Contraception - The Implant

At a glance: the implant


If implanted correctly, it's more than 99% effective. Fewer than one woman in 1,000 who use the implant as contraception will get pregnant in one year.
It's very useful for women who know they don't want to get pregnant for a while. Once the implant is in place, you don't have to think about contraception for three years.
It can be useful for women who can't use contraception that contains oestrogen.
It's very useful for women who find it difficult to take a pill at the same time every day.
If you have side effects, the implant can be taken out. You can have the implant removed at any time, and your natural fertility will return very quickly.
When it's first put in, you may feel some bruising, tenderness or swelling around the implant.
In the first year after the implant is fitted, your periods may become irregular, lighter, heavier or longer. This usually settles down after the first year.
A common side effect of the implant is that your periods stop (amenorrhoea). It's not harmful, but you may want to consider this before deciding to have an implant.
Some medications can make the implant less effective, and additional contraceptive precautions need to be followed when you are taking these medications (see Will other medicines affect the implant?).
The implant does not protect against sexually transmitted infections (STIs). By using condoms as well as the implant, you'll help to protect yourself against STIs.

How the implant works

The implant steadily releases the hormone progestogen into your bloodstream. Progestogen is similar to the natural hormone progesterone, which is released by a woman's ovaries during her period.
The continuous release of progestogen:
stops a woman releasing an egg every month (ovulation)
thickens the mucus from the cervix (entrance to the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg
makes the lining of the womb thinner so that it is unable to support a fertilised egg
The implant can be put in at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant. In the UK, Nexplanon is the main contraceptive implant currently in use. Implants inserted before October 2010 were called Implanon. Since October 2010 insertion of Implanon has decreased as stocks are used up, and Nexplanon has become the most commonly used implant.
Both types of implant work in the same way, but Nexplanon is designed to reduce the risk of insertion errors and is visible on an X-ray or CT (computerised tomography) scan. There is no need for existing Implanon users to have their implant removed and replaced by Nexplanon ahead of its usual replacement time.
Nexplanon is a small, thin, flexible tube about 4cm long. It is implanted under the skin of your upper arm by a doctor or nurse. A local anaesthetic is used to numb the area. The small wound made in your arm is closed with a dressing and does not need stitches.
Nexplanon works for up to three years before it needs to be replaced. You can continue to use it until you reach the menopause, when a woman’s monthly periods stop at around 52 years of age. The implant can be removed at any time by a specially trained doctor or nurse. It only takes a few minutes to remove, using a local anaesthetic.
As soon as the implant has been removed, you will no longer be protected against pregnancy.


Advantages and disadvantages of the implant

The main advantages of the contraceptive implant are:
it works for three years
the implant does not interrupt sex
it is an option if you cannot use oestrogen-based contraception, such as the combined contraceptive pill, contraceptive patch or vaginal ring
you do not have to remember to take a pill every day
the implant is safe to use while you are breastfeeding
your fertility should return to normal as soon as the implant is removed
implants offer some protection against pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb
the implant may reduce heavy periods or painful periods after the first year of use
after the contraceptive implant has been inserted, you should be able to carry out normal activities
Using a contraceptive implant may have some disadvantages, which you should consider carefully before deciding on the right method of contraception for you. These include:

Disrupted periods

Your periods may change significantly while using a contraceptive implant. Around 20% of women using the implant will have no bleeding, and almost 50% will have infrequent or prolonged bleeding. Bleeding patterns are likely to remain irregular, although they may settle down after the first year.
Although these changes are not harmful, they may not be acceptable for some women. Your GP may be able to help by providing additional medication if you have prolonged bleeding.
Other side effects that some women report are:
headaches
acne
nausea
breast tenderness
changes in mood
loss of sex drive
These side effects usually stop after the first few months. If you have prolonged or severe headaches or other side effects, tell your doctor.
Some women put on weight while using the implant, but there is no evidence to show that the implant causes weight gain.

Contraception - The Female Condom

At a glance: the female condom

If used correctly and consistently, female condoms are 95% effective. This means that five out of 100 women using female condoms as contraception will become pregnant in a year.
Using female condoms protects against both pregnancy and STIs.
A female condom needs to be placed inside the vagina before there is any contact between the vagina and the penis.
Female condoms need to be stored in places that aren't too hot or too cold, and away from sharp or rough surfaces that could tear them or wear them away.
Always buy condoms that have the CE mark on the packet. This means they've been tested to European safety standards. Condoms that don't have the CE mark won't meet these standards, so don't use them.
A female condom can get pushed too far into the vagina, but it's easy to remove it yourself.
Female condoms may not be suitable for women who are not comfortable touching their genital area.
Do not use a female condom more than once. If you have sex again, use a new female condom.

How female condoms work

The female condom is worn inside the vagina to stop sperm getting to the womb.
It is important to use condoms correctly, and to make sure the penis doesn't make contact with the vagina before a condom has been put in. This is because semen can come out of the penis before a man has fully ejaculated (come). A female condom can be put in up to eight hours before sex.

How to use a female condom

take the female condom out of the packet, taking care not to tear the condom – do not open the packet with your teeth
squeeze the smaller ring at the closed end of the condom and insert it into the vagina
make sure that the large ring at the open end of the female condom covers the area around the vaginal opening
make sure the penis enters into the female condom, not between the condom and the side of the vagina
remove the female condom immediately after sex by gently pulling it out – you can twist the large ring to prevent semen leaking out
throw the condom away in a bin, not down the toilet

Advantages and disadvantages of female condoms

It is important to consider which form of contraception is right for you and your partner. Take care to use condoms correctly, and consider using other forms of contraception for extra protection.

Advantages

by preventing the exchange of bodily fluids (semen and vaginal fluid), female condoms help to protect against many STIs, including HIV
when used correctly and consistently, condoms are a reliable method of preventing pregnancy
you only need to use them when you have sex – they do not need advance preparation and are suitable for unplanned sex
in most cases, there are no medical side effects from using condoms
female condoms can be inserted up to eight hours before sex, and mean that women share the responsibility for using condoms with their partner

Disadvantages

some couples find that putting a condom in can interrupt sex – to get around this, try making using a condom part of foreplay or insert the female condom in advance
condoms are very strong but may split or tear if not used properly
female condoms are not as widely available as male condoms and are more expensive to buy


Can anything make condoms less effective?

Sperm can sometimes get into the vagina during sex even when using a condom. This may happen if:
the penis touches the area around the vagina before a condom is put in
the female condom gets pushed too far into the vagina
the man’s penis enters the vagina outside the female condom by mistake
the condom gets damaged by sharp fingernails or jewellery
Although female condoms (when used correctly) offer reliable protection against pregnancy, using an additional method of contraception will protect you against pregnancy if the female condom fails. If a female condom slips or fails, you can use emergency contraception to help to prevent pregnancy. This is for emergencies only, and shouldn't be used as a regular form of contraception.
If you've been at risk of unintended pregnancy, you're also at risk of catching an STI, so have a check-up at:
a GP surgery
a local sexual health clinic or genitourinary medicine (GUM) clinic (Find sexual health services near you)
a young persons' service (call 0800 567123)

Contraception - The Contraceptive Injection

At a glance: the contraceptive injection


If used correctly the contraceptive injection is more than 99% effective. This means that less than one woman in 100 who use the injection will become pregnant in a year.
The injection lasts for eight weeks or 12 weeks (depending on the type), so you don't have to think about contraception every day or every time you have sex.
It can be useful for women who might forget to take the contraceptive pill every day.
It can be useful for women who can't use contraception that contains oestrogen.
It's not affected by medication.
The contraceptive injection may provide some protection against cancer of the womb and pelvic inflammatory disease.
Side effects can include weight gain, headaches, mood swings, breast tenderness and irregular bleeding. The injection can't be removed from your body, so if you have side effects they'll last as long as the injection and for some time afterwards.
Your periods may become more irregular or longer, or stop altogether (amenorrhoea). Treatment is available if your bleeding is heavy or longer than normal – talk to your doctor or nurse about this.
It can take up to one year for your fertility to return to normal after the injection wears off, so it may not be suitable if you want to have a baby in the near future.
Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones.
The injection does not protect against sexually transmitted infections (STIs). By using condoms as well as the injection, you'll help to protect yourself against STIs.


How the injection works

The contraceptive injection is usually given into a muscle in your bottom, although sometimes it may be given in a muscle in your upper arm. The contraceptive injection works in the same way as the implant. It steadily releases the hormone progestogen into your bloodstream. Progestogen is similar to the natural hormone progesterone, which is released by a woman's ovaries during her period.
The continuous release of progestogen:
stops a woman releasing an egg every month (ovulation)
thickens the mucus from the cervix (neck of the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg
makes the lining of the womb thinner so that it is unable to support a fertilised egg
The injection can be given at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant.

When it starts to work

If you have the injection during the first five days of your cycle, you will be immediately protected against becoming pregnant.
If you have the injection on any other day of your cycle, you will not be protected against pregnancy for up to seven days. Use condoms or another method of contraception during this time.

After giving birth

You can have the contraceptive injection at any time after you have given birth, if you are not breastfeeding. If you are breastfeeding, the injection will usually be given after six weeks, although it may be given earlier if necessary.
If you start injections on or before day 21 after giving birth, you will be immediately protected against becoming pregnant.
If you start injections after day 21, you will need to use additional contraception for the following seven days.
Heavy and irregular bleeding is more likely to occur if you have the contraceptive injection during the first few weeks after giving birth.
It is safe to use contraceptive injections while you are breastfeeding.

After a miscarriage or abortion

You can have the injection immediately after a miscarriage or abortion, and you will be protected against pregnancy straight away. If you have the injection more than five days after a miscarriage or abortion, you'll need to use additional contraception for seven days.


Advantages and disadvantages of the injection

The main advantages of the contraceptive injection are:
each injection lasts for either eight or 12 weeks
the injection does not interrupt sex
the injection is an option if you cannot use oestrogen-based contraception, such as the combined pill, contraceptive patch or vaginal ring
you do not have to remember to take a pill every day
the injection is safe to use while you are breastfeeding
the injection is not affected by other medicines
the injection may reduce heavy, painful periods and help with premenstrual symptoms for some women
the injection offers some protection from pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb
Using the contraceptive injection may have some disadvantages, which you should consider carefully before deciding on the right method of contraception for you. These are as follows.

Disrupted periods

Your periods may change significantly during the first year of using the injection. They will usually become irregular and may be very heavy, or shorter and lighter, or stop altogether. This may settle down after the first year, but may continue as long as the injected progestogen remains in your body.
It can take a while for your periods and natural fertility to return after you stop using the injection. It takes around eight to 12 weeks for injected progestogen to leave the body, but you may have to wait longer for your periods to return to normal if you are trying to get pregnant.
Until you are ovulating regularly each month, it can be difficult to work out when you are at your most fertile. In some cases, it can take three months to a year for your periods to return to normal.

Weight gain

You may put on weight when you use contraceptive injections, although some women lose weight. Use of the injections may be associated with an increase in weight of up to 2–3kg over one year.

Depo-Provera, oestrogen and bone risk

Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones but it does not increase your risk of bone fracture (breaking a bone). This isn't a problem for most women because the bone replaces itself when you stop the injection, and it doesn't appear to cause any long-term problems.
Thinning of the bones may be a problem for women who already have an increased risk of developing osteoporosis (for example because they have low oestrogen, or a family history of osteoporosis). It may also be a concern for women under 19 because the body is still making bone at this age. Women under 19 may use Depo-Provera, but only after careful evaluation by a doctor.

Other side effects that some women report are:
headaches
acne
tender breasts
changes in mood
loss of sex drive

Contraception - The Combined Pill

At a glance: the combined pill


When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than one woman in 100 who use the combined pill as contraception will get pregnant in one year.
You need to take the pill every day for 21 days, then stop for seven days, and during this week you have a period-type bleed. You start taking the pill again after seven days.
You need to take the pill at the same time every day. You could get pregnant if you don't do this, or if you miss a pill, or vomit or have severe diarrhoea.
If you have heavy periods or painful periods, the combined pill can help.
Minor side effects include mood swings, breast tenderness and headaches.
There is no evidence that the pill makes women gain weight.
There's a very low risk of serious side effects such as blood clots and cervical cancer.
The combined pill is not suitable for women over 35 who smoke, or women with certain medical conditions.
The pill does not protect against sexually transmitted infections (STIs), so using a condom as well will help to protect you against STIs.


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 seven days. Microgynon, Brevinor and Cilest are examples of this type of pill.

Phasic 21-day pills

Phasic pills contain two or three 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 seven days. Phasic pills need to be taken in the right order. Binovum and Logynon are examples of this type of pill.

Every day (ED) pills

There are 21 active pills and seven 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 and Logynon ED are examples of this type of pill.
Follow the instructions that come with your packet. If you have any questions about how to take the pill, ask your GP, practice 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.


How to take 21-day pills

Take your first pill from the packet marked with the correct day of the week, or the first pill of the first colour (phasic pills).
Continue to take a pill at the same time each day until the pack is finished.
Stop taking pills for seven days (during these seven days you will get a bleed).
Start your next pack of pills on the eighth day, whether you are still bleeding or not. This should be the same day of the week as when you took your first pill.


How to take every day pills

Take the first pill from the section of the packet marked ‘start’. This will be an active pill.
Continue to take a pill every day, in the correct order and preferably at the same time each day, until the pack is finished (28 days).
During the seven days of taking the inactive pills you will get a bleed.
Start your next pack of pills after you have finished the first, whether you are still bleeding or not.


Starting the combined pill

Most women can start the pill at any time in their menstrual cycle. There is special guidance if you have just had a baby, abortion or miscarriage. You may need to use additional contraception during your first days on the pill – this depends on when in your menstrual cycle you start taking it.
If you start the combined pill on the first day of your period (day one of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.
If you start the pill on the fifth day of your period or before you will still be protected from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle you will need additional contraception, such as condoms, until you have taken the pill for seven days.
If you start the pill on any other 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 seven days.

Taking pill packs back to back

For monophasic combined pills (pills all the same colour and with the same level of hormones), it is normally fine to start a new pack of pills straight after your last one, for example if you want to delay your period for a holiday.
However, avoid taking more than two packs together unless advised to by a doctor or nurse. This is because you may have breakthrough bleeding as the womb lining sheds slightly. Also, some women find they feel bloated if they run several packs of the pill together.

What to do if you miss a pill

If you miss a pill or pills, or you start a pack late, this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:
when the pills are missed
how many pills are missed
A pill is late when you have forgotten to take it at your usual time. You have missed a pill when it is more than 24 hours since the time you should have taken it. Missing one pill anywhere in your pack or starting the new pack one day late isn’t a problem as you will still be protected against pregnancy (known as having contraceptive cover).
However, missing two or more pills or starting the pack two or more days late (more than 48 hours late) may affect your contraceptive cover. In particular, if you make the seven-day pill-free break longer by forgetting two or more pills, your ovaries might release an egg and there is a risk of getting pregnant. This is because your ovaries are not getting any effect from the pill during the seven-day break.
If you miss a pill, follow the advice below. If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.

If you have missed one pill, anywhere in the pack:
take the last pill you missed now, even if it means taking two pills in one day
continue taking the rest of the pack as usual
you don’t need to use additional contraception, such as condoms
take your seven-day pill-free break as normal
If you have missed two or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:
take the last pill you missed now, even if it means taking two pills in one day
leave any earlier missed pills
continue taking the rest of the pack as usual and use an extra method of contraception for the next seven days
you may need emergency contraception
you may need to start the next pack of pills without a break (see Starting the next pack after missing two or more pills)
You may need emergency contraception if you have had unprotected sex in the previous seven days and have missed two or more pills (you are taking your pill more than 48 hours late) in the first week of a pack.
Get advice from your contraception clinic, doctor or pharmacist about this. You can also call NHS Direct on 0845 46 47 (24 hours a day).

Starting the next pack after missing two or more pills

If there are seven or more pills left in the pack after the last missed pill:
finish the pack
have the usual seven-day break
If there are fewer than seven pills left in the pack after the last missed pill:
finish the pack and start the new one the next day, without having a break


Advantages and disadvantages

Some advantages of the pill include:
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 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

Some disadvantages of the pill include:
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 thrombosis (blood clots) and breast cancer

Contraception - The Mirena Coil (IUS)

At a glance: IUS (mirena coil)


It's more than 99% effective. Less than one in every 100 women who use the IUS will get pregnant in five years.
It can be taken out at any time by a specially trained doctor or nurse and your fertility quickly returns to normal.
The IUS can make your periods lighter, shorter or stop altogether, so it may help women who have heavy periods or painful periods.
It can be used by women who can't use combined contraception (such as the combined pill), for example those who have migraines.
Once the IUS is in place, you don't have to think about contraception every day or each time you have sex.
Some women may experience mood swings, skin problems or breast tenderness.
There's a small risk of getting an infection after it's inserted.
It can be uncomfortable when the IUS is put in. Painkillers can help with this.
The IUS can be fitted at any time during your monthly menstrual cycle, as long as you're definitely not pregnant. Ideally, it should be fitted within seven days of the start of your period because this will protect against pregnancy straight away. You should use condoms for seven days if the IUS is fitted at any other time.
The IUS does not protect against sexually transmitted infections (STIs). By using condoms as well as the IUS, you'll help to protect yourself against STIs.

Having an IUS fitted

An IUS can be fitted at any stage of your menstrual cycle, as long as you are not pregnant. If it's fitted in the first seven days of your cycle, you will be protected against pregnancy straight away. If it's fitted at any other time, you need to use another method of contraception (such as condoms) for seven days after it's fitted.
Before you have an IUS fitted you will have an internal examination to determine the size and position of your womb. This is to make sure that the IUS can be positioned in the correct place.
You may also be tested for any existing infections, such as sexually transmitted infections (STIs). It is best to do this before an IUS is fitted so that any infections can be treated. Sometimes, you may be given antibiotics at the same time as an IUS is fitted.
It takes about 15 to 20 minutes to insert an IUS:
the vagina is held open, like it is during a cervical screening (smear) test, and
the IUS is inserted through the cervix and into the womb
The fitting process can be uncomfortable or painful for some women, and you may also experience cramps afterwards.
You can ask for a local anaesthetic or painkillers before having the IUS fitted. Discuss this with your GP or nurse beforehand. An anaesthetic injection itself can be painful, so many women have the procedure without one.
Once an IUS is fitted it will need to be checked by a doctor after three to six weeks to make sure that everything is fine. Speak to your GP or clinician if you have any problems after this initial check or if you want the IUS removed.
Also speak to your GP if you or your partner are at risk of contracting an STI as this can lead to infection in the pelvis.
See your GP or go back to the clinic if you:
have pain in your lower abdomen
have a high temperature
have a smelly discharge
This may mean you have an infection.

How to tell if an IUS is still in place

An IUS has two thin threads that hang down a little way from your womb into the top of your vagina. The GP or clinician that fits your IUS will teach you how to feel for these threads and check that the IUS is still in place.
Check your IUS is in place a few times in the first month and then after each period at regular intervals.
It is very unlikely that your IUS will come out, but if you can't feel the threads or if you think the IUS has moved, you may not be fully protected against pregnancy. See your doctor or nurse straight away and use extra contraception, such as condoms, until your IUS has been checked. If you've had sex recently, you may need to use emergency contraception.
Your partner shouldn't be able to feel your IUS during sex. If he can feel the threads, get your GP or clinician to check that your IUS is in place. They may be able to cut the threads a little. If you feel any pain during sex, go for a check-up with your GP or clinician.

Removing an IUS

Your IUS can be removed at any time by a trained doctor or nurse.
If you're not going to have another IUS put in and you don't want to become pregnant, use another contraceptive method (such as condoms) for seven days before you have the IUS removed. Sperm can live for seven days in the body and could fertilise an egg once the IUS is removed. As soon as an IUS is taken out, your normal fertility should return.


Advantages and disadvantages of the IUS

Although an IUS is an effective method of contraception, there are several things to consider before having an IUS fitted.
Advantages of the IUS

it works for five years
it's one of the most effective forms of contraception available in the UK
it doesn't interrupt sex
an IUS may be useful if you have heavy or painful periods because your periods usually become much lighter and shorter, and sometimes less painful – they may stop completely after the first year of use
it can be used safely if you're breastfeeding
it's not affected by other medicines
it may be a good option if you can't take the hormone oestrogen, which is used in the combined contraceptive pill
your fertility will return to normal when the IUS is removed
There's no evidence that an IUS will affect your weight or that having an IUS fitted will increase the risk of cervical cancer, cancer of the uterus or ovarian cancer. Some women experience changes in mood and libido, but these changes are very small.
Disadvantages of the IUS



An uncommon side effect of the IUS is the appearance of small fluid-filled cysts on the ovaries – these usually disappear without treatment.
An IUS doesn't protect you against sexually transmitted infections (STIs) so you may also have to use condoms when having sex. If you get an STI while you have an IUS fitted, it could lead to pelvic infection if it's not treated.
Most women who stop using an IUS do so because of vaginal bleeding and pain, although this is uncommon. Hormonal problems can also occur, but these are even less common

Contraception - The Copper Coil (IUD)

At a glance: IUD (copper coil)


There are different types of IUD, some with more copper than others. IUDs with more copper are more than 99% effective. This means that fewer than one in 100 women who use an IUD will get pregnant in one year. IUDs with less copper will be less effective.
An IUD works as soon as it's put in, and lasts for five to 10 years, depending on the type.
It can be put in at any time during your menstrual cycle, as long as you're not pregnant.
It can be removed at any time by a specially trained doctor or nurse and you'll quickly return to normal levels of fertility.
Changes to your periods (for example, being heavier, longer or more painful) are common in the first three to six months after an IUD is put in, but they're likely to settle down after this. You might get spotting or bleeding between periods.
There's a very small chance of infection within 20 days of the IUD being fitted.
There's a risk that your body may expel the IUD.
If you get pregnant, there's an increased risk of ectopic pregnancy (when the egg implants outside the womb). But because you're unlikely to get pregnant, the overall risk of ectopic pregnancy is lower than in women who don't use contraception.
Having the IUD put in can be uncomfortable. Ask the doctor or nurse about pain relief.
An IUD may not be suitable for you if you've had previous pelvic infections.
The IUD does not protect against sexually transmitted infections (STIs). By using condoms as well as the IUD you'll help to protect yourself against STIs.



Having an IUD fitted

An IUD can be fitted at any time during your menstrual cycle, as long as you are not pregnant. You'll be protected against pregnancy straight away.
Before you have an IUD fitted, you will have an internal examination to find out the size and position of your womb. This is to make sure that the IUD can be put in the correct place.
You may also be tested for infections, such as STIs. It's best to do this before an IUD is fitted so that you can have treatment (if you need it) before the IUD is put in. Sometimes, you may be given antibiotics at the same time as the IUD is fitted.
It takes about 15 to 20 minutes to insert an IUD. The vagina is held open, like it is during a cervical screening (smear) test, and the IUD is inserted through the cervix and into the womb.
The fitting process can be uncomfortable and sometimes painful. You may get cramps afterwards. You can ask for a local anaesthetic or painkillers before having the IUD fitted. An anaesthetic injection itself can be painful, so many women have the procedure without.
You may get pain and bleeding for a few days after having an IUD fitted. Discuss this with your GP or nurse beforehand.
The IUD needs to be checked by a doctor after three to six weeks. Speak to your doctor or nurse if you have any problems before or after this first check or if you want the IUD removed.
Also speak to your doctor or nurse if you or your partner are at risk of getting an STI. This is because STIs can lead to an infection in the pelvis.
See your GP or go back to the clinic where your IUD was fitted as soon as you can if you:
have pain in your lower abdomen
have a high temperature
have a smelly discharge
These may mean you have an infection.


How to tell whether an IUD is still in place

An IUD has two thin threads that hang down a little way from your womb into the top of your vagina. The doctor or nurse who fits your IUD will teach you how to feel for these threads and check that it is still in place.
Check your IUD is in place a few times in the first month, and then after each period or at regular intervals.
It's very unlikely that your IUD will come out, but if you can't feel the threads or if you think the IUD has moved, you may not be fully protected against getting pregnant. See your doctor or nurse straight away and use an extra method of contraception, such as condoms, until your IUD has been checked. If you've had sex recently you may need to use emergency contraception.
Your partner shouldn't be able to feel your IUD during sex. If he can feel the threads, get your doctor or nurse to check that your IUD is in place. They may be able to cut the threads to a shorter length. If you feel any pain during sex, go for a check-up.

An IUD can be removed at any time by a trained doctor or nurse.
If you're not going to have another IUD put in and you don't want to get pregnant, use another method (such as condoms) for seven days before you have the IUD removed. This is to stop sperm getting into your body. Sperm can live for up to seven days in the body and could make you pregnant once the IUD is removed.
As soon as an IUD is taken out, your normal fertility should return.


Advantages and disadvantages of the IUD

Although an IUD is an effective method of contraception, there are some things to consider before having one fitted.
Advantages of the IUD

most women can use an IUD, including women who have never been pregnant
once an IUD is fitted, it works straight away and lasts for up to 10 years or until it's removed
it doesn't interrupt sex
it can be used if you're breastfeeding
your normal fertility returns as soon as the IUD is taken out
it's not affected by other medicines
There's no evidence that having an IUD fitted will increase the risk of cancer of the cervix, endometrial cancer (cancer of the lining of the womb) or ovarian cancer. Some women experience changes in mood and libido, but these changes are very small. There is no evidence that the IUD affects weight.
Disadvantages of the IUD

Your periods may become heavier, longer or more painful, though this may improve after a few months.
An IUD doesn't protect against STIs, so you may have to use condoms as well. If you get an STI while you have an IUD, it could lead to a pelvic infection if not treated.
The most common reasons that women stop using an IUD are vaginal bleeding and pain.

Damage to the womb

In fewer than one in 1,000 cases, an IUD && IUScan perforate (make a hole in) the womb or neck of the womb (cervix) when it's put in. This can cause pain in the lower abdomen but doesn't usually cause any other symptoms. If the doctor or nurse fitting your IUD or IUS is experienced, the risk of this is very low.
If perforation occurs, you may need surgery to remove the IUD or IUS. Contact your GP straight away if you feel a lot of pain after having an IUD or IUS fitted as perforations should be treated immediately

Contraception - The Contraceptive Diaphragm

At a glance: contraceptive diaphragm


When used correctly with spermicide, a diaphragm is 92-96% effective at preventing pregnancy – this means that between four and eight women out of every 100 who use a diaphragm as contraception will become pregnant within a year.
There are no serious health risks.
You only have to think about it when you have sex.
You can put a diaphragm in several hours before you have sex.
It can take time to learn how to use it.
Some women develop cystitis (a bladder infection) when they use a diaphragm. Your doctor or nurse can check the size – switching to a smaller size may help.
If you lose or gain more than 3kg (7lbs) in weight, or have a baby, miscarriage or abortion, you may need to be fitted with a new diaphragm.
By using condoms as well as a diaphragm you'll help to protect yourself against sexually transmitted infections (STIs).

A contraceptive diaphragm is inserted into the vagina before sex, and it covers the cervix so that sperm can't get into the womb (uterus). You need to use spermicide with it (spermicides kill sperm).
The diaphragm must be left in place for at least six hours after sex. After that time you take out the diaphragm and wash it. They're reusable. Diaphragms come in different sizes – you must be fitted for the correct size by a trained doctor or nurse.




Inserting a diaphragm

Your doctor or nurse will show you how to put in a diaphragm. Diaphragms come with instructions and are all inserted in a similar way.
with clean hands, put a small amount of spermicide on each side of the diaphragm (also putting a little spermicide on the rim may make the diaphragm easier to put in)
put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers
slide the diaphragm into your vagina upwards
this should ensure that the diaphragm covers your cervix
always check that your cervix is covered – it feels like a lump, a bit like the end of your nose
if your cervix is not covered, take the diaphragm out by hooking your finger under the rim or loop (if there is one) and pulling downwards, then try again
some women squat while they put their diaphragm in, others lie down or stand with one foot up on a chair – use the position that's easiest for you
you can insert a diaphragm up to three hours before you have sex – after this time you will need to take it out and put some more spermicide on it
You may be fitted with a temporary diaphragm by your doctor or nurse. This is for you to practise with at home. It gives you the chance to learn how to use it properly, see how it feels and find out if the method is suitable for you. During this time you are not protected against pregnancy and need to use additional contraception, such as condoms, when you have sex.
When you go back for a follow-up appointment with your doctor or nurse, wear the diaphragm so they can check that it is the right size and you have put it in properly. When they are happy that you can use a diaphragm properly, they will give you one to use as contraception.


Removing a diaphragm

A diaphragm can be easily removed by gently hooking your finger under its rim, loop or strap and pulling it downwards and out. You must leave all types of diaphragm in place for at least six hours after the last time you had sex.
You can leave them in for longer than this, but do not leave them in for longer than the recommended time of 30 hours (including the minimum six).


Looking after your diaphragm

After use, you can wash your diaphragm with warm water and mild unperfumed soap. Rinse it thoroughly, then leave it to dry. You will be given a small container for it, which you should keep in a cool, dry place.
Never boil a diaphragm.
Do not use disinfectant, detergent, oil-based products or talcum powder to keep it clean, as these products can damage it.
Your diaphragm may become discoloured over time but this does not make it less effective.
Always check your diaphragm or cap for any signs of damage before using it.
You can visit your GP or nurse when you want to replace your diaphragm. Most women can use the same diaphragm for a year before they need to replace it. You may need to get a different size diaphragm if you gain or lose more than 3kg (7lb) in weight, or if you have a baby, miscarriage or abortion.



Advantages and disadvantages

A diaphragm has the following advantages:

you only need to use a diaphragm when you want to have sex
you can put it in at a convenient time before having sex (but do not forget to use extra spermicide if you have it in for more than three hours)
there are no serious associated health risks or side effects
you are in control of your contraception

A diaphragm has the following disadvantages:

it is not as effective as other types of contraception
it only provides limited protection against sexually transmitted infections (STIs)
it can take time to learn how to use it
putting it in can interrupt sex
cystitis (bladder infection) can be a problem for some women who use a diaphragm
latex and spermicide can cause irritation in some women and their sexual partners