Contraception I Rongoā ārai hapūtanga

Contraception or birth control is a way to prevent pregnancy. There are different contraceptive methods, both hormonal and non-hormonal. Throughout different stages of your life, you may need a different method. Some contraception works better than others and each method has its pros and cons. Talk with your healthcare provider about the best form of contraception for you.

Which contraception method is best for me? 

Need to figure out what birth control fits you best? Chat with your doctor or nurse and they’ll discuss the pros and cons of each option. They'll have a simple conversation with you about your health and what runs in your family. They'll also ask you some straight-up questions about your sex life and make sure you're feeling safe and good about it.

The ideal contraception method for you depends on factors such as:

• Your health
• Whether you take medicines that may interact with the method
• Whether you smoke
• How reliable you need your contraception to be
• How often you have sex
• How many sexual partners you have
• Your preference
• Whether you want to have children in the future

They will also talk about how to prevent STIs, eg, using condoms, and will do screening for STIs if you are sexually active. All appointments are confidential and you are welcome to ask your nurse or doctor anything you would like to know.

Who can get contraception?

Anyone of any age can get contraception from a nurse or doctor. If you want to get contraception, see your GP or visit a Sexual Wellbeing Aotearoa clinic in your area. If you're under 22 years old and are a New Zealand resident, your Family Planning clinic visit is free. Your visit will also be confidential.

Non-hormonal contraception methods

Condoms (Pūkoro ure)

These are thin tubes of latex that fit over an erect penis before sex. 

How does it work? 

• Condoms acts as a barrier, stops sperm from reaching the egg after ejaculation and prevents pregnancy. 
• Condoms are the only method of birth control that also protects against sexually transmitted infections (STIs).
• Condoms significantly reduce the chance of you catching or spreading HIV, chlamydia and gonorrhoea.
• Condoms also reduce the chance of syphilis, herpes and genital wart virus infection. However, they don’t give 100% protection because sometimes skin not covered by condoms can be infected with these viruses. 

For the best protection, use condoms during vaginal, oral, anal sex and when sharing sex toys (put a fresh one on before you start and whenever you switch who’s using it).

How effective is it?

When used correctly and every time, condoms are 98% effective in preventing pregnancy. This means that among couples who use condoms perfectly for 1 year, only 2 out of 100 will become pregnant.

Correct or perfect use of condoms involves:

• ‍‍Using a condom every time you have sex
• Putting a condom on before the penis touches the vaginal area
• The penis not touching the vaginal area after the condom is taken off.
• Using lubrication makes it easy to slide in and out during sex. If there is not enough lubrication, the condom is much more likely to break.
• Do use a water-based or silicone-based lubricant (eg, KY Jelly, Wet Stuff, Sylk or Durex Perfect Glide).
• f your condom breaks and your main concern is pregnancy go to a  Sexual Wellbeing Aotearoa clinic , your doctor or a pharmacy for emergency contraception within 72 hours.
• If you are worried about STIs talk to a healthcare provider. 
• If you think your condom has broken before ejaculation (coming), stop and put on a new condom.

It's important to use condoms correctly to stop them from slipping or breaking and so they work well to prevent pregnancy. Your healthcare provider will be able to teach you how to use them correctly and give advice if you have any problems.

Copper IUD

An IUD is a small, T-shaped plastic device that is inserted into your uterus (womb) and has a plastic string tied to the end which hangs down through the cervix into the vagina. It is a long-acting form of contraception and is reversible which means that your natural fertility returns after the IUD is removed. It does not protect against STIs.

How does it work?

• The copper IUD works by releasing tiny amounts of copper into the womb which damages or kills the sperm
• Affects the lining of the uterus, making it unsuitable for a fertilised egg to implant and grow. 

How effective is it?

• They are at least 99% effective in preventing pregnancy.
• The copper IUD is generally effective for 5 years and is usually changed 5 years after insertion. 
• Your doctor will advise you if your IUD can be left for longer.   

Hormonal contraception methods

Combined oral contraceptive pill

Commonly referred to as “The Pill” is used to prevent pregnancy. This pill contains a combination of both hormones - estrogen and progesterone. It does not protect against STIs. 

There are a variety of brands and strengths of the pill available in Aotearoa New Zealand, which contain a different combination of oestrogen and progestogen. Most people who want to can take the pill, but the pill is not suitable for everyone depending on your medical history and health conditions. Your doctor or nurse will be able to work out whether the pill is the right option for you. If you experience side effects, you may need to try a few different types before you find one that suits you. 

How does it work?

• Stops ovulation — you don’t release eggs on the pill 
• Making it hard for sperm to reach an egg  
• Making it hard for an egg to implant itself in the lining of your uterus

How effective is it?

• If used correctly, the pill is 99% effective in preventing pregnancy.
• However most of us are not perfect, so in reality it’s typically only 92% effective.
• To make sure the pill works best, you need to take it every day, whether you have sex on that day or not. It is also important to know that if you are sick (vomiting) soon after taking your pill, then it may not be absorbed and may not work. 

‍Things to keep in mind

• It may cause irregular bleeding for a few months after starting. As long as you have not missed any pills, it will still be working. If the bleeding continues, talk with your nurse or doctor.

Progestogen-only oral contraceptive pill

Also called the “Mini Pill” this contains only one hormone - progestogen. It does not protect against STIs. There are very few side effects and it can be used by women who are breastfeeding.

How does it work?

• Mainly by thickening the mucus in your cervix so sperm can’t travel through it. 
• It also changes the lining of the uterus — making it less likely to accept a fertilised egg. 
• It may also prevent an egg being released every month.

How effective is it?

• The progestogen-only pill can be 99% effective if it’s taken correctly. 
• However with typical use the progestogen-only pill is 92% effective.  
• You must remember to take it at the same time every day whether you have sex or not to be taking it correctly. 

Things to keep in mind

• It doesn't protect against sexually transmitted infections (STIs), so it’s important to use condoms when you have sex.
• It may cause irregular bleeding for a few months after starting. As long as you haven't missed any pills, it will still be working as a contraceptive. If the bleeding continues, talk to your healthcare provider.

Emergency contraceptive pill (ECP)

Commonly known as the “Morning After Pill”. It is a high dose contraceptive pill with a hormone called progestogen. The ECP can be taken up to 72 hours (3 days) after unprotected sex, but is most effective when taken in the first 24 hours – it is less effective as time passes.

You can buy the ECP from most community pharmacies, Accident and emergency clinics, sexual health clinics,  Sexual Wellbeing Aotearoa clinic , or your healthcare provider on prescription.

How does it work?

• Stop or delay the release of an egg from your ovaries — until the sperm in your body aren’t active anymore
• Prevent sperm from fertilising your egg by changing the way sperm moves in your body
• Delaying ovulation, but there is a risk of pregnancy if you have unprotected sex later in your cycle. It doesn’t work once the egg has been released and fertilised. 

How effective is it?

• If you weigh less than 70kg, the ECP is typically 98% effective at preventing pregnancy.
• If you weigh more than 70kg, you may be advised to take two ECP pills or have a copper IUD put in. 

Possible side effects

The ECP can cause side effects, although not everybody gets them. Very common side effects include:

• feeling sick (nausea)
• some irregular bleeding until your next period
• lower abdominal pain
• tiredness
• headache.

Injection (Depo-Provera)

The injection (Depo-Provera) is given every 13 weeks (approximately every 3 months) when used for contraception. It contains only one hormone, called medroxyprogesterone. It does not contain estrogen. It does not protect against STIs.

How does it work?

• By stopping the ovaries producing a monthly egg
• Changes the lining of the womb so it is less likely to accept a fertilised egg.
• Its effect is reversible which means that your natural fertility returns to normal after you stop using it. This usually takes about 6 months, but can take up to one year.
• Most women will not have periods while on Depo-Provera.

How effective is it?

• Typically, the injection is 97% effective at preventing pregnancy. 
• The injection can be more than 99% effective if it is always given on time — once every 13 weeks. 

You may experience a number of side effects, including:

• May cause irregular bleeding, no periods or occasional heavy bleeding. This is more common on first starting to use Depo-Provera and often improves with time.
• Headaches.
• Nervousness.
• Depression.
• Acne.
• Changes in appetite.
• Weight gain.
• Excessive growth of facial and body hair.

Things to keep in mind

• Remember it does not protect against STIs, so it’s important to use condoms when you have sex.
• Once you have had an injection of Depo-Provera, it lasts at least 13 weeks which can be a nuisance if you experience a side effect.
• Your periods and fertility take an average of 6 months to return after stopping the injection.

Implant (Jadelle)

The implant is made up of two small rods (each about the size of a matchstick) that contain progestogen. The rods are placed under your skin, on the inside of your arm (you can feel the rods under your skin). It contains progestogen, a hormone similar to one produced by your ovaries. It does not contain estrogen or protect against STIs.  

Using a Jadelle means you don’t have to remember to take anything like a pill every day, and it lasts for up to 5 years. It is also reversible – you can choose to have it taken out at any time.

How does it work?

• The rods slowly release a hormone called progestogen, which can stop your body from releasing an egg each month. 
• The implant also thickens the mucus in your cervix — so sperm cannot get to an egg.

How effective is it?

• The implant is a very reliable form of contraception and is usually 99% effective in preventing pregnancy
• The implant lasts for up to 5 years.
• Its effect is reversible which means that your natural fertility returns to normal when the rod is removed.

Things to keep in mind when using an implant (Jadelle)

• It may cause irregular periods or periods that last longer. This is quite common in the first 6 months but it can last as long as you use the implant. This can be annoying, but it’s not harmful and the implant will still work. If the bleeding is a problem, you can get pills to help.
• It may cause a sore or bruised arm after the implant is put in or taken out. There is a small risk of infection.
• Sometimes it’s not easy for the nurse or doctor to find the implant and you might have to see someone else to take it out. 
• Does not protect against STIs, so it’s important to use condoms when you have sex.

Hormonal IUD 

An IUD is a small device that is put inside your uterus to prevent pregnancy. It is a long-acting form of contraception and is reversible which means that your natural fertility returns after the IUD is removed. The hormonal or progestogen-only IUD contains a progestogen called levonorgestrel that it releases slowly into the womb. It does not protect against STIs. 

How does it work

• It prevents fertilisation of the egg by damaging or killing the sperm.
• It also affects the lining of the uterus, making it unsuitable for a fertilised egg to implant and grow.
• Progestogen hormones in this IUD also reduce menstrual bleeding and cramping. Because of this, it is often used to treat heavy periods.

How effective is it?

• IUDs are more than 99% effective. 
• Mirena® is effective for 5 years
• While Jaydess® is effective for 3 years
• At the end of this time, your IUD will need to be changed.    
• You can decide to have your IUD taken out at any time.

Things to keep in mind when using an IUD

• May cause irregular bleeding, more bleeding or cramping initially, but this gets better over time. 
• May cause pain, cramps or dizziness when IUD is inserted or taken out. 
• Has a small risk of infection and a very small risk of damage to your womb when it is inserted. 
• In rare instances it can come out by itself. You will be taught how to feel and check the threads are still in the right place. 
• Does not protect against STIs, so it’s important to use condoms when you have sex.