What types of contraception are there?

Short-acting or Long-acting are the two main types of contraception methods

Short acting methods of contraception include barrier methods such as condoms, or the pill which require taking a daily tablet. There are also long-acting reversible methods like implants or injections which last for several months to years.

Long acting non-reversible methods are female sterilisation or vasectomy. Long acting reversible contraceptives (LARCs) are the most reliable if you wish to avoid an unintended pregnancy, but may want children at some point in the future. They have the advantage that, once in place, you don’t need to think about them until they need replacing and none of them interrupt sex.

Only male or female condoms can prevent the spread of sexually transmitted infections.

Contraception Options

Short acting contraceptives include:

Male or female condoms
Combined pill
Contraceptive patch (Evra)
Contraceptive vaginal ring
Progestogen (every day) pill

Long-acting reversible contraceptives include:

Contraceptive injection
Contraceptive implant
IUS – hormonal coil
IUD – copper coil

Long acting, non-reversible contraceptive methods include:

Female sterilisation
Vasectomy

Emergency contraception

You can also get emergency contraception such as the IUD or emergency contraception pill (or so-called morning after pill). You should only use these methods in an emergency e.g. if a condom splits during sex.

Short acting contraceptives

1. The combined pill

The combined pill works by preventing the ovaries from releasing an egg each month (ovulation). It thickens cervical mucus so that it is harder for a sperm to reach the womb and thins the lining of the womb.

Most combined oral contraceptives are taken every day for 21 days followed by a 7 day break. Some preparations are taken slightly differently.

Combined pill advantages

Things to consider about taking the combined pill

The combined pill is not suitable for women with high blood pressure.
It is not suitable for women over 35 who smoke
It may not be suitable for women who have migraines.
Missing pills, taking some other medications, vomiting, or severe diarrhoea can make it less effective.
Side effects include mood swings, breast tenderness and headaches.
There is a small risk of blood clots.
It does not protect against sexually transmitted infections.

Aftercare advice

If you start the combined pill on the first day of a period, it will work straight away. If started on any other day of the cycle, extra precautions such as condoms or abstaining from sex should be used for seven days.

Take it for 21 days at about the same time each day, and then have a 7-day break. During the break you should have a bleed but it is usually lighter, shorter and less painful than a usual period. On the 8th day, start the next pack (the starting day of the week for each pack should always be the same if you are taking it correctly).

2. The contraceptive patch (Evra)

The contraceptive or combined patch is a thin, sticky patch that is applied to clean, dry skin. A new patch is used every 7 days for 21 days, followed by 7 days without a patch. In SA, its brand name is Evra.

How does the contraceptive patch work?

The patch works by releasing the hormones oestrogen and progestogen. It is applied once a week for 3 weeks each month. When in place, the released hormones prevent the ovaries from releasing an egg each month (ovulation), thicken cervical mucus (so that it is harder for sperm to move into the womb) and thin the lining of the womb.
Typical use failure rate is up to 9%. (Up to 9 women in 100 will have an unplanned pregnancy in the first year of use.)

Contraceptive patch advantages

You don’t have to think about contraception every day, like with the pill.
It can make periods regular, lighter and less painful.
It is not affected by vomiting or diarrhoea.

How to use the contraceptive patch

Apply a patch to the skin of your abdomen, buttock, arm, shoulder or top of your leg – but avoid your breasts. The patch will work straight away.
Wear this patch for 7 days and then change for a new one.
After another 7 days, change it again for a third patch (the patch change day every week should be the same).
After you have worn 3 patches for 7 days each, have a 7 day break, during which time you should have a period-like bleed.
After the 7 day break start a new patch cycle.

Things to consider about using the patch

It can be seen on the skin.
It can occasionally cause skin irritation.
It may fall off within the 7 days.
It is not suitable for women with high blood pressure.
It is not suitable for women over 35 who smoke.
It may not be suitable for women who have migraines.
Taking some other medications can make it less effective.
Side effects include mood swings, breast tenderness, and headaches.
There’s a small risk of blood clots.
Unlike condoms, the patch offers no protection against sexually transmitted infections.

3. The contraceptive vaginal ring

The contraceptive vaginal ring is a flexible, transparent ring which is placed inside the vagina for 21 days at a time followed by a 7 day break. In SA, its brand name is Nuvaring.

How does the vaginal ring work?

The ring works in a similar way to the combined pill by releasing a daily dose of of oestrogen and progestogen. This prevent the ovaries from releasing an egg each month (ovulation), thickens cervical mucus, and thins the lining of the womb, making it harder for sperm to move through the womb.

Typical use failure rate is up to 9% (up to 9 women in 100 will have an unplanned pregnancy in the first year of use).

Vaginal ring advantages

One ring stays in for three weeks.
There is no need to thinking about contraception every day, like when taking the pill.
It can make periods regular, lighter and less painful.
Unlike the combined pill, the vaginal ring is not affected by vomiting or diarrhoea.

Things to consider about using the vaginal ring

You need to learn how to insert and remove it.
It is not suitable for women with high blood pressure.
It is not suitable for women over 35 who smoke.
It may not be suitable for women who have migraines.
Taking some other medications can make it less effective.
Side effects include mood swings, breast tenderness, and headaches.
There is a low risk of blood clots.
Unlike condoms, it offers no protection against sexually transmitted infections.

How to insert the vaginal ring

With clean hands, squeeze the ring between your thumb and finger and use one hand to insert it into your vagina. If necessary, spread your labia (vaginal lips) with your other hand.
Push the ring into your vagina until it feels comfortable. It does not need to cover your cervix (entrance to the uterus) to work.
If you insert the ring on day one of a period, it will start to work straight away. If inserted on any otherday, use extra precautions such as condoms, or abstain from sex for seven days.