill does not work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for 2 days after recovering.

Speak to a GP or nurse or call NHS 111 for more information, if your sickness or diarrhoea continues.

• it does not interrupt sex
• it usually makes your bleeds regular, lighter and less painful
• it reduces your risk of cancer of the ovaries, womb and colon
• it can reduce symptoms of PMS (premenstrual syndrome)
• it can sometimes reduce acne
• it may protect against pelvic inflammatory disease
• it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Cons

• it can cause temporary side effects at first, such as headaches, nausea, breast tenderness and mood swings – if these do not go after a few months, 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, such as blood clots and breast cancer

• ask a GP, 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. Other antibiotics do not have this effect.

If you are prescribed rifampicin or rifabutin, you may be advised to change to an alternative contraceptive. If not, you will need to use additional contraception (such as condoms) while taking the antibiotic and for a short time after. Speak to a doctor or nurse for advice.

Epilepsy and HIV medicines, and St John’s wort

The combined pill can interact with medicines called enzyme inducers. These speed up the breakdown of hormones by your liver, reducing the effectiveness of the pill.

Examples of enzyme inducers are:

• the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
• St John’s wort (a herbal remedy)
• antiretroviral medicines used to treat HIV (research suggests that interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both)

A GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year.

• External condom
  Perfect use: If external condoms are always used according to instructions they’re 98% effective. This means that 2 women in 100 will get pregnant in 1 year.
  Typical use: If external condoms are not always used according to instructions, about 18 in 100 women will get pregnant in 1 year.
• Internal condom
  Perfect use: If internal condoms are always used according to instructions they’re 95% effective. This means that 5 women in 100 will get pregnant in 1 year.
  Typical use: If internal condoms are not always used according to instructions, about 21 in 100 women will get pregnant in 1 year.

Sperm can get into the vagina during sex, even if you use a condom. This may happen if:

• the penis touches the area around the vagina before a condom is put on (pre-ejaculation fluid, which leaks out of the penis before ejaculation, may contain sperm)
• the condom splits
• you use the wrong type or size of condom
• you don’t use the condom correctly
• the condom slips off (external)
• the condom gets pushed into the vagina (internal)
• the penis enters the vagina outside the internal condom by mistake
• the condom gets damaged, for example by sharp fingernails or jewellery
• you use too much or too little lubricant
• you use oil-based products (such as body lotions) with latex or polyisoprene condoms. These damage the condom.

If any of these happen, or if you’ve had sex without using contraception, you can get advice about emergency contraception.

Some men may find that they have trouble maintaining an erection when wearing a condom or that the condom slips off when they are having sex. Getting the right condom for you can make a massive difference, so it’s worth trying out a range of condoms or coming into one of our clinics for advice. We’ll even give you some free condoms to try out.

There has been lots of innovation in the development of condoms over the past few years and they are now available in a huge variety of sizes, shapes, colours and flavours. Just make sure that it has a BSI kite mark and the European CE mark on the packet. This means they have been tested to the required safety standards.

Internal condoms are suitable for most people, but may not be suitable if you don’t feel comfortable touching the genital area to insert them.

• wheezing
• swelling
• dizziness,
• light-headedness

If you or your partner are allergic to latex, polyurethane or polyisoprene condoms are also available.

You can buy them from a pharmacy, by mail order or online, as well as from vending machines, supermarkets, garages and other shops.

Internal condoms aren’t as widely available as external condoms. They’re also free from some contraception and sexual health clinics, young people’s services and GP surgeries, or you can buy them online and from some pharmacies.

• You only need to use them when you have sex
• They help to protect both partners from some sexually transmitted infections, including HIV
• There are no serious side-effects or health impacts (unless you or your partner are allergic to latex)
• An internal condom can be put in any time before sex
• Condoms are widely available (external condoms more so)
• External condoms come in a variety of sizes, colours, flavours, textures and shapes. It can be fun to experiment.

Cons

• An external condom can sometimes slip off or split
• Some people are sensitive to latex condoms, though this is rare
• It’s important to pull out after ejaculation, before the penis goes soft, holding the external condom firmly in place at the base of the penis
• When using an internal condom, you need to make sure the penis is in the condom and not between the condom and vagina and that the open end of the condom stays outside the vagina
• Internal condoms can slip out or get pushed into the vagina
• There are also external novelty condoms available. These condoms may not protect you from pregnancy and don’t help protect you from sexually transmitted infections.

An implant may not be suitable for you if:

• you think you might already be pregnant
• you don’t want your periods to change
• you take certain medicines

It may not be suitable if you have, or had in the past:

• breast cancer
• unexplained vaginal bleeding (for example bleeding between periods or after sex)
• heart disease or stroke
• serious liver disease

Always tell your healthcare professional that you’re using an implant if you’re prescribed any medicines.

• Most implant users will have irregular and unpredictable bleeding
• Sometimes bleeding stops completely
• A few implant users will have bleeding that’s more frequent or lasts longer

These changes may be a nuisance but they’re not harmful.

If you have bleeding that’s a problem for you in the first few months after starting the implant, there’s about a 1 in 2 (50%) chance that this will improve over time.

If you have bleeding that’s a problem for you at any time, talk to your healthcare professional. They may be able to give you some additional hormone or medicine that can help control the bleeding. They may also check that the bleeding isn’t due to other causes, such as an infection.

If the implant is put in during the first 5 days of your period, you’ll be protected from pregnancy immediately.

If the implant is put in on any other day, you won’t be protected from pregnancy for the first 7 days after it’s been inserted. You’ll need to avoid sex or use additional contraception, such as condoms, during this time.

A trained healthcare professional will give you a local anaesthetic to numb the part of your arm where the implant will go, so it won’t hurt.

It only takes a few minutes to insert and feels like having an injection. You won’t need stitches.

After it’s been inserted, the healthcare professional will check your arm to make sure the implant’s in place. You’ll be shown how to feel the implant with your fingers, so you can check it’s in place.

The area may be tender for a day or two and may be bruised and slightly swollen. The healthcare professional will put a dressing on it to keep it clean and dry and to help reduce the bruising. Keep this dressing on for a few days and try not to knock the area.

Don’t worry about knocking the implant once the area has healed. It shouldn’t break or move around your arm. You’ll be able to do normal activities and you won’t be able to see it.

You don’t need a vaginal examination or cervical screening (smear) test to have an implant inserted.

A specially trained healthcare professional must take it out. They’ll feel your arm to locate the implant. They’ll give you a local anaesthetic injection in the area where the implant is. They’ll make a small cut in your skin and gently pull the implant out.

They’ll put a dressing on the arm to keep it clean and dry and to help reduce any bruising. Keep this dressing on for a few days.

It usually only takes a few minutes to remove an implant. If the implant’s been inserted correctly, it shouldn’t be difficult to remove.

Occasionally, an implant is difficult to feel under the skin and it may not be so easy to remove. If this happens, you may be referred to a specialist centre to have it removed with the help of an ultrasound scan.

If you want to carry on using an implant, you can get a new one inserted at the same time. You’ll then continue to be protected from pregnancy.

• Fit and forget: You don’t have to remember to take it every day like the contraceptive pill
• The most effective method of contraception and effective for 3 years
• It may reduce painful or heavy periods
• Your fertility will return as soon as it’s removed
• It may improve acne for some people

Cons

• Your periods may change in a way that isn’t acceptable to you
• It doesn’t work if you take certain medication
• It takes a small procedure to both insert and remove it
• It does not protect you from sexually transmitted infections (STIs)

• Depo-Provera: an intramuscular injection
• Sayana Press: a subcutaneous injection

The injection may not be suitable for you if:

• you think you might already be pregnant
• you don’t want your periods to change
• you take certain medicines
• you want a baby in the next year

It may not be suitable if you have, or had in the past:

• breast cancer
• unexplained vaginal bleeding (for example bleeding between periods or after sex)
• heart disease or stroke
• serious liver disease
• risk factors for osteoporosis (thinning of the bones)

Always tell your healthcare professional that you’re using the contraceptive injection if you’re prescribed any medicines.

If you have bleeding that’s a problem for you at any time, talk to your healthcare professional. They may be able to give you some additional hormone or medicine that can help control the bleeding. They may also check that the bleeding isn’t due to other causes, such as an infection.

If you start having the contraceptive injection during the first 5 days of your period, you’ll be protected from pregnancy immediately.

If you start having the contraceptive injection on any other day, you won’t be protected from pregnancy for the first 7 days. You’ll need to avoid sex or use additional contraception, such as condoms, during this time.

Thinning of the bones may be more of a problem if you already have risk factors for osteoporosis (being underweight, smoking, heavy drinking).

If you are under 18 years of age the contraceptive injection may not be the doctor or nurse’s first choice of contraception for you as your bones are still growing.

• You don’t have to think about contraception for as long as the injection lasts (13 weeks)
• It may reduce heavy painful periods and help with premenstrual symptoms for some people
• You can use it if you’re breastfeeding
• It’s a good method if you can’t use estrogens, like those in the combined contraceptive pill, patch or vaginal ring

Cons

• Your periods may change in a way that isn’t acceptable to you
• Irregular bleeding may continue for some months after stopping the injections
• There can be a delay of up to one year before the return of your periods and fertility after stopping the injection
• Some people may put on weight
• It does not protect you from sexually transmitted infections (STIs)

If the patch is always used perfectly, according to instructions, it’s over 99% effective. This means that less than one person in 100 who uses the patch perfectly will get pregnant in one year.

If the patch is not always used according to instructions, about nine in 100 people who use the patch will get pregnant in one year.

Research has shown that the patch may not be so effective if you weigh 90kg (14 stone) or more – an alternative method may be advisable.

• you smoke and are 35 years old or over
• you’re 35 years old or over and stopped smoking less than a year ago
• you’re very overweight
• you take certain medicines
• you’re breastfeeding a baby less than six weeks old

The patch may not be suitable for you if you have now or had in the past:

• thrombosis (blood clots) in any vein or artery, or a member of your immediate family had thrombosis before they were 45 years old
• heart disease or a stroke
• systemic lupus erythematosus with positive antiphospholipid antibodies
• a heart abnormality or circulatory disease, including hypertension (raised blood pressure)
• migraine aura
• breast cancer, or you have a gene that’s associated with breast cancer
• active disease of the gall bladder or liver
• diabetes with complications
• you’re immobile for a long period of time or use a wheelchair
• you’re at high altitude (more than 4,500m) for more than a week.

If you’re healthy, don’t smoke and there are no medical reasons for you not to use the patch, you can use it until you’re 50 years old. You’ll then need to change to another method of contraception.

If the patch is always used perfectly, according to instructions, it’s over 99% effective. This means that less than one person in 100 who uses the patch perfectly will get pregnant in one year.

If the patch is not always used according to instructions, about nine in 100 people who use the patch will get pregnant in one year.

Research has shown that the patch may not be so effective if you weigh 90kg (14 stone) or more – an alternative method may be advisable.

• on the first day of your period (the day you start your period), you’ll be protected from pregnancy immediately.
• up to and including the fifth day of your period, you’ll be protected from pregnancy immediately. Talk to your doctor, nurse, or online provider about whether you need additional contraception if you have a very short cycle or a cycle that changes.
• at any other time in your menstrual cycle, you’ll need to avoid sex or use additional contraception, such as condoms, for the first seven days of using the patch.

You shouldn’t put it on skin that’s sore or irritated, or anywhere that can be rubbed by tight clothing.

Don’t put it on your breasts. It’s also a good idea to change the position of each new patch to help reduce the chance of any possible skin irritation.

Patch instructions tell you to take a seven-day patch-free break, but you can choose to shorten this break or to miss it and not have a withdrawal bleed.

Missing or shortening the patch-free break could help you if you get heavy or painful bleeding, headaches or mood swings on patch-free days.

The riskiest time to forget your patch is just before or after the patch-free break. You’re more at risk of pregnancy, so taking a shorter break or missing a break could make this less risky. You can use the patch in the following ways.

• Apply a new patch once a week, every week for three weeks, then stop using the patch for the next 4 or 7 days. This has been the standard way to use the patch. You’ll usually have a withdrawal bleed during the patch-free break. This is called a ‘patch cycle’. Start using the patch again on the fifth or eighth day, even if you’re still bleeding.
• Apply a new patch once a week, every week for nine weeks (three packs of patches) then no patch for the next 4 or 7 days. This is called extended use or tricycling. You’ll usually have a withdrawal bleed during the patch-free break. Start using the patch again on the fifth or eighth day, even if you’re still bleeding.
• Apply a new patch once a week, every week continuously, with no break. This is called continuous patch use. You won’t have a withdrawal bleed, but you may still get some bleeding which may be occasional or more frequent. Any bleeding you get is likely to reduce over time if you keep using the patch continuously.
• Apply a new patch once a week, every week for at least three weeks. If you get bleeding that’s unacceptable to you for 3-4 days, then have a four day patch-free break. This is called flexible extended use. Apply a new patch again on the fifth day, even if you’re still bleeding – this can help manage the bleeding. Continue to replace the patch every week for three weeks before taking your next break.

You can use the patch continuously without a break for as long as you like, as long as your doctor, nurse or online provider doesn’t advise you to stop.

Disposal of the patch: Used patches should be placed in the disposal sachet provided and put in a waste bin. They must not be flushed down the toilet.

Am I protected from pregnancy during the patch-free break?

Yes. You’re protected if:

• you’ve used the previous three patches correctly and
• you start the patch cycle again on time and
• you’re not taking other medicines that will affect the patch

What if I forget to replace my patch on time, or it comes off?

If you’re late applying a new patch after a patch-free break, if the patch comes off when it’s not a patch-free break, or if you’ve kept a patch on for too long, follow the instructions below:

I’m restarting after a patch-free break

If it’s less than eight full days since you removed your last patch:

• apply a new patch now
• continue using the patch as normal

If it’s eight or more full days since you removed your last patch:

• apply a new patch now
• keep the new patch on until the day you usually change it
• use condoms or avoid sex for the next seven days
• You may need emergency contraception and a follow-up pregnancy test if you had unprotected sex in or after the patch-free break. Talk to a doctor, nurse or pharmacist as soon as possible.

Up to 48 hours since the patch came off OR patch left on for up to 48 hours too long

• Apply a new patch as soon as possible
• Keep the new patch on until the day you usually change it

If you’re in the first week after a patch-free break, you don’t need additional or emergency contraception, as long as you’ve used the patch correctly every day so far this week, and in the week before the patch-free break.

If you’re in any other week you don’t need additional emergency contraception, as long as you’ve used the patch correctly for the previous seven days.

48 hours or more since the patch came off OR patch left on for 48 hours or more too long

• Apply a new patch as soon as possible
• Keep the new patch on until the day you usually change it
• Use condoms or avoid sex until a patch has been worn for seven days in a row
• If you are due to start a patch-free break in the next seven days, don’t take the break

You might need emergency contraception now and a pregnancy test in three weeks if:

• you’re in the first week after a patch-free break and
• you had unprotected sex this week OR during the patch-free break.

If you’re in any other week, you don’t need emergency contraception, as long as you’ve used the patch correctly for the previous seven days.

If you take these medicines, it’ll be recommended that you use additional contraception, such as condoms, or that you change to a different method of contraception.

Always tell your healthcare professional that you’re using the patch if you’re prescribed any medicines.

• It may help with premenstrual symptoms and painful periods
• The effectiveness of the contraceptive patch is not affected should you vomit or have diarrhoea, unlike oral contraceptive pills
• You have the option not to have a monthly bleed
• It reduces the risk of cancer of the ovaries, uterus and colon
• It may reduce menopausal symptoms
• It may improve acne.

Cons

• The contraceptive patch is visible
• The contraceptive patch doesn’t protect you against sexually transmitted infections, so you may need to use condoms as well
• The contraceptive patch could cause some skin irritation
• You have to remember to change the contraceptive patch every week
• You may get some side effects when you first start using the contraceptive patch, such as spotty skin, breast tenderness and headaches. These may stop within a few months.
• Some contraceptive patch users may develop small fluid-filled cysts on their ovaries. These aren’t dangerous and don’t usually need to be removed. Often there are no symptoms, but some people may have pelvic pain. These cysts usually disappear without treatment.
• Research about the risk of breast cancer and hormonal contraception is complex and contradictory. Research suggests women who use hormonal contraception may have a small increase in the risk of being diagnosed with breast cancer compared to women who don’t use hormonal contraception.

If you don’t use your diaphragm or cap perfectly every time, they’re around 71-88% effective. This means that around 12-29 users out of 100 will get pregnant in one year.

If 100 sexually active women don’t use any contraception, 80 to 90 will get pregnant in a year.

A diaphragm or cap will be less effective if:

• it’s damaged
• it doesn’t cover your cervix completely
• it isn’t the right size
• you use it without spermicide
• you have sex three hours or more after you put it in and don’t use extra spermicide
• you don’t use extra spermicide with your diaphragm or cap every time you have sex
• you remove it too soon (less than six hours after the last time you had sex).

If any of these happen, or if you’ve had sex without using contraception, you can get advice about emergency contraception from one of our clinics.

A diaphragm may not be suitable for you if:

• you have an unusual shaped cervix
• you can’t reach your cervix (this feels like a hard bump inside your vagina)
• you have weak vaginal muscles (perhaps from giving birth)
• you are allergic to latex or spermicide
• you have a vaginal infection
• you have multiple sexual partners

It is really important to remember that the diaphragm cannot prevent sexually transmitted infections (STIs).

They come with instructions to help you learn to fit them, but it’s recommended that you also get advice on using them from a doctor or nurse.

We will probably ask you to come back, with your diaphragm fitted, for a check-up.

• You only have to use it when you have sex
• It has no serious health risks or side effects
• You’re in control of your contraception
• You can put it in before you have sex. (Add extra spermicide if sex takes place more than three hours after putting it in.)

Cons

• It’s not as effective as other forms of contraception
• You need to learn how to use it properly
• You need to remember / stop and fit it before having sex
• It does not protect against STIs
• You may find spermicide messy
• You may be sensitive to spermicide – this may cause irritation in you or a partner

ellaOne won’t continue to protect you against pregnancy – if you have unprotected sex at any time after taking the emergency pill, you can become pregnant.

It isn’t intended to be used as a regular form of contraception. But you can use emergency contraception more than once in a menstrual cycle if you need to.

• forgot to take some of your regular contraceptive pills
• didn’t use your contraceptive patch or vaginal ring correctly
• were late having your contraceptive implant or contraceptive injection

If you have taken Levonelle, you should:

• take your next contraceptive pill, apply a new patch or insert a new ring within 12 hours of taking the emergency pill
• continue taking your regular contraceptive pill as normal
• use additional contraception, such as condoms, for:
  • 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
  • 9 days for the combined pill Qlaira
  • 2 days if you use the progestogen-only pill

If you have taken ellaOne, you should:

• wait at least 5 days before taking your next contraceptive pill, applying a new patch or inserting a new ring
• use additional contraception, such as condoms, until you restart your contraception and for an additional:
  • 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
  • 9 days for the combined pill Qlaira
  • 2 days if you use the progestogen-only pill

A GP or nurse can advise further on when you can start taking regular contraception and how long you should use additional contraception.

Ovulation is triggered by rising levels of a hormone called luteinising hormone (LH).

Levonelle appears not to be effective after levels of LH start to rise. EllaOne continues to be effective a little later in the cycle.

A 2017 review of the evidence estimated that around 1 to 2% of women who take ellaOne after unprotected sex will become pregnant. In comparison, it’s estimated that 0.6 to 2.6% of women who take Levonelle after unprotected sex will become pregnant.

The effectiveness of both Levonelle or ellaOne may be reduced if a woman has a high body mass index (BMI). This makes it harder to provide a more precise estimate for either pill.

Get medical advice if you vomit within 2 hours of taking Levonelle or 3 hours of taking ellaOne. You’ll need to take another dose or have an IUD/IUS fitted.

But you may not be able to take the emergency contraceptive pill if you’re allergic to anything in it, have severe asthma or take any medicines that may interact with it, such as:

• the herbal medicine St John’s Wort
• some medicines used to treat epilepsy, HIV or tuberculosis (TB)
• medicine to make your stomach less acidic, such as omeprazole
• some less commonly used antibiotics (rifampicin and rifabutin)

EllaOne can’t be used if you’re already taking one of these medicines, as it may not work. Levonelle may still be used, but the dose may need to be increased.

Tell a GP, nurse or pharmacist what medicines you’re taking, and they can advise you if they’re safe to take with the emergency contraceptive pill.

You can also read the patient information leaflet that comes with your medicine for more information.

But it can cause:

• headaches
• tummy pain
• changes to your next period – it can be earlier, later or more painful than usual
• feeling or being sick – get medical attention if you’re sick within 2 hours of taking Levonelle or 3 hours of taking EllaOne, as you’ll need to take another dose or have an IUD fitted.

See a GP or nurse if your symptoms don’t go away after a few days or if:

• you think you might be pregnant
• your next period is more than 7 days late
• your period is shorter or lighter than usual
• you have sudden pain in your lower tummy – in rare cases, a fertilised egg may have implanted outside the womb (ectopic pregnancy)

• sexual health clinic
• some GP surgeries
• some young people’s clinics
• most NHS walk-in centres and minor injuries units
• most pharmacies
• some accident and emergency (A&E) departments (phone first to check)

• Reliable contraception – If you take ellaOne within 5 days of contraceptive failure or unprotected sex, it is 95% effective for preventing pregnancies, while Levonelle’s effectiveness drops over time, and after 3 days it is only about 58% successful.
• Convenient – You can buy the morning after pill in advance, so that you always have it on hand if you need it. You might want to buy some emergency contraception if you are going on holiday, or if you don’t have easy access to it.
• No serious side effects – While there are some morning after pill side effects that you may experience, none of them are considered “severe” by the NHS.
• Single dose – Taking the morning after pill is as simple as it sounds: you take one pill and you’re done, and many women won’t even experience any emergency contraception side effects.
• Not harmful to foetuses – If the emergency pill doesn’t work and you become pregnant, there is no evidence that it will affect your baby.

Cons

• Morning after pill side effects – The morning after pill does sometimes have unwanted side effects, but none of these are considered severe.
• Effective for a limited time – If it’s been more than 5 days since you had unprotected sex or your contraception failed, there is no reason for you to take the morning after pill.
• Only protects against pregnancy – It’s not really a negative point, but there are certainly some misconceptions about this. To be clear, the morning after pill doesn’t protect you from STIs, so if you have had unprotected sex you should still have an STI check-up even if you take emergency contraception.
• Vomiting – If you vomit within 3 hours of taking the morning after pill, you will need to take another dose.
• Not all women are suitable – The morning after pill is not suitable for some women. If you are not sure whether you should take the emergency contraception, speak to your doctor. People who are not suitable for the morning after pill include:
  • Women with liver problems or gut absorption problems
  • Women who take medicines to treat epilepsy
  • Women with severe uncontrolled asthma should seek medical advice before using ellaOne.

Natural family planning may not be a suitable method if you don’t have periods. It may take longer to recognise your fertility indicators and to start natural family planning if you have irregular cycles, after stopping hormonal contraception, after having a baby, during breastfeeding, after an abortion or miscarriage, or when approaching the menopause.

There are many natural family planning apps that are designed to support observing the menstrual cycle and body changes. However, these tend to focus on monitoring only basic indicators of fertility, so they are not always reliable, especially in women with irregular menstrual cycles.

If it is hormonal methods of contraception you are concerned about using, please be aware that the copper IUD is a very reliable method of contraception which is hormone free and is freely available at all our clinics.

The average length of the menstrual cycle is around 28 days, although many women have longer or shorter cycles and this is normal.

Regardless of how long or short the cycle is, ovulation (when the ovaries release an egg) will usually happen around 10–16 days before the start of the next period.

During your menstrual cycle:

• eggs develop in your ovaries and usually one is released
• the mucus in the cervix (entrance to the uterus – womb) changes to allow sperm to pass more easily through the cervix to reach the egg
• the lining of the uterus thickens to prepare for a pregnancy
• if the egg isn’t fertilised by sperm and you don’t get pregnant the uterus sheds its lining as your period, which signals the beginning of a new menstrual cycle.

The menstrual cycle is controlled by your body’s natural hormones – oestrogen and progesterone.

• It doesn’t involve any chemicals or hormones
• Using fertility awareness makes you more aware of your fertility and can help to plan a pregnancy or avoid a pregnancy
• There are no physical side effects
• It can help you recognise normal and abnormal vaginal secretions
• It can help you to communicate about your fertility and sexuality
• It’s acceptable to all faiths and cultures

Cons

• It doesn’t protect you against STIs
• It takes 3–6 menstrual cycles to learn effectively
• It is not an easy method of contraception to use
• You have to keep daily records
• Some events, such as illness, lifestyle, stress or travel, can disrupt your usual cycle and may make fertility indicators harder to interpret
• You need to use an alternative form of contraception when your risk of pregnancy is highest
• It needs commitment and practice in order to be effective

If it is fitted at the age of 45 years it can last up to 10 years for contraception purposes (but only for 5 years if being used as part of an HRT regimen). It starts working 7 days after it is fitted and your fertility will return to normal as soon as it is removed.

Occasionally, the IUS can be pushed out by your uterus, or it can move, which could affect how it works. This doesn’t happen very often and staff at your sexual health clinic will show you how to check so you know it’s in the right place.

The IUS does release a small amount of hormone. This is released into the womb and only a very small amount, if any, is absorbed into the bloodstream. You may notice some breast tenderness after it is first inserted or before a period and some acne or mood changes initially. However, these should settle and many women say it “evens out” their moods. There does not seem to be any difference in the hormonal side effects of the different types of IUS.

The hormonal IUS is an extremely effective form of contraception and it’s very unlikely that you will get pregnant. If you do, there is a slightly increased chance that it will result in an ectopic pregnancy.

It’s also important to remember that an IUS cannot prevent you from getting a sexually transmitted infection. If you have a new partner or are unsure of your partner’s sexual history, you should still come in for a check-up

Inserting the IUS takes around 5 minutes and can be a little uncomfortable. Don’t worry, the doctor or nurse will talk you through this beforehand and may offer you a local anaesthetic if needed. They may be able to fit the IUS at this consultation or they will bring you back for the fitting at a later date. The appointment will last for approximately 30 minutes.

If you decide to have it removed, you need to visit one of our clinics. A specially-trained doctor or nurse will remove it and will give you advice about other forms of contraception you could use instead. Your fertility will return as soon as the IUS is removed. You need to make sure that you have used additional contraception or avoided sex for 7 days before you have the IUS removed, otherwise you could still get pregnant.

• It lasts for 3-5 years and will lighten or stop your periods
• It is over 99% effective
• You can’t forget to take it and it does not interfere with sex

Cons

• It can cause erratic bleeding
• It doesn’t protect you from STIs
• You have to book an appointment to have one fitted (although this only takes 30 minutes)

Perfect use: If the POP is always used perfectly, according to instructions, it’s more than 99% effective. This means that less than one POP user in 100 will get pregnant in one year.

Typical use: If the POP is not always used according to instructions, about nine in 100 POP users will get pregnant in one year.

Some of the conditions which may mean you shouldn’t use the POP are:

• you think you might already be pregnant
• you take certain medicines.

You have now or had in the past:

• heart disease or a stroke
• disease of the liver
• breast cancer.

If you’re healthy and there are no medical reasons for you not to take the POP, you can take it until your menopause or until you’re 55 years old.

If you start the POP on the first day of your period you’ll be protected from pregnancy immediately.

You can also start the POP up to and including the fifth day of your period and you’ll be protected from pregnancy immediately.

However, if you have a short menstrual cycle with your period coming every 23 days or less, starting the POP as late as the fifth day of your period may not give you immediate contraceptive protection. This is because you may ovulate (release an egg) early in your menstrual cycle. You may wish to talk to your doctor or nurse about this and whether you need additional contraception for the first two days.

If you start the POP at any other time in your menstrual cycle, use another contraceptive method, such as condoms, for the first two days of pill taking.

Once you’ve chosen a time, you must take one POP each day at this same time until you finish all the pills in the pack. You continue to take POP daily while you require contraception.

You do not have any breaks (hormone-free intervals) like you do with the combined contraceptive pill (COC).

If it’s more than 12 hours since you took your last POP:

• Take a pill as soon as you remember. If you’ve missed more than one, only take one
• Take your next pill at the usual time. This may mean taking two pills in one day. This isn’t harmful.
• You’re not protected from pregnancy. Continue to take your pills as usual but use an additional method of contraception, such as condoms, for the next two days.
• If you’ve had unprotected sex during this time, you may need emergency contraception. Seek advice immediately.

If it’s less than 12 hours since you took your last POP:

• Take a pill as soon as you remember. Take your next pill at the usual time. You’re protected from pregnancy.

Always tell your healthcare professional that you’re taking the POP if you’re prescribed any medicines.

• You can probably use it if you can’t take estrogens, like those found in the COC, combined contraceptive patch or ring
• It can be prescribed independently of Body Mass Index (BMI)
• You can use it at any age, but it’s especially useful if you smoke and are 35 or over
• It may help with premenstrual symptoms and painful periods
• You can use it if you’re breastfeeding

Cons

• Your periods may change in a way that’s not acceptable to you; this is particularly true when you first start the POP (or any method of hormonal contraception). Lots of women may stop bleeding completely with the POP and this is usually nothing to worry about.
• The POP doesn’t protect you against sexually transmitted infections, so you may need to use condoms as well.
• You have to remember to take the pill at the same time every day.
• You may get some side effects when you first start taking the POP, such as spotty skin, breast tenderness and headaches. These may stop within a few months.
• Some POP users may develop small fluid-filled cysts on their ovaries. These aren’t dangerous and don’t usually need to be removed. Often there are no symptoms, but some people may have pelvic pain. These cysts usually disappear without treatment.
• Research about the risk of breast cancer and hormonal contraception is complex and contradictory. Research suggests women who use hormonal contraception may have a small increase in the risk of being diagnosed with breast cancer compared to women who don’t use hormonal contraception.
• If you do become pregnant while you’re using the POP, there’s a risk of you having an ectopic pregnancy (where the pregnancy develops outside of the uterus), this can prove fatal and urgent medical treatment/advice should be sought.