Contraception

Methods offered or referred (in order of effectiveness) include:

[A] Very effective methods:


• Discussion of and referral for Vasectomy
  We no longer offer this in the our surgery so you will need to see a urologist
  or a GP with a special interest.

• Referral for Tubal Ligation -modern methods using a laporoscope make this a less traumatic precure than in the past. Nowadays the Fallopian Tubes can be removed instead of being tied or clamped to prevent Ovarian Cancers that generally originate in the tubes.

• The Mirena System -a hormonal intrauterine system which lasts for five to seven years and has a pregnancy rate of under 0.5%. It is very useful for women with heavy periods and the device (but not the fitting) is now funded.

• Depo Provera -an injection of progesterone lasting 3 months (we will recall you each 12 weeks). It is highly effective (<1% pregnancy if given 12 weekly, 3% if not given on-time). There can be irregular periods for a while but these can be managed and do settle. Mood and weight issues can be a problem that can often be prevented or managed. It does not cause cancer and in fact reduces endometrial (uterine lining) cancer by 80%.

• Jadelle implants -two "rods" are placed under the skin (upper arm) and can provide 4-5 years protection (depending on weight) and have a pregnancy rate less than 1%.
  However, for funding reasons we do not fit Jadelle rods (refer to Family Planning), but we often remove them! We can provide a trial of the same hormone taken orally to produce a similar exposure as a trial of tolerance before committing to having them inserted.

• Combined oral contraceptives (O/Cs) -a variety are available. The "third generation" pills remain the best tolerated and have THE SAME low risk of DVT (clots) for low risk women as the less well tolerated "second generation" pills and a lower risk than women not taking the pill (because of the higher risk in pregnancy). Pregnancy rates of less than 1% require correct use but the modern continuous use (no break for a period) largely removes the risk from forgotten pills.

• Non-hormonal IUDs (or more correctly, IUCDs) -well tolerated copper containing Intra-uterine Contraceptive Devices, also lasting 5 years. They come in two strengths (375 & 380) and two sizes (short and standard). Preferably only used if you have had at least one vaginal delivery, have normal to light periods AND you are in a stable relationship (as contraindicated with pelvic infections). It can provide post-coital protection if fitted within 5 days and the standard 380 can last 10 years!

• Progesterone only pills (including Minipill) -these progesterone only pills are a good alternative for breast feeding women, those near the menopause who want to stop the combined pill but don't want to risk a pregnancy and those who shouldn't take oestrogen (as in the combined pill). Cerazette stops ovulation so has a similar failure to combined O/Cs but is not funded, while minipills such as Noriday have a pregnancy rate of 8% (less if also fully breast feeding or used around the menopause), or more if not taken at the same time of the day.

• Breast Feeding -believe it or not, FULLY breast feeding (feeding on demand, at least one night feed and no bottles, solids or dummies) is associated with a failure rate of 1-2%. I suggest adding another method (eg the minipill) as soon as these conditions are no longer true.

[B] Less effective methods:


• The Diaphragm -this requires an individual fitting. It only suits those women who are comfortable checking themselves internally. The failure rate (about 5%) reduces to about 1% after 5 years as women not suited to the method "drop out" or get pregnant.
  We no longer offer this in the our surgery because of a lack of demand.

• The Condom -this should primarily be seen as a barrier to STDs (sexually transmitted diseases) and a "back-up" when normal contraception is unavailable or unreliable (such as forgotten pills or taking an antibiotic which is causing diarrhoea) as on-going reliance for contraception eventually leads to failure in many women because the failure rate is approximately 10% per annum.

• The "morning after pill" -this is available as an emergency service (up to 72 hours after exposure, so usually no need to attend ED or a pharmacy) and is combined with a review of contraceptive needs and methods (unless you use an ED or pharmacy).

[C] Very unreliable methods:


• Natural Family Planning -as 1 in 4 become pregnant in New Zealand using the "fertility awareness" method, I don't advise it unless there is no alternative. In that case I would recomend (a) attending a Natural Family Planning advisor and (b) a lifestyle compatible with a healthy pregnancy ie no smoking, no alcohol, no drugs etc, good stress management and high folic acid intake (tablets or never overcooking the blues which you eat in abundance!)

• Coitus Interuptus (Withdrawal) -an absolute waste of effort (60% failure rate and doesn't prevent sexually transmitted diseases).
  Do not get your health advce from porn flicks where it is the norm!