Alternative Forms of Contraception

The pill has been the main form of hormonal contraception since its development in 1960. The pill has been very successful in stopping pregnancy and has offered women freedom from unwanted pregnancy and, in some women, painful period. The pill is very user friendly and reliable however, can have many adverse side effects – including mood swings, headaches, skin changes, bloating and nausea.

Women often endure these issues without realising there are other contraception options – such as Implanon, Mirena, birth control injection or birth control vaginal ring. These newer forms of female contraception are often cheaper in the long run and are more reliable as women do not have to remember to take the pill daily. In a recent article by the BBC News, women in the UK are moving away from the pill towards longer acting forms of contraception. In light of these changes in women’s use of hormonal contraception we have put together a Q&A for both the Implanon and Mirena, which we offer at the Practice. If you would like to discuss alternative forms of hormonal contraception please contact Reception to make an appointment 9908 2233.

Implanon

What is an Implanon?
Implanon is a contraceptive device. It consists of a small plastic rod, which is inserted just underneath the skin of the upper arm, providing protection against pregnancy for the 3 years it is in place.

How does it work?
The insertion of the Implanon works by slowly releasing a female hormone called progesterone into the blood stream. In doing so, it does the following:

stops ovulation (the release of the egg from the ovary every month).
thickens the cervical mucus so that the sperm cannot enter the uterus (womb).

How is an Implanon inserted?
An initial 20 minute appointment is needed for you with one of our specially trained doctors to discuss if the Implanon is a viable contraceptive method for you. If suitable, a prescription for the device will be given and a further 30 minute appointment should be made for the insertion. On the day of the appointment the Doctor places a small dot on the skin inside the upper arm where the device is to be inserted. After cleaning the area, a local anaesthetic is administered at the insertion site. Once this takes effect, the device is inserted. A dressing is then applied which can be removed after 24 hours. A common after-effect is bruising and tenderness in the area for up to a week.

How is an Implanon removed?
It is very important to ensure that the device is removed after the 3 years, as the contraceptive will no longer be effective and it can increase the chances of having an ectopic pregnancy. The removal of the Implanon is done again in a 30 minute doctor’s appointment by administering a local anaesthetic to the area and making a tiny incision in the skin. The device is then pushed through the excision site and grabbed by a small instrument and removed. A small mark can be left as a result.

Why would I consider Implanon?

Effective and convenient – >99.9% effective in preventing pregnancy
A long term contraceptive solution – lasts for 3 years
Easily removed, making it a quickly reversible contraceptive solution and with a rapid return to fertility
Cost effective

Other factors to consider:

Does not give protection against sexually transmitted diseases (STIs)
May affect the menstrual cycle and pattern of bleeding including
- Change in bleeding frequency
- Irregular light bleeding
- Prolonged and or frequent light bleeding
- Prolonged and or heavy bleeding
Hormone sensitive – some women experience headaches, weight gain, breast tenderness, mood changes and new onset acne.

Mirena:

What is a Mirena?
A Mirena is a type of intrauterine contraceptive device (IUD) that is fitted inside the uterus, where it releases a hormone called progesterone.
It can be used:

to treat abnormal menstrual bleeding and reduce pain during the menstrual cycle
to protect the uterine lining during hormone therapy
for contraception
to manage polycystic ovarian syndrome
after pregnancy and whilst breast feeding as long a pregnancy has been excluded.

How does a Mirena work?
It is a thin plastic T shaped device with two fine nylon strings attached. The long arm of the IUD is coated with a fine membrane containing the hormone progesterone. Once inserted, the IUD sits in the uterus and the two strings feed through the cervix sitting up against the wall of the upper vagina. It then steadily releases small amounts of the hormone in to the uterus which:

changes the lining of the uterus not allowing a pregnancy to grow
thickens the cervical mucus, so that sperm cannot enter the uterus
affects the ability of the sperm and eggs to move through the uterus and fallopian tubes, reducing the chance of the eggs being fertilised

The Mirena needs to be replaced at least every 5 years.

How is a Mirena inserted?
An initial appointment is needed by one of our specially trained doctors to assess whether this IUD is suitable for you. If suitable, the doctor will provide a prescription and a follow up appointment should be made for 25 minutes.

The best time for insertion of the IUD is within 7 days of the first day of your period. The procedure can be performed without anaesthetic, but taking pain relief prior to the appointment is recommended. The device is inserted in a similar way to a pap smear, a speculum will be placed in your vagina and your cervix cleaned with an antiseptic. This is to reduce the chance of pelvic infection (PID) that can occur in 1 in every 500 insertions. The length of the uterus is measured and the IUD is placed inside through the cervix or the opening to the uterus. The string is cut so that it is well up into the vagina. You or your sexual partner won’t notice it but you should be able to feel the string if you reach right up into your vagina.

The device is removed in a similar way to the insertion.

Why would I consider Mirena?

Effective and convenient – it is at least 99% effective in preventing pregnancy for up to 5 years
Usually reduces pain and heavy periods with up to 90% of recipients finding significant improvement of their symptoms
Easily removed, making it a quickly reversible contraceptive solution, with immediate return to fertility

Other factors to consider:

May be more difficult to insert if you had not had children or only caesarean deliveries
Does not give protection against sexually transmitted diseases (STIs)
It does not suit women with an unusually shaped uterus as it could be expelled
After insertion there may be irregular bleeding and spotting in the first few months, but bleeding usually settles and periods become shorter and lighter
Some women experience hormonal side effects such as bloating or skin changes. This is uncommon as the hormone dose is so small

If you would like to discuss Mirena, Implanon or other forms of contraception, please contact Reception at Cremorne Medical Practice on (02) 9908 2233 to book an appointment.