CONTRACEPTION

Choosing and using CONDOMS

No contraceptive method is 100% effective, and condoms are statistically less reliable than, for example, many brands of the contraceptive pill. However, condoms act not only as a contraceptive, but also act as a barrier to Sexually Transmitted Diseases (STDs). It is sensible therefore to consider using a condom at the same time as another method of contraception.

1. Use a good quality condom (one with a "kite mark").
2. Make sure the condom is within its use-by date.
3. Put it on correctly, pinching the tip to leave a space for the sperm.
4. Make sure it's on properly before the penis touches the vagina.
5. Make sure it doesn't slip off (this may happen when the penis starts to go soft).
6. Don't damage it by rough handling, sharp rings etc, and don't use anything greasy or oily as a lubricant- water-based lubricants such as KY Jelly are fine.
7. After use, wrap in tissue paper, and burn or dispose of along with household rubbish. Try not to use the toilet for disposal!

Injectable contraception

The brand most commonly used in the UK is called Depo Provera. It gives protection against pregnancy for at least 12 weeks, though it may take much longer, on average 20 weeks, for its effects to wear off. It is normally given every 12 weeks into the muscle of the buttock or the thigh.

1. Depo Provera is a single hormone method, like the mini-pill and the implant. The hormone used in Depo Provera, progestogen, is one of the two female hormones. Both oestrogen and progestogen are used together in the ordinary "combined" pill, which gives very reliable protection but can also cause some unpleasant or even dangerous side effects. Some women with medical problems and all smokers over 35 should avoid the combined pill, as the risks are too great. Progestogen on its own does not seem to cause any dangerous side effects, and almost all women can take it without risk to health. The mini-pill is less reliable than the combined pill, especially if the women fails to take it at the same time of the day, but the injection gives steady blood levels and is very reliable. If 1000 women use this method for a year, only about one will get pregnant.
2. How The Injection Works. Like the combined pill, it stops the ovaries producing eggs (ovulation). Because there is no monthly break, you do not usually have regular periods. Most women on Depo Provera go for months without seeing a period, either having no period at all or just slight irregular bleeding. This is not harmful, as blood does not get "left behind". The womb does not build up a lining for the egg, as no egg is released, so there is nothing to come away. If she wants to make completely sure she is not pregnant, a woman can request a pregnancy test at any time. Progestogen also thickens the mucus at the neck of the womb, making it harder for sperms (and germs) to get in.
3. Side Effects. Some women, in the early months of usage, bleed more than usual. If this does not settle quickly, it is helpful to give the next injection(s) earlier than 12 weeks.

   Some women gain weight whilst using Depo Provera. This is very variable, and most women do not gain at all, or only gain a few pounds. Sensible eating and exercise help control this problem.

   It is possible that it makes depression worse, though this is uncommon. As the injection cannot be removed from the body once given and may take months to wear off completely, women who tend to get depressed should think carefully before using this method. However, women who are depressed because they are worried about getting pregnant could find that the injection gives them more peace of mind than any other method.

   It is not likely to suit a woman who wants to get pregnant soon, as it could delay her getting pregnant, but once the injection has worn off, women are as likely to get pregnant as if they had never had it.

4. Advantages of the injectable contraceptive: The method is very convenient, as you do not need to remember to take pills or to do anything that would interfere with making love. The chances of an ectopic (outside the womb) pregnancy is lessened and so is the risk of cancer of the womb lining. Other cancers, e.g. cervix, breast or liver do not seem to be affected.
5. Timing of Injections: The first injection is usually given within 5 days of the start of a period or within 5 days of miscarriage or termination of pregnancy. If you are changing from the combined pill or mini-pill, you may not be protected for the next 14 days, and should use condoms if you have intercourse. If you have just had a baby, it is best to wait 6 weeks before having an injection, as there may be a risk of heavy bleeding. As you are not at risk of getting pregnant until 21 days after the birth, a convenient plan is to start a packet of pills (combined or mini, whichever is most suitable for you) when the baby is 21 days old, and have the injection 3 weeks later, at the end of the packet; condoms are advised for the next 14 days.

   The next injection should be given no more than 12 weeks and 5 days later, or you may lose your protection against pregnancy.

6. If you are late for your injection you cannot tell whether you are at risk of pregnancy or not. Some doctors advise waiting for the next period before you have the next injection, but this could take months, and you could be fertile before the period came. To be sure of avoiding pregnancy you might need to avoid intercourse or use condoms for a long time. However, if you know that you are late for the injection you can use condoms or avoid sexual intercourse until you get back to the Doctor. The injection can then be given at once, as you have not had sexual intercourse without protection, but it may be another 14 days before the injection is fully effective again (as it has not been given on the first day of a period.) Condoms or avoiding sexual intercourse should therefore continue for the next 14 days.
7. If you have unprotected sexual intercourse after the 12 weeks and five days from the last injection but less than 72 hours before you attend the Centre, you can take Emergency Contraceptive Pills- or have a coil fitted up to five days after unprotected sexual intercourse and removed later. The injection could then be given at once, but you should avoid intercourse or use condoms for 14 days (unless you have had the coil) AND return for a pregnancy test four weeks later, as emergency contraception does not always work. There is no evidence that Depo Provera would harm an unborn baby if given to a pregnant woman, but it is important that you have the chance to find out early if you are pregnant, so that you have time to fully consider whether you wish to continue with the pregnancy.
8. If you have had unprotected sexual intercourse but are "out of time" for emergency contraception you should avoid intercourse or use condoms for three weeks and return for a pregnancy test. If this is negative, you can have the injection and then avoid sexual intercourse or use condoms for 14 days until Depo Provera is fully effective again.
9. Safer Sex. The contraceptive injection may give some protection against infection of the womb and tubes (pelvic infection) but gives no protection at all from viruses such as HIV or Herpes. You should therefore consider whether to use condoms as well. Free condoms are available from all Brook Centres.