Methods of Contraception PDF

**Methods of contraception** Find out about the different methods of contraception for preventing pregnancy, how to get them and how well they work - [**[Combined pill]**](https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/) Contains hormones progestogen and oestrogen...

**Methods of contraception** Find out about the different methods of contraception for preventing pregnancy, how to get them and how well they work - [**[Combined pill]**](https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/) Contains hormones progestogen and oestrogen The combined contraceptive pill (also called the pill) is a type of hormonal contraception. **What is the combined pill?** - - - - - - - Information: The combined pill does not stop you getting and passing on [[sexually transmitted infections (STIs)]](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs, including [[HIV]](https://www.nhs.uk/conditions/hiv-and-aids/). Who can take the combined pill ============================== Can I take the combined pill? ----------------------------- The combined contraceptive pill (also called the pill) is not suitable for everyone. You may not be able to take it if you're living with obesity, or you're aged 35 or over and you smoke. The pill may not be suitable if you have ever had: - [blood clots](https://www.nhs.uk/conditions/blood-clots/), or a family member had blood clots under the age of 45 - narrowed or blocked arteries, or a stroke - a heart problem, heart disease, or high blood pressure - [migraines](https://www.nhs.uk/conditions/migraine/) with warning signs called aura - breast cancer - gallbladder or bile duct problems - liver cancer or severe [cirrhosis](https://www.nhs.uk/conditions/cirrhosis/) - complications due to [diabetes](https://www.nhs.uk/conditions/diabetes/) If any of these apply to you, talk to a doctor, nurse or pharmacist about whether it's safe for you to take the pill. ### Taking the combined pill for acne and heavy or painful periods Taking the combined pill usually makes your periods regular, lighter and less painful. The pill may also help the symptoms of: - [premenstrual syndrome (PMS)](https://www.nhs.uk/conditions/pre-menstrual-syndrome/) - [endometriosis](https://www.nhs.uk/conditions/endometriosis/) - [polycystic ovary syndrome](https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/) (PCOS) - severe [acne](https://www.nhs.uk/conditions/acne/) If you have painful or heavy periods, or problem acne, ask a GP or pharmacist whether the pill could help with your symptoms. ### Taking the combined pill after birth or when breastfeeding If you have just had a baby and are not breastfeeding, you can usually start the pill on day 21 after the birth, but check with a midwife, health visitor, doctor, nurse or pharmacist first. You'll need to use another type of contraception, such as condoms, for 7 days after you start taking the pill. If you're breastfeeding, you should wait 6 weeks after giving birth before you start taking the pill. You'll need to use a different method of contraception, such as condoms, until then and for 7 days after you start taking the pill. ### Taking the combined pill after a miscarriage or abortion If you're less than 24 weeks pregnant and have a miscarriage or abortion, you can start taking the pill straight away. If you start taking it within 5 days you'll be protected from pregnancy immediately. If you start the pill more than 5 days after a miscarriage or abortion, use another type of contraception, such as condoms, until you've taken the pill for 7 days. If you're more than 24 weeks pregnant and have a miscarriage, you can usually start the pill on day 21 after the miscarriage. Use another type of contraception, such as condoms, for 7 days after you start taking the pill. Side effects and risks of the combined pill =========================================== Common side effects of the combined pill ---------------------------------------- You may have some side effects when you first start taking the combined contraceptive pill (also called the pill). Bleeding between periods (breakthrough bleeding) or changes to your periods are common in the first few months. Taking the pill can cause high blood pressure in a small number of people. Some people report headaches, feeling sick or dizzy, and sore breasts. But there is not enough evidence to say whether this is caused by taking the pill. For some people the pill improves period pain and other symptoms linked to periods, such as headaches. There is no evidence that taking the pill makes you put on weight or changes your sex drive. If you still have side effects after 3 months and they're a problem for you, speak to a pharmacist or doctor. It may help to change to a different pill, or to have a shorter pill-free break or no break between pills (a tailored regime). Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of the combined pill -------------------------- There are some other problems linked to taking the combined pill. But the chance of getting these is small. ### Blood clots The risk of getting a blood clot is very small and affects up to 1 in 1,000 people using combined hormonal contraception like the pill. A doctor, nurse or pharmacist will check if you have certain risk factors before prescribing the pill. There is a potential risk of: - a blood clot in your leg or lung - a blood clot causing a [heart attack](https://www.nhs.uk/conditions/heart-attack/) - a blood clot causing a [stroke](https://www.nhs.uk/conditions/stroke-old/) Find out more about [blood clots](https://www.nhs.uk/conditions/blood-clots/), including symptoms and when to get help. ### Cancer Taking the pill can slightly increase your risk of getting: - [breast cancer](https://www.nhs.uk/conditions/breast-cancer/) - [cervical cancer](https://www.nhs.uk/conditions/cervical-cancer/) But your risk of breast cancer and cervical cancer goes back to normal 10 years after you stop taking the pill. Taking the pill can also lower your risk of getting: - [womb (uterus) cancer](https://www.nhs.uk/conditions/womb-cancer/) - [ovarian cancer](https://www.nhs.uk/conditions/ovarian-cancer/) - [bowel cancer](https://www.nhs.uk/conditions/bowel-cancer/) What to do if you miss a combined pill or take an extra one =========================================================== What to do if you miss a combined pill -------------------------------------- If you forget to take your pills, or you're late taking a pill, what you need to do next depends on: - what type of combined pill you're on - how many pills you've missed - where you are in the pack (day and week) Talk to a pharmacist to find out what to do, or read the information leaflet that comes in your pill pack. You may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). ### Emergency contraception Speak to a pharmacist, sexual health clinic or GP or call 111, as the combined pill can affect how some emergency contraception works. What to do if you take an extra combined pill --------------------------------------------- Taking more than one contraceptive pill is unlikely to harm you. However, it may make you: - feel sick or be sick (vomit) - have some vaginal bleeding Speak to a doctor or pharmacist if you get any of these symptoms. - [**[Progestogen-only pill]**](https://www.nhs.uk/contraception/methods-of-contraception/progestogen-only-pill/) Also called the mini pill, contains the hormone progestogen Progestogen-only pill ===================== The progestogen-only pill, also called the mini pill, is a type of hormonal contraception. **What is the progestogen-only pill?** - - - - - - - Information: The progestogen-only pill does not stop you getting or passing on [[sexually transmitted infections (STIs)]](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs, including [[HIV]](https://www.nhs.uk/conditions/hiv-and-aids/). Who can take the progestogen-only pill ====================================== Can I take the progestogen-only pill? ------------------------------------- The progestogen-only pill (mini pill) is not suitable for everyone. It may not be suitable if you have ever had: - a condition affecting your heart or blood vessels ([cardiovascular disease](https://www.nhs.uk/conditions/cardiovascular-disease/)) - a stroke - a liver condition, such as [cirrhosis](https://www.nhs.uk/conditions/cirrhosis/) - breast cancer - a condition that affects your kidneys If any of these apply to you, talk to a doctor, nurse or pharmacist about whether it's safe for you to take the progestogen-only pill. ### If you cannot take contraception with oestrogen The progestogen-only pill does not contain the hormone oestrogen, meaning this type of contraception is suitable for many people who cannot take oestrogen. Ask a doctor, nurse or pharmacist whether it's safe for you. Oestrogen is in the combined pill, contraceptive patch and vaginal ring. ### Taking the progestogen-only pill after giving birth If you\'ve just had a baby, you can start taking the progestogen-only pill straight away. The progestogen-only pill is safe to use when you\'re breastfeeding. Side effects of the progestogen-only pill ----------------------------------------- The progestogen-only pill (mini pill) has few side effects. The progestogen-only pill may change your periods. It can affect periods in different ways. Your periods may be lighter, more frequent or may stop altogether. You may get some bleeding (spotting) between periods. Some people may get acne, mood swings, weight gain or changes to sex drive (libido). But there\'s not enough evidence to say whether these are caused by the progestogen-only pill. What to do if you miss progestogen-only pills --------------------------------------------- If you\'re late taking your progestogen-only pill (mini pill), or you\'ve missed 1 or more pills, what you need to do will depend on: - how much time has passed - the type of progestogen-only pill you take Talk to a pharmacist to find out what to do, or read the information leaflet that comes in your pill pack. You may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). ### Emergency contraception Speak to a pharmacist, sexual health clinic or GP or call 111, as the progestogen-only pill can affect how some emergency contraception works. What to do if you take an extra progestogen-only pill ----------------------------------------------------- If you\'ve taken any extra pills, it\'s unlikely to harm you. Carry on taking the rest of your packet as normal. Take them at the usual time you take your pill each day. You may get side effects such as: - feeling sick (nausea) - being sick (vomiting) - vaginal bleeding If you're sick or have diarrhoea when taking the progestogen-only pill (mini pill), what you need to do will depend on: - how much time has passed - whether you take a traditional progestogen-only pill, desogestrel pill or drospirenone pill If you're not sure what type of pill you're taking, check the pack to see if it contains desogestrel or drospirenone, a type of progestogen. The progestogen-only pill may not work if: - you vomit within 2 hours of taking a traditional progestogen-only pill - you vomit within 3 to 4 hours of taking a desogestrel or drospirenone pill - you have severe watery diarrhoea You may need [[emergency contraception]](https://www.nhs.uk/contraception/emergency-contraception/). Speak to a pharmacist, sexual health clinic or GP or call 111, as the progestogen-only pill can affect how some types of emergency contraception work. Talk to a pharmacist or check the information leaflet that comes with your progestogen-only pill to find out what to do about taking your pills. - [**[IUD (intrauterine device, or copper coil)]**](https://www.nhs.uk/contraception/methods-of-contraception/iud-coil/) Inserted into the womb (uterus), does not contain hormones, and can be used as emergency contraception IUD (intrauterine device) or copper coil ======================================== Find out about an IUD (intrauterine device) or copper coil, including who can use it, how well it works and possible side effects. **What is an IUD (intrauterine device) or copper coil?** Someone holding an IUD (intrauterine device). It is a thin plastic t-shape about a quarter of the size of their palm. Credit: [[Jake Lyell]](https://www.alamy.com/search/imageresults.aspx?pseudoid=%7bE1383D14-7272-462C-B800-22FA90023D37%7d&name=Jake%2bLyell&st=11&mode=0&comp=1) / Alamy Stock Photo: [[https://www.alamy.com/stock-photo-a-midwife-talks-about-an-intrauterine-device-with-a-patient-at-a-reproductive-34853588.html?imageid=E08885FC-B368-4110-9BE5-A174E18D1095&p=82939&pn=1&searchId=4888221c910f14fc88f1e1798021bd17&searchtype=0]](https://www.alamy.com/stock-photo-a-midwife-talks-about-an-intrauterine-device-with-a-patient-at-a-reproductive-34853588.html?imageid=E08885FC-B368-4110-9BE5-A174E18D1095&p=82939&pn=1&searchId=4888221c910f14fc88f1e1798021bd17&searchtype=0) - - - - - - - - - - Who can get an IUD (intrauterine device) or copper coil ======================================================= Can I get an IUD? ----------------- A doctor or nurse will ask about your medical history to check if you can get an IUD (intrauterine device), also called a copper coil. You may not be able to have an IUD if: - you think you might be pregnant - you have a sexually transmitted infection (STI) or pelvic infection - you have problems with your womb or cervix, such as fibroids or cervical cancer - you have unexplained bleeding between periods or after sex If any of these apply to you, speak to the doctor or nurse about your contraception options. ### Getting an IUD after giving birth An IUD can sometimes be fitted within 48 hours of giving birth. But you\'ll usually be advised to wait until 4 weeks after birth to have an IUD fitted. It's possible to get pregnant starting from 3 weeks (21 days) after giving birth. It\'s important to use another form of contraception, such as condoms, until your IUD is fitted. #### IUDs and breastfeeding It\'s safe to have an IUD when you\'re breastfeeding, and it will not affect your baby or your milk supply. ### Getting an IUD after a miscarriage or abortion You can get an IUD straight after an abortion or miscarriage. You\'ll be protected against pregnancy straight away. IUD and medicines ----------------- An IUD is not affected by other medicines, including prescription medicines or herbal remedies. Getting an IUD (intrauterine device) or copper coil fitted or removed ===================================================================== Having an IUD fitted -------------------- You can usually have an IUD (intrauterine device), also called a copper coil, fitted by a specially trained doctor or nurse at a GP surgery or sexual health clinic. Having an IUD fitted should take about 5 to 10 minutes, but allow at least 30 minutes for the appointment. Before your IUD is fitted you might be offered: - a test for sexually transmitted infections (STIs) - a pregnancy test (an IUD cannot be fitted if you might be pregnant) Some people find having an IUD fitted painful. You may want to take some painkillers like paracetamol or ibuprofen an hour before. If you\'re concerned about pain during the fitting, speak to the nurse or doctor. They may be able to offer you extra pain relief. ### The procedure During the procedure: - a nurse or doctor will gently put a smooth, tube-shaped tool (a speculum) into your vagina so they can open it, like a [cervical screening (a smear test)](https://www.nhs.uk/conditions/cervical-screening/) - they will insert the IUD into your womb through your cervix Tell the person fitting your IUD if you feel any pain or discomfort. You can ask them to stop at any time. You can have a friend, family member or other member of staff in the room with you during the fitting if you want. ### After an IUD is fitted You might have some period-like pain for a few days after having an IUD fitted. Painkillers such as paracetamol and ibuprofen can help with any pain. You may also have some light bleeding (spotting). Checking an IUD is still in place --------------------------------- An IUD has 2 thin, soft 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 these threads to check it\'s still in place. Check your IUD is in place a few times in the first month and then regularly, such as after each period. ### Important:If you cannot feel your IUD threads If you cannot feel the threads your IUD might not be in place. Get help from a sexual health clinic, 111 or your GP straight away. If you cannot feel the threads when you check for them, you might not be protected against pregnancy and may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). Use another form of contraception until a doctor or nurse has checked your IUD. Having an IUD removed --------------------- A trained doctor or nurse can remove your IUD at any time. An IUD is effective for 5 to 10 years, depending on the type. Talk to your doctor to find out when your IUD is due to be removed or replaced. It\'s possible to get pregnant as soon as your IUD has been taken out. If you do not want to get pregnant, use another type of contraception, such as condoms, starting 7 days before you have it removed. Side effects of an IUD (intrauterine device) or copper coil =========================================================== Side effects of an IUD ---------------------- After you get an IUD fitted: - you might have some period-like pain for a few days - you may have some bleeding between your periods - your periods may become heavier, longer or more painful -- this may improve after a few months - you have a small chance of getting thrush that keeps coming back -- talk to your GP if this happens Your partner should not be able to feel your IUD threads during sex. If they can and it's a problem, see a doctor or nurse to get the threads checked. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. How well an IUD works --------------------- An IUD is over 99% effective at preventing pregnancy. This means that less than 1 in 100 women using an IUD as their method of contraception get pregnant each year. Risks of an IUD --------------- An IUD is very safe, but there are some rare risks, including: - pelvic infections, usually within 3 weeks of having an IUD fitted - your IUD moving or coming out, usually within 3 months after it's fitted - damage to the womb - [ectopic pregnancy](https://www.nhs.uk/conditions/ectopic-pregnancy/) in the rare case that your IUD fails Urgent advice:Ask for an urgent GP appointment or get help from NHS 111 if: --------------------------------------------------------------------------- You\'ve had an IUD fitted and: - you have pain in your lower tummy (abdomen) and painkillers do not help - you get sudden pain in your lower tummy that gets worse or does not go away - you have a high temperature - you have abnormal or smelly discharge - you have very heavy vaginal bleeding - you think you might be pregnant - you cannot feel the threads of your IUD, or they feel different You can call 111 or [get help from 111 online](https://111.nhs.uk/). ### Important:If you cannot feel your IUD threads If you cannot feel the threads when you check for them you might not be protected against pregnancy, and you may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). Use another form of contraception until a doctor or nurse has checked your IUD. - [**[IUS (intrauterine system or hormonal coil)]**](https://www.nhs.uk/contraception/methods-of-contraception/ius-hormonal-coil/) Inserted into the womb (uterus), and releases the hormone progestogen Find out about an IUS (intrauterine system) or hormonal coil, including who can use it, how well it works and possible side effects. What is an IUS (intrauterine system) or hormonal coil?-Brand names: Mirena, Levosert, Kyleena, Jaydess, Benilexa ================================================================================================================ - An IUS (intrauterine system), also called a hormonal coil, is a small plastic T-shape that a doctor or nurse puts into your womb (uterus). It stops pregnancy by releasing the hormone progestogen into your womb. - An IUS is not suitable for everyone. - An IUS is over 99% effective and lasts for 3 to 8 years, depending on the type. - An IUS is safe to use while breastfeeding and can usually be fitted soon after giving birth. - After an IUS is removed your fertility returns to previous levels straight away. - An IUS can make periods lighter, shorter, and less painful. It can be an effective treatment for heavy periods. - An IUS can be used as part of [hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/) for [menopause symptoms](https://www.nhs.uk/conditions/menopause/). - This information is about the hormonal coil. For information about the copper coil, see [intrauterine device (IUD)](https://www.nhs.uk/contraception/methods-of-contraception/iud-coil/). - You can compare different methods, including how well they work and side effects, when [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/). Information: An IUS does not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). Side effects and risks of an IUS (intrauterine system) or hormonal coil ======================================================================= How well does an IUS work? -------------------------- An IUS is over 99% effective at preventing pregnancy. This means that less than 1 in 100 women using an IUS as their method of contraception get pregnant each year. Side effects of an IUS ---------------------- Side effects of an IUS (intrauterine system), also called a hormonal coil, are most common for a few months after having it fitted. Many IUS users do not get any side effects. Possible side effects include: - period-like pain and bleeding (spotting) after having an IUS fitted - small fluid-filled sacs (cysts) on your ovaries -- these are usually harmless and disappear without treatment - a small chance of getting thrush that keeps coming back -- talk to your GP if this happens Some people report headaches, acne, sore breasts, and mood changes. There is not enough evidence to say if an IUS causes these. If you get any of these symptoms, they should go away within a few months. If side effects are a problem for you, speak to a doctor or nurse. Your partner should not be able to feel your IUS threads during sex. If they can, see a doctor or nurse to have the threads checked. ### How an IUS affects periods An IUS can make periods shorter or lighter, or stop them altogether. For 3 to 6 months after having an IUS fitted, your periods might become longer, irregular or more frequent. You may also have some light bleeding between your periods. This should improve within a few months. If irregular or heavy bleeding continues for longer than 6 months, see your doctor or nurse for a check-up. Some types of IUS are effective treatments for heavy periods. ### Side effects of an IUS as hormone replacement therapy (HRT) An IUS is sometimes used as part of [hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/) for symptoms of [menopause](https://www.nhs.uk/womens-health/menopause/). It has fewer side effects than other kinds of progestogen used for HRT, and can be a good option if you have heavy bleeding when taking HRT. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of an IUS --------------- An IUS is very safe, but there are some rare risks, including: - pelvic infections, usually within 3 weeks of having an IUS fitted - your IUS moving or coming out, usually within 3 months of having it fitted - damage to the womb - [ectopic pregnancy](https://www.nhs.uk/conditions/ectopic-pregnancy/) if your IUS fails Urgent advice:Ask for an urgent GP appointment or get help from NHS 111 if: --------------------------------------------------------------------------- You have an IUS and: - you have pain in your lower tummy (abdomen) and painkillers do not help - you get sudden pain in your lower tummy that gets worse or does not go away - you have a high temperature - you have unusual or smelly discharge - you have very heavy vaginal bleeding - you think you might be pregnant - you cannot feel the threads of your IUS, or they feel different You can call 111 or [get help from 111 online](https://111.nhs.uk/). ### Important:If you cannot feel your IUS threads If you cannot feel the threads when you check for them you might not be protected against pregnancy, and you may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). The IUS can make some types of emergency contraception less effective, so speak to a pharmacist, sexual health clinic, GP or call 111 for advice. Use another form of contraception until a doctor or nurse has checked your IUS. - [**[Contraceptive implant]**](https://www.nhs.uk/contraception/methods-of-contraception/contraceptive-implant/) Inserted under the skin of your arm, and releases the hormone progestogen What is the contraceptive implant? ================================== - The contraceptive implant is a small plastic rod, around 4 cm long, that a doctor or nurse puts under the skin of your arm. - It prevents pregnancy by releasing the hormone progestogen. This stops the ovaries releasing an egg each month. - The contraceptive implant is not suitable for everyone. - The implant works for 3 years before it needs to be replaced. - An implant is over 99% effective if it\'s replaced every 3 years. If not it\'s less effective. - A specially trained doctor or nurse can remove the implant at any time if you no longer want to use it. - Once the implant is removed your chance of getting pregnant will return to what it was before the implant was fitted straight away. - You can compare different methods, including how well they work and side effects, when [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/). Who can use the contraceptive implant ===================================== Can I use the contraceptive implant? ------------------------------------ The contraceptive implant is not suitable for everyone. The implant may not be suitable if you\'ve ever had: - a condition affecting your heart or blood vessels ([cardiovascular disease](https://www.nhs.uk/conditions/cardiovascular-disease/)), such as a [stroke](https://www.nhs.uk/conditions/stroke-old/) - a liver condition, such as [cirrhosis](https://www.nhs.uk/conditions/cirrhosis/) - breast cancer - unexplained vaginal bleeding If you have any of these health conditions, talk to a doctor, nurse or pharmacist about whether the implant is suitable for you. ### Pregnancy and breastfeeding You can have the contraceptive implant fitted any time after you\'ve given birth. If it\'s fitted before day 21 after the birth, you\'ll be protected against pregnancy straight away. If it\'s fitted on or after day 21, you\'ll need to use additional contraception such as condoms for the next 7 days. The implant is safe to use while breastfeeding and will not affect your baby or milk supply. ### Using the implant after a miscarriage or abortion If you've had a [miscarriage](https://www.nhs.uk/conditions/miscarriage/) or [abortion](https://www.nhs.uk/conditions/abortion/), you can have the contraceptive implant fitted as soon as you want to. If the implant is fitted within 5 days after a miscarriage or abortion, you'll be protected from pregnancy immediately. If it's fitted more than 5 days afterwards, you\'ll need to use another type of contraception, such as condoms, until the implant has been in place for 7 days. A doctor or nurse can give you more information. Medicines and the contraceptive implant --------------------------------------- Some medicines and herbal remedies can affect how the contraceptive implant works. It may not work properly to stop you getting pregnant. How the contraceptive implant is fitted or removed ================================================== Having the contraceptive implant fitted --------------------------------------- A nurse or doctor will fit the contraceptive implant under the skin of your arm. It takes a few minutes. The nurse or doctor will: - use a local anaesthetic injection or spray so you will not feel pain - make a small cut in the skin of your upper arm - put the implant under your skin -- it's about the size of a matchstick and will not be visible once fitted - seal the cut with a dressing, which you can remove once the cut has healed The implant works for 3 years and then needs to be replaced with a new one. If there's a chance you may be pregnant, the doctor or nurse will ask you to do a pregnancy test just before having the implant. How well does the contraceptive implant work? --------------------------------------------- The contraceptive implant is over 99% effective. Less than 1 in 100 women who use it for a year will get pregnant. The implant will protect against pregnancy immediately if it's fitted during the first 5 days of your menstrual cycle. The first day of your period is day 1 of your menstrual cycle. If the implant is fitted after day 5 of your menstrual cycle, you will not be protected against pregnancy immediately. You'll need to use another form of contraception such as condoms until you've had the implant in for 7 days. The contraceptive implant needs to be replaced after 3 years because it becomes less effective at preventing pregnancy. ### Emergency contraception If it's not replaced it stops working and there's a chance you could get pregnant. If this happens, you may need emergency contraception. Speak to a pharmacist, sexual health clinic, GP or call 111 for advice, as the contraceptive implant can make some emergency contraception less effective. Getting the implant removed --------------------------- You can ask for the contraceptive implant to be removed at any time. To do this you can contact a sexual health clinic, GP surgery or young people's service. You do not need to contact the same clinic or service that put the implant in. Getting the implant removed is very similar to having it put in. A doctor or nurse will use a local anaesthetic for pain relief. A small cut is made in your arm, the implant is removed and the cut is sealed with a dressing. ### Important It's possible to get pregnant soon after a contraceptive implant is removed. If you do not want to get pregnant, use another method of contraception, such as condoms, as soon as your implant is removed. If you need emergency contraception talk to a pharmacist, sexual health clinic, GP or call 111 for advice, as the implant can affect how some emergency contraception works. Getting the contraceptive implant replaced ------------------------------------------ You should make an appointment to get the implant replaced 3 years after you have it fitted. You can do this by contacting a sexual health clinic, GP surgery or young people's service. A doctor or nurse can remove the implant and can put a new one in at the same appointment. Side effects and risks of the contraceptive implant =================================================== The contraceptive implant is very safe and serious side effects and complications are rare. Side effects of the contraceptive implant ----------------------------------------- The contraceptive implant is very safe and serious side effects and complications are rare. ### Changes to your periods It's very common to have a change in your periods after you have an implant fitted. You may notice your periods: - are lighter - are less regular with light bleeding (spotting) between periods - are heavier or more painful - last longer - stop completely It's also possible for your periods to become more unpredictable, for example having a heavy period followed by a very light period, or missing a period. These changes are not usually anything to worry about, but if they become a problem for you contact a GP or sexual health clinic. ### Other reported side effects Other reported side effects of the contraceptive implant include headache, sore breasts, weight gain, acne, and [thrush](https://www.nhs.uk/conditions/thrush-in-men-and-women/) or [bacterial vaginosis](https://www.nhs.uk/conditions/bacterial-vaginosis/). There\'s not enough evidence to say whether these side effects are caused by the implant. If side effects are a problem for you, contact a GP or sexual health clinic for advice. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of the contraceptive implant ---------------------------------- The contraceptive implant is very safe, but there are some risks including: - infection where implant is put in -- this can lead to swelling and pain at the site of the implant - the implant moving out of place, usually a few centimetres away from where it was put in If you think you have an infection or the implant has moved out of place then contact a GP or sexual health clinic. Rarer, more serious risks include: - a [blood clot](https://www.nhs.uk/conditions/blood-clots/) - [ectopic pregnancy](https://www.nhs.uk/conditions/ectopic-pregnancy/) in the rare case that the implant fails - [**[Contraceptive injection]**](https://www.nhs.uk/contraception/methods-of-contraception/contraceptive-injection/) An injection that contains the hormone progestogen Find out about the contraceptive injection, including who can use it, how well it works and possible side effects. What is the contraceptive injection? ==================================== - The contraceptive injection contains the hormone progestogen. - It prevents pregnancy by stopping the ovaries releasing an egg (ovulation). - The contraceptive injection is not suitable for everyone. - The contraceptive injection is more than 99% effective if used correctly. If you get your injection late, it's less effective. - It lasts for 8 to 13 weeks, depending on the type. The types of contraceptive injection used in the UK include Depo Provera, Sayana Press and Noristerat. - When you stop getting the contraceptive injection, it can take up to 1 year for your fertility to return to previous levels. - You can compare different methods, including how well they work and side effects, when [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/). Information: The contraceptive injection does not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). Where to get the contraceptive injection ======================================== Where can I get the contraceptive injection? -------------------------------------------- Contraception services are free and confidential on the NHS. You can get the contraceptive injection free from: - sexual health clinics, also called family planning or contraception clinics - some GP surgeries - some young people\'s services (call the national sexual health helpline on 0300 123 7123 for more information) [**Find contraception services**](https://www.nhs.uk/nhs-services/sexual-health-services/find-contraception-services/) ### Getting contraception if you're under 16 Contraception is free and confidential, including for young people under the age of 16. The doctor or nurse will not tell anyone, including your parents or carer, unless they think you or someone else is at risk of harm. Getting the contraceptive injection =================================== How well the contraceptive injection works ------------------------------------------ When used correctly, the contraceptive injection is more than 99% effective. If you get your injection late, it's 94% effective, which means 6 in 100 women using it will get pregnant in one year. Find out [how well contraception works at preventing pregnancy](https://www.nhs.uk/contraception/choosing-contraception/how-well-it-works-at-preventing-pregnancy/). Getting the contraceptive injection ----------------------------------- The contraceptive injection is given by a doctor or nurse once every 8 to 13 weeks, depending on the type. If you prefer, you can choose to do one type of contraceptive injection (Sayana Press) yourself at home. A doctor or nurse can show you how to do this. If you use the contraceptive injection for more than 2 years, have a check-up with your doctor to make sure it's still the right contraception for you. ### Starting the contraceptive injection If you get your first contraceptive injection in the first 5 days of your menstrual cycle (day 1 is the first day of your period), you will be protected from pregnancy immediately. If you get your first contraceptive injection after day 5 of your menstrual cycle, you will not be protected from pregnancy immediately. Use another form of contraception, such as condoms, for 7 days after getting your injection. If there's a chance you could already be pregnant when you get your first contraceptive injection, take a pregnancy test 3 weeks after the last time you had sex without contraception. If you are pregnant, speak to your doctor or nurse for advice. ### If you're late for your injection If your injection is due and you do not have it on time, there's a risk of pregnancy if you have sex without a condom. Use condoms until you can get your injection, and for 7 days afterwards. #### Emergency contraception If you have sex without a condom when late for your injection, you may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). Side effects and risks of the contraceptive injection ===================================================== Side effects of the contraceptive injection ------------------------------------------- Common side effects of the contraceptive injection include: - changes to your periods, such as periods stopping, being irregular or lasting longer -- the longer you use it the more likely it is that your periods will stop completely - putting on weight - pain, a small lump or a scar where the injection is done Some people report acne, lower sex drive, mood changes, hot flushes and headaches. There is not enough evidence to say if the contraceptive injection causes these. If you have side effects and they're a problem for you, speak to a doctor or nurse. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of the contraceptive injection ------------------------------------ There are some other problems linked to taking the contraceptive injection. But the chance of getting these is small. If you have any concerns, speak to a doctor or nurse. ### Bone health Using the contraceptive injection for more than 1 year can cause your bones to become weaker. Your bones are likely to return to normal after you stop having contraceptive injections. ### Cancer The contraceptive injection can slightly increase your risk of getting: - [breast cancer](https://www.nhs.uk/conditions/breast-cancer/) - [cervical cancer](https://www.nhs.uk/conditions/cervical-cancer/) The risk is very small and is likely to get smaller after you stop having the injection. - [**[Contraceptive patch]**](https://www.nhs.uk/contraception/methods-of-contraception/contraceptive-patch/) A sticky patch is worn on the skin and releases the hormones progestogen and oestrogen What is the contraceptive patch? ================================ - The contraceptive patch is a small square patch, 5cm by 5cm, that you wear on your skin. - It prevents pregnancy by releasing the hormones oestrogen and progestogen into the blood. This stops the ovaries releasing an egg each month. - The contraceptive patch is not suitable for everyone. - You wear a patch for 7 days and then replace it with a new one. - The contraceptive patch is 99% effective if you use it correctly all the time. If not used correctly it's less effective. - When you stop using the contraceptive patch, your fertility usually returns to previous levels after around 1 to 3 months. - You can compare different methods, including how well they work and side effects, when [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/). Information: The contraceptive patch does not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs, including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). Who can use the contraceptive patch =================================== Can I use the contraceptive patch? ---------------------------------- The contraceptive patch is not suitable for everyone. You may not be able to use it if you're living with obesity, or you're aged 35 or over and you smoke. The patch may not be suitable if you have ever had: - [blood clots](https://www.nhs.uk/conditions/blood-clots/), or a family member had blood clots under the age of 45 - narrowed or blocked arteries, or you've had a stroke - a heart problem, heart disease, or high blood pressure - [migraines](https://www.nhs.uk/conditions/migraine/) with warning signs called aura - breast cancer - gallbladder or bile duct problems - liver cancer or severe [cirrhosis](https://www.nhs.uk/conditions/cirrhosis/) - complications due to [diabetes](https://www.nhs.uk/conditions/diabetes/) If you have any of these health conditions, talk to a doctor, nurse or pharmacist about whether it's safe for you to use the patch. ### Giving birth You can start using the contraceptive patch on day 21 after giving birth, if you\'re not breastfeeding. You\'ll need to use condoms for 7 days after starting the patch. Your midwife can discuss this with you. Avoid using the contraceptive patch if you're breastfeeding as it can reduce your milk supply ### Miscarriage or abortion If you had a miscarriage or abortion before 24 weeks of pregnancy, you can use the patch as soon as you want to. You\'ll need to start using the patch within 5 days of the end of the pregnancy to be protected against another pregnancy. If you do start using the patch after these 5 days, you\'ll need to use a condom for 7 days after starting the patch. A doctor, nurse or midwife can discuss this with you. If you had a miscarriage or abortion after 24 weeks, talk to a doctor, nurse or midwife to see if the contraceptive patch is suitable for you. How to use the contraceptive patch ================================== Putting on the contraceptive patch ---------------------------------- You put the contraceptive patch on an area of clean, dry hairless skin that\'s unlikely to get rubbed against tight clothing. This could be the top of your arm or back, your bottom or your tummy. You use 3 patches each month. To use contraceptive patches correctly: - wear the 1st patch for 7 days before taking it off and putting on the 2nd patch - wear the 2nd patch for 7 days before taking it off and putting on the 3rd patch - wear the 3rd patch for 7 days before taking it off - have 7 days with no patch -- you may have a bleed during your patch free week - after 7 days, put on a new patch -- this is the 1st patch of your new cycle Starting the contraceptive patch -------------------------------- If you start using the contraceptive patch between the 1st and 5th day of your period you should be protected against pregnancy straight away. Speak to a doctor or nurse for advice if you want to start the patch after the 5th day of your period. Speak to a pharmacist, doctor or nurse if you're already using hormonal contraception and are thinking of starting the contraceptive patch. You may need to use condoms for some time to make sure you're protected against pregnancy. How well the contraceptive patch works -------------------------------------- When used correctly all the time, the contraceptive patch is more than 99% effective. If not used correctly, it's 91% effective and about 9 in 100 women will get pregnant in a year. Incorrect use includes things like forgetting to put a new patch on at the right time. If a contraceptive patch comes loose or you forget to replace it ---------------------------------------------------------------- What to do if a contraceptive patch comes off or you forget to replace it depends on where you are in your 28-day patch cycle and when it came off or was due to be replaced. Talk to a pharmacist, doctor or nurse, to find out what to do, or read the information leaflet that comes in your contraceptive patch pack. Information: [Find the contraceptive patch's patient information leaflet online by searching the medicines A-Z on the eMC website](https://www.medicines.org.uk/emc/browse-medicines#gref) You may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/). Speak to a pharmacist, sexual health clinic, or GP or call 111 for advice as contraceptive patches can affect how some emergency contraception works. Contact a sexual health clinic or pharmacist for advice if your patches keep coming loose. They can check you're putting them on correctly. Medicines and herbal remedies that affect the contraceptive patch ----------------------------------------------------------------- Some medicines and herbal remedies can affect how the contraceptive patch works. The patch may not work properly to stop you getting pregnant. You may need to use another type of contraception. Ask a doctor or pharmacist for advice before using the contraceptive patch if you take medicine to treat TB (tuberculosis), epilepsy or HIV. Side effects and risks of the contraceptive patch ================================================= Common side effects of the contraceptive patch ---------------------------------------------- You may have some side effects when you first start using the contraceptive patch. Bleeding between periods (breakthrough bleeding) or changes to your periods are common in the first few months. Using the contraceptive patch can cause [high blood pressure](https://www.nhs.uk/conditions/high-blood-pressure-hypertension/) in a small number of people. Some people have headaches, feel sick or dizzy, or have sore breasts. But there is not enough evidence to say whether this is caused by using the patch. For some people the patch improves period pain and other symptoms linked to periods, such as headaches. There is no evidence that using the patch makes you put on weight or changes your sex drive. If you have side effects 3 months after starting the patch and they're a problem for you, trying another type of contraception may help. Staff at a sexual health clinic or a GP can discuss this with you. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of the contraceptive patch -------------------------------- There are some risks linked to using the contraceptive patch. But the chance of getting these is small. ### Blood clots The risk of getting a [blood clot](https://www.nhs.uk/conditions/blood-clots/) is very small and affects up to 1 in 1,000 people using combined hormonal contraception like the patch. Your doctor will check if you have certain risk factors before prescribing the patch. There is a small risk of: - getting a blood clot in your leg or lung - a blood clot causing a [heart attack](https://www.nhs.uk/conditions/heart-attack/) - a blood clot causing a [stroke](https://www.nhs.uk/conditions/stroke-old/) ### Cancer Using the patch can slightly increase your risk of getting: - [breast cancer](https://www.nhs.uk/conditions/breast-cancer/) - [cervical cancer](https://www.nhs.uk/conditions/cervical-cancer/) But your risk of breast cancer and cervical cancer goes back to normal 10 years after you stop using the patch. Using the patch can also lower your risk of getting: - [womb (uterus) cancer](https://www.nhs.uk/conditions/womb-cancer/) - [ovarian cancer](https://www.nhs.uk/conditions/ovarian-cancer/) - [bowel cancer](https://www.nhs.uk/conditions/bowel-cancer/) Womb (uterus) cancer ==================== Contents -------- 1. **Overview** 2. [Symptoms](https://www.nhs.uk/conditions/womb-cancer/symptoms/) 3. [Causes](https://www.nhs.uk/conditions/womb-cancer/causes/) 4. [Tests and next steps](https://www.nhs.uk/conditions/womb-cancer/tests-and-next-steps/) 5. [Treatment](https://www.nhs.uk/conditions/womb-cancer/treatment/) 6. [Help and support](https://www.nhs.uk/conditions/womb-cancer/help-and-support/)  Credit: Created by Multimedia Team at nhs.uk - Womb cancer is cancer that affects the womb (uterus). It\'s most common in women who\'ve been through menopause. - Anyone with a womb can get womb cancer. - The womb is where a baby grows during pregnancy. - Most womb cancer usually starts in the lining of the womb (endometrium), this is also known as endometrial cancer. - How serious the womb cancer is depends on how big it is, if it has spread and your general health. Important:Get your symptoms checked ----------------------------------- It\'s important to get any [symptoms of womb cancer](https://www.nhs.uk/conditions/womb-cancer/symptoms/) checked as soon as possible. Finding it earlier makes it easier to treat. Main symptoms of womb cancer ---------------------------- Main symptoms of womb cancer can include: - bleeding or spotting from the vagina after the menopause - heavy periods that are unusual for you - vaginal bleeding between your periods - a change to your vaginal discharge Other symptoms of womb cancer can include: - a lump or swelling in your tummy or between your hip bones (pelvis) - pain in your lower back or between your hip bones (pelvis) - pain during sex - changes to how often you pee and poo (this can be either more, or less, than usual) Non-urgent advice:See a GP if: ------------------------------ - you have any symptoms of womb cancer Try not to be embarrassed, the doctor or nurse will be used to talking about these kinds of symptoms. Important --------- These symptoms are common and can be caused by many different conditions. Having them does not definitely mean you have womb cancer. But it\'s important to get the symptoms checked by a GP. Do not wait to contact a GP. This is because if they\'re caused by cancer, finding it early can mean it\'s easier to treat. What happens at the GP appointment ---------------------------------- You will be asked some questions about your health, family medical history, medical conditions and your symptoms. Tell the GP if you or your family have any history of cancer or Lynch syndrome (a genetic condition that increases cancer risk). You may be asked to be examined, you can ask for a female doctor or nurse. You\'ll be asked to undress from the waist down, behind a screen. You\'ll be given a sheet to put over you. Then the GP may: - feel inside your vagina with 2 fingers while pressing on your tummy (they will be wearing gloves) - feel inside your bottom - gently put a smooth, tube-shaped tool (a speculum) into your vagina to check your cervix, like they do during cervical screening The GP may ask to check inside your vagina like they do during a [cervical screening](https://www.nhs.uk/conditions/cervical-screening/). They may also ask to check your tummy area and inside your bottom to feel for any lumps or changes in size or shape. Before starting these checks, they should explain what will happen during them and answer any questions you have. ### Referral to a specialist The GP may refer you for more tests or to see a specialist in hospital if they think you have a condition that needs to be investigated. You may get an urgent referral for more tests or to see a specialist in hospital if the GP thinks you have symptoms which could be cancer. This does not definitely mean you have cancer. Causes-Womb (uterus) cancer =========================== Contents -------- 1. [Overview](https://www.nhs.uk/conditions/womb-cancer/) 2. [Symptoms](https://www.nhs.uk/conditions/womb-cancer/symptoms/) 3. **Causes** 4. [Tests and next steps](https://www.nhs.uk/conditions/womb-cancer/tests-and-next-steps/) 5. [Treatment](https://www.nhs.uk/conditions/womb-cancer/treatment/) 6. [Help and support](https://www.nhs.uk/conditions/womb-cancer/help-and-support/) Who is more likely to get womb cancer ------------------------------------- Womb cancer is most common in women who\'ve been through menopause. It can affect anyone with a womb. You cannot get womb cancer if you\'ve had surgery to remove your womb (hysterectomy). Having a high level of a hormone called oestrogen is one of the main things that can increase your chance of getting womb cancer. You may have high levels of oestrogen if you: - are overweight - take some types of [hormone replacement therapy (HRT)](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/) - have never given birth - have [polycystic ovary syndrome](https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/) - went through the menopause after the age of 55 You might also be more likely to get womb cancer if you have: - diabetes - a family history of bowel, ovarian or womb cancer - inherited a rare gene that causes Lynch syndrome - taken medicines like tamoxifen (used to treat breast cancer) - had radiotherapy on your pelvis Information: ### Find out more - [Cancer Research UK: risks and causes of womb cancer](https://www.cancerresearchuk.org/about-cancer/womb-cancer/risks-causes) How to lower your risk of getting womb cancer --------------------------------------------- You cannot always prevent womb cancer, but there are things you can do to lower your chance of getting it. ### Do - make sure you\'re a healthy weight - stay active and do regular exercise - eat a healthy balanced diet - talk to a GP about which HRT is best for you if you are thinking about taking it If you have Lynch syndrome, your care team will talk with you about what you can do to reduce your cancer risk. Information: It\'s important to get any [symptoms of womb cancer](https://www.nhs.uk/conditions/womb-cancer/symptoms/) checked by a GP. Main tests for womb cancer -------------------------- If a GP refers you to a specialist, you will have tests to check if you have womb cancer. The tests you have will depend on your symptoms. They can include: - a scan of your womb -- a scanning device around the size of a finger is inserted into your vagina (transvaginal scan) - blood tests - [hysteroscopy](https://www.nhs.uk/conditions/hysteroscopy/) -- this is a test where a thin tube with a camera in it is used to look inside the womb - removing cells from the lining of your womb to be tested ([biopsy](https://www.nhs.uk/conditions/biopsy/)) -- this may be done during a hysteroscopy or carried out as a separate procedure The tests should not be painful, but you may find some uncomfortable. Talk to a healthcare professional if you are feeling uncomfortable. If you have a biopsy, you may have a small amount of cramping or bleeding from your vagina afterwards. Information: ### Find out more - [Cancer Research UK: tests for womb cancer](https://www.cancerresearchuk.org/about-cancer/womb-cancer/getting-diagnosed/tests-diagnose) Getting your results -------------------- You should get the results of your tests within a few weeks. Try not to worry if your results are taking longer than you expect. It does not mean anything is wrong. You can call the hospital or GP if you\'re worried. They should be able to update you. A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support. If you\'re told you have womb cancer ------------------------------------ Being told you have womb cancer can feel overwhelming. You may be feeling anxious about what will happen next. It can help to bring someone with you to any appointments you have. A group of specialists will look after you throughout your diagnosis, during and after treatment. Your team will include a clinical nurse specialist who will be your main point of contact during and after treatment. You can ask them any questions you have. Information: ### Get support Macmillan Cancer Support has a free helpline that\'s open every day from 8am to 8pm. They\'re there to listen if you have anything you want to talk about. Call 0808 808 0000. Next steps ---------- If you\'ve been told you have womb cancer, you\'ll usually need more tests, such as: - [CT scan](https://www.nhs.uk/conditions/ct-scan/) - [MRI scan](https://www.nhs.uk/conditions/mri-scan/) - [PET scan](https://www.nhs.uk/conditions/pet-scan/) - chest x-ray - [genetic tests](https://www.nhs.uk/conditions/genetic-and-genomic-testing/) These will help the specialists find out the size of the cancer and how far it\'s spread (called the stage). [Find out about what womb cancer stages and grades mean on Cancer Research UK.](https://www.cancerresearchuk.org/about-cancer/womb-cancer/stages) Your tests may show you have Lynch syndrome. This is a condition that can cause some types of cancer. If you do have Lynch syndrome you will be referred to a specialist. The specialist will be able to provide more information on what this means for you and your family. [Macmillan Cancer Support has more information about Lynch syndrome (LS)](https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/causes-and-risk-factors/lynch-syndrome-ls). Information: ### Find out more - [Macmillan Cancer Support: information and support if you\'ve just been diagnosed with cancer](https://www.macmillan.org.uk/cancer-information-and-support/diagnosis/just-been-diagnosed) Side effects and risks of the contraceptive patch ================================================= Common side effects of the contraceptive patch ---------------------------------------------- You may have some side effects when you first start using the contraceptive patch. Bleeding between periods (breakthrough bleeding) or changes to your periods are common in the first few months. Using the contraceptive patch can cause [high blood pressure](https://www.nhs.uk/conditions/high-blood-pressure-hypertension/) in a small number of people. Some people have headaches, feel sick or dizzy, or have sore breasts. But there is not enough evidence to say whether this is caused by using the patch. For some people the patch improves period pain and other symptoms linked to periods, such as headaches. There is no evidence that using the patch makes you put on weight or changes your sex drive. If you have side effects 3 months after starting the patch and they're a problem for you, trying another type of contraception may help. Staff at a sexual health clinic or a GP can discuss this with you. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of the contraceptive patch -------------------------------- There are some risks linked to using the contraceptive patch. But the chance of getting these is small. ### Blood clots The risk of getting a [blood clot](https://www.nhs.uk/conditions/blood-clots/) is very small and affects up to 1 in 1,000 people using combined hormonal contraception like the patch. Your doctor will check if you have certain risk factors before prescribing the patch. There is a small risk of: - getting a blood clot in your leg or lung - a blood clot causing a [heart attack](https://www.nhs.uk/conditions/heart-attack/) - a blood clot causing a [stroke](https://www.nhs.uk/conditions/stroke-old/) ### Cancer Using the patch can slightly increase your risk of getting: - [breast cancer](https://www.nhs.uk/conditions/breast-cancer/) - [cervical cancer](https://www.nhs.uk/conditions/cervical-cancer/) But your risk of breast cancer and cervical cancer goes back to normal 10 years after you stop using the patch. Using the patch can also lower your risk of getting: - [womb (uterus) cancer](https://www.nhs.uk/conditions/womb-cancer/) - [ovarian cancer](https://www.nhs.uk/conditions/ovarian-cancer/) - [bowel cancer](https://www.nhs.uk/conditions/bowel-cancer/) - [**[Vaginal ring]**](https://www.nhs.uk/contraception/methods-of-contraception/vaginal-ring/) A soft, flexible ring put in the vagina, releasing the hormones progestogen and oestrogen What is the vaginal ring? ========================= - The vaginal ring is a type of contraception you put inside your vagina. It's made of soft plastic and is around 5cm across. - It prevents pregnancy by releasing the hormones oestrogen and progestogen into the blood. This stops the ovaries releasing an egg each month. - The vaginal ring is not suitable for everyone. - You put the ring inside your vagina and leave it there for 3 weeks. - The vaginal ring is 99% effective if you use it correctly all the time. If not used correctly, it\'s less effective. - When you stop using the vaginal ring, your fertility usually returns to previous levels after around 1 to 3 months. - You can compare different methods, including how well they work and side effects, when [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/). Information: The vaginal ring does not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to help protect you and your partner against STIs, including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). Who can use the vaginal ring ============================ Can I use the vaginal ring? --------------------------- The vaginal ring is not suitable for everyone. You may not be able to use it if you're living with obesity, or you're aged 35 or over and you smoke. The ring may not be suitable if you have ever had: - [blood clots](https://www.nhs.uk/conditions/blood-clots/), or a family member has had blood clots under the age of 45 - narrowed or blocked arteries, or you've had a stroke - a heart problem, heart disease, or high blood pressure - [migraines](https://www.nhs.uk/conditions/migraine/) with warning signs called aura - breast cancer - gallbladder or bile duct problems - liver cancer or severe [cirrhosis](https://www.nhs.uk/conditions/cirrhosis/) - [diabetes](https://www.nhs.uk/conditions/diabetes/) If you have any of these health conditions, talk to a doctor, nurse or pharmacist about whether it's safe for you to use the vaginal ring. ### Using the vaginal ring after giving birth You can start using the vaginal ring on day 21 after giving birth. If you choose to start using the ring after this date, you should use another method of contraception, such as condoms, for 7 days after starting the ring. Avoid using the vaginal ring if you're breastfeeding as it can reduce your milk supply. ### Using the vaginal ring after a miscarriage or abortion If you had a miscarriage or abortion before 24 weeks of pregnancy, you should be able to start using a vaginal ring as soon as you want to. If you had a miscarriage or abortion after 24 weeks you may be advised to wait 21 days before using a ring. A doctor or pharmacist can give you more information. Information: How to use the vaginal ring =========================== Putting in the vaginal ring --------------------------- You put the vaginal ring inside your vagina on the first day of your period. The ring is soft and flexible, and it's similar to inserting a tampon. Once the ring is in place, you should not be able to feel it, including during sex. You leave the ring in for 21 days before removing it using your finger. You then wait 7 days before putting in a new ring. You may have period-like bleeding during this time. This is nothing to worry about. When you've taken the vaginal ring out, put it in the pouch that comes in the pack and throw it in the bin. Do not flush it down the toilet. The packaging that comes with your vaginal ring will have a leaflet with pictures showing how to put the ring in and take it out. Follow the instructions carefully to make sure the ring is properly fitted in place. How well the vaginal ring works ------------------------------- When used correctly all the time, the vaginal ring is more than 99% effective. If not used correctly, it's 91% effective, which means that about 9 in 100 women will get pregnant in a year. This is because things can go wrong, for example you might forget to replace a ring at the right time. Starting the vaginal ring ------------------------- If you\'re not already using hormonal contraception, you can usually start using the vaginal ring from day 1 to day 5 of your period. You should be protected from pregnancy straight away. Speak to a doctor, nurse or pharmacist for advice if you\'re planning to start using the vaginal ring after day 5 of your period. You will need to use additional contraception, such as a condom, for 7 days. Speak to a doctor or nurse if you're already using hormonal contraception and are thinking of changing to the vaginal ring. You may need to use condoms for some time to make sure you're protected against pregnancy. Things that can happen when using the vaginal ring -------------------------------------------------- Things that can sometimes happen when using the vaginal ring include: - forgetting to take the ring out after 21 days - forgetting to put in a new ring after the 7 days break - the ring coming out of the vagina If any of these happen to you, speak to a pharmacist, nurse or doctor, or read the leaflet that comes with your ring to find out what to do. Information: Side effects and risks of the vaginal ring ========================================== Common side effects of the vaginal ring --------------------------------------- You may have some side effects when you first start using the vaginal ring. Bleeding between periods (breakthrough bleeding) or changes to your periods are common in the first few months. Some people report headaches, feeling sick or having sore breasts. But there is not enough evidence to say whether this is caused by using the ring. There is a small chance your blood pressure may go up so you will have regular blood pressure tests while using the ring. For some people the ring improves period pain and other symptoms linked to periods, such as headaches. There is no evidence that using the ring makes you put on weight or changes your sex drive. If you have side effects 3 months after starting the ring and they're a problem for you, a doctor or nurse at a sexual health clinic or GP surgery can discuss this with you. Information: Find out about [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/), including side effects and risks of different methods. Risks of the vaginal ring ------------------------- There are some risks linked to using the vaginal ring. But the chance of getting these is small. ### Blood clots The risk of getting a [blood clot](https://www.nhs.uk/conditions/blood-clots/) is very small and affects up to 1 in 1,000 people using combined hormonal contraception like the vaginal ring. Your doctor will check if you have certain risk factors before prescribing the ring. There is a small risk of: - getting a blood clot in your leg or lung - a blood clot causing a [heart attack](https://www.nhs.uk/conditions/heart-attack/) - a blood clot causing a [stroke](https://www.nhs.uk/conditions/stroke-old/) ### Cancer Using the vaginal ring can slightly increase your risk of getting: - [breast cancer](https://www.nhs.uk/conditions/breast-cancer/) - [cervical cancer](https://www.nhs.uk/conditions/cervical-cancer/) But your risk of getting breast cancer and cervical cancer goes back to normal 10 years after you stop using the ring. Using the vaginal ring can also lower your risk of getting: - [womb (uterus) cancer](https://www.nhs.uk/conditions/womb-cancer/) - [ovarian cancer](https://www.nhs.uk/conditions/ovarian-cancer/) - [bowel cancer](https://www.nhs.uk/conditions/bowel-cancer/) - [**[Condoms]**](https://www.nhs.uk/contraception/methods-of-contraception/condoms/) Worn on the penis to help prevent pregnancy and sexually transmitted infections (STIs) Condoms (also called external, or male, condoms) help prevent pregnancy and reduce the risk of sexually transmitted infections (STIs). You put a condom on the penis before vaginal, anal or oral sex. There is separate information about [internal (female) condoms](https://www.nhs.uk/contraception/methods-of-contraception/internal-condoms/). Who can use condoms ------------------- Most people can use condoms. Some condoms are made from latex, others are latex free. It will say on the packet what the condom is made of. Do not use latex condoms if: - you have a latex allergy - you're using antifungal medicine on or around your anus, vulva and vagina, or penis and testicles Using a condom -------------- Condoms can be used for: - vaginal sex - anal sex - oral sex Some people also put condoms on sex toys. ### Do - use a new condom every time you have sex - follow the instructions on the condom packet to put it on correctly - check the use by date has not expired -- an expired condom may not be effective - check the packet for a European CE mark or UKCA mark -- this means it's been tested to high safety standards ### Don't - do not use more than one condom -- this can make one or both condoms split - do not use oil-based lubricant with latex condoms -- use water-based or silicone-based lubricant instead ### How to use a condom Put the condom on before you start having sex (before the penis touches the vagina or anus). 1. Make sure the penis is fully erect. 2. Open the packet carefully so you do not damage the condom. Do not use your teeth as this could rip the condom. 3. Hold the tip of the condom to squeeze out any air. 4. Roll the condom all the way down to the base of the penis. If the condom does not roll down, you may have put it on the wrong way round. Throw it away and use a new condom. 5. Keep the condom on until you finish having sex. When you\'ve finished, grip the base of the condom as you pull out to stop it coming off the penis. 6. Always put used condoms in the bin, not in the toilet. Information: [Watch a video about how to put on a condom on the NHS YouTube channel](https://youtu.be/vww9rk1USss/). ### Urgent advice:Get urgent help from a pharmacist, sexual health clinic, 111 or a GP if: - a condom splits or comes off during sex You may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/) or an STI test. You can call 111 or [get help from 111 online](https://111.nhs.uk/). How well condoms work --------------------- ### How well condoms work at preventing pregnancy Condoms are up to 98% effective at preventing pregnancy if you use them correctly every time you have sex. If not used correctly they're 82% effective, which means around 1 in 5 women who use condoms for a year will get pregnant. Incorrect use includes: - putting a condom on after the penis has touched the vagina - a condom splitting or coming off during sex ### How well condoms work to prevent sexually transmitted infections (STIs) Using a condom every time you have sex is the best way to protect you and your partner from HIV and other STIs. Information: [Find out how well each method of contraception works at preventing pregnancy](https://www.nhs.uk/contraception/choosing-contraception/how-well-it-works-at-preventing-pregnancy/) Where to get condoms -------------------- Contraception services are free and confidential on the NHS. You can get condoms for free from: - sexual health clinics, also called family planning or contraception clinics - some GP surgeries and pharmacies - some young people\'s services (call the national sexual health helpline on 0300 123 7123 for more information) You can also buy condoms from pharmacies and supermarkets or online. [**Find contraception services**](https://www.nhs.uk/nhs-services/sexual-health-services/find-contraception-services/) ### Getting contraception if you're under 16 Contraception is free and confidential, including for young people under the age of 16. The doctor or nurse will not tell anyone, including your parents or carer, unless they think you or someone else is at risk of harm. - [**[Internal (female) condoms]**](https://www.nhs.uk/contraception/methods-of-contraception/internal-condoms/) Put in the vagina before sex to help prevent pregnancy and sexually transmitted infections (STIs) Internal (female) condoms ========================= Internal condoms, sometimes called female condoms, help prevent pregnancy and reduce the risk of sexually transmitted infections (STIs). Two hands holding an internal condom made of clear, colourless plastic. There is a thin colourless ring at each end of the condom. Credit: GARO / PHANIE / SCIENCE PHOTO LIBRARY https://www.sciencephoto.com/media/808304/view An internal condom is made of thin, soft plastic or rubber. You put it inside the vagina or anus before having sex. Information: For information about condoms you put on the penis before sex, read about [condoms (also called external or male condoms)](https://www.nhs.uk/contraception/methods-of-contraception/condoms/). Who can use internal condoms ---------------------------- Most people can use internal condoms. Almost all internal condoms are made of thin, soft plastic or synthetic rubber. Some internal condoms are made of latex. It will say on the packet what the condom is made of. Do not use latex condoms if: - you have a latex allergy - you\'re using antifungal medicine on or around your anus, vulva and vagina, or penis and testicles Using an internal condom ------------------------ ### Do - use a new internal condom every time you have sex - follow the instructions on the condom packet - check the use by date has not expired -- an expired condom may not be effective - check the packet for a European CE mark or UKCA mark -- this means it's been tested to high safety standards ### Don't - do not use more than one internal condom, or an internal condom with an external (male) condom -- this can make one or both condoms split - do not use oil-based lubricant with internal condoms made of latex -- use water-based or silicone-based lubricant instead ### How to use an internal condom You can insert an internal condom up to 8 hours before sex. 1. Open the packet carefully so you do not damage the condom. Do not use your teeth. 2. Hold the inner ring and insert the condom into the vagina. 3. Put a finger into the condom and push it as far into the vagina as you can. 4. Make sure the outer ring stays outside the vagina. 5. During sex, make sure the penis goes inside the condom. 6. After sex, twist the outer ring a few times to prevent semen leaking out when you remove the condom. 7. Always put used internal condoms in the bin, not the toilet. Information: If you choose to use an internal condom for anal sex, you can insert it into the anus using your finger, or by putting it on the penis or a sex toy like an external (male) condom. Always use lubricant on the outside and inside of the condom. ### Further information: - [Terrence Higgins Trust: using an internal condom (for vaginal sex)](https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/improving-your-sexual-health/condoms/how-use-internal-condoms) - [aidsmap: using internal (female) condoms for anal sex](https://www.aidsmap.com/about-hiv/female-condoms-anal-sex) Urgent advice:Get urgent help from a pharmacist, sexual health clinic, 111 or a GP if: -------------------------------------------------------------------------------------- - an internal condom splits, moves out of place, or leaks during sex You may need [emergency contraception](https://www.nhs.uk/contraception/emergency-contraception/) or an STI test. You can call 111 or [get help from 111 online](https://111.nhs.uk/). How well internal condoms work ------------------------------ ### How well internal condoms work at preventing pregnancy Internal condoms are up to 95% effective at preventing pregnancy if you use them correctly every time you have sex. If not used correctly they're 79% effective, which means around 1 in 5 women who use internal condoms for a year will get pregnant. Incorrect use includes: - inserting an internal condom after the penis has touched the vagina - an internal condom splitting or moving out of place during sex - the penis entering the vagina outside the internal condom ### How well internal condoms work at preventing sexually transmitted infections When used correctly for vaginal sex, internal condoms help protect against [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). When used correctly for anal sex, internal condoms may help protect against STIs, but there's not enough evidence to say how much protection they offer. - [**[Female sterilisation]**](https://www.nhs.uk/contraception/methods-of-contraception/female-sterilisation/) A procedure that permanently stops eggs meeting sperm What is female sterilisation? ============================= - Female sterilisation is a permanent type of contraception, where the fallopian tubes are blocked or cut to stop sperm meeting an egg. - Fallopian tubes connect the ovaries with the womb. - This is sometimes called tubal ligation or "getting your tubes tied". - Sterilisation is more than 99% effective at preventing pregnancy. - It does not affect your hormones and you'll still have periods. - Reversing a female sterilisation is not usually available on the NHS.  Credit: Multimedia Team - nhs.uk Information: Female sterilisation does not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). You need to use a condom to protect yourself and others against STIs, including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). Preparing for female sterilisation ================================== How to prepare for sterilisation -------------------------------- Some time before the surgery, you'll have a pre-assessment appointment at the hospital. This is to check your health and discuss what will happen during the operation. You should keep using your usual contraception right up to the day of your operation. If you\'re having a general anaesthetic, you\'ll get instructions about not eating or drinking before the operation. If you\'re pregnant ------------------- It's possible to be sterilised at the same time as having a [caesarean section](https://www.nhs.uk/conditions/caesarean-section/) or an abortion, but you\'re usually recommended to wait several weeks between the procedures. What happens during female sterilisation ======================================== How female sterilisation is done -------------------------------- Female sterilisation is done in hospital. You\'ll usually have [general anaesthetic](https://www.nhs.uk/conditions/general-anaesthesia/) so that you are asleep during the operation. You'll have a pregnancy test on the day to make sure you\'re not pregnant. The operation is usually done using keyhole surgery ([laparoscopy](https://www.nhs.uk/conditions/laparoscopy/)) and takes 20 to 30 minutes. The doctor will: - make 2 or 3 small cuts in your abdomen, near your belly button - put gas into your abdomen, to make it easier to see your organs - use a long, thin tube with a camera (laparoscope) to reach your fallopian tubes - block your fallopian tubes, or remove part of the tubes and seal them - close the cut in your abdomen using surgical glue or dissolvable stitches If keyhole surgery (laparoscopy) is not possible, the doctor can make a slightly larger cut. This is called a mini-laparotomy. After the operation ------------------- You can usually go home the same day after female sterilisation. If you've had a general anaesthetic, a friend or family member needs to take you home from hospital. You're also recommended to have someone to stay with you overnight after a general anaesthetic. The doctor or nurse will tell you how to look after the wound and stitches at home, and discuss pain relief with you. What happens during female sterilisation ======================================== How female sterilisation is done -------------------------------- Female sterilisation is done in hospital. You\'ll usually have [general anaesthetic](https://www.nhs.uk/conditions/general-anaesthesia/) so that you are asleep during the operation. You'll have a pregnancy test on the day to make sure you\'re not pregnant. The operation is usually done using keyhole surgery ([laparoscopy](https://www.nhs.uk/conditions/laparoscopy/)) and takes 20 to 30 minutes. The doctor will: - make 2 or 3 small cuts in your abdomen, near your belly button - put gas into your abdomen, to make it easier to see your organs - use a long, thin tube with a camera (laparoscope) to reach your fallopian tubes - block your fallopian tubes, or remove part of the tubes and seal them - close the cut in your abdomen using surgical glue or dissolvable stitches If keyhole surgery (laparoscopy) is not possible, the doctor can make a slightly larger cut. This is called a mini-laparotomy. After the operation ------------------- You can usually go home the same day after female sterilisation. If you've had a general anaesthetic, a friend or family member needs to take you home from hospital. You're also recommended to have someone to stay with you overnight after a general anaesthetic. The doctor or nurse will tell you how to look after the wound and stitches at home, and discuss pain relief with you. Recovering after female sterilisation ===================================== Recovering at home after a sterilisation ---------------------------------------- You may have some tummy pain and light bleeding from your vagina for few days after female sterilisation. Before you leave the hospital, a doctor or nurse will tell you how to look after your wound and give you advice on which painkillers you can take. They\'ll also give you information about how soon you can get back to your everyday activities. This can take longer if you\'ve had a mini-laparotomy rather than keyhole surgery ([laparoscopy](https://www.nhs.uk/conditions/laparoscopy/)). This is because it involves larger cuts to your tummy. ### Do - stay off work for about 7 days (2 to 4 weeks after a mini-laparotomy) - keep your wound clean, following the instructions from the doctor or nurse - take ibuprofen or paracetamol to ease any tummy pain - put a covered hot water bottle on your tummy for bloating or trapped wind - use period pads if you have any light bleeding ### Don't - do not lift heavy objects or take part in exercise or sport for 7 days (4 to 6 weeks after a mini-laparotomy) - do not drive until you can wear a seat belt and do an emergency stop without any tummy pain (up to 6 weeks after a mini-laparotomy) - do not to have sex for at least 7 days after the procedure - do not use tampons for light bleeding after the procedure When to stop taking your usual contraception -------------------------------------------- There\'s a very small chance of pregnancy in the first week after the procedure, so it\'s important to carry on using your usual contraception for 7 days. This applies to most types of contraception, including: - hormonal contraception such as the combined pill, mini pill, patch and vaginal ring - non-hormonal types of contraception such as the diaphragm, cap and condoms - IUS or IUD (hormonal or copper coil) -- your coil can be removed after 7 days This does not apply if you have a contraceptive implant. The implant can be removed at the same time as your procedure or at any time afterwards. You will not need to use additional contraception. How sterilisation affects your periods -------------------------------------- Being sterilised should not affect your hormone levels or your periods. If you were using hormonal contraception before the operation, the hormones may have affected your periods, for example making them lighter. So your periods may change when you stop using hormonal contraception. These changes will usually improve after a few months. Complications of female sterilisation ===================================== Possible complications of female sterilisation ---------------------------------------------- Female sterilisation is usually a very safe procedure. But, as with any operation, there are risks. Your doctor will explain these to you. Most people who have a sterilisation have no complications. If there are any, they are usually minor and can be treated. There is a small risk of serious complications, including blood clots, infection or ectopic pregnancy.  ### Blood clots or DVT (deep vein thrombosis) [Blood clots](https://www.nhs.uk/conditions/blood-clots/) or [DVT (deep vein thrombosis)](https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/) are possible because of how the blood flows and clots after surgery. A blood clot that forms in the leg can sometimes travel to your lungs ([pulmonary embolism](https://www.nhs.uk/conditions/pulmonary-embolism/)). This can cause serious complications. To reduce the If your doctor thinks you're at risk of getting blood clots they might suggest wearing compression stockings or taking [anticoagulant medicines](https://www.nhs.uk/conditions/anticoagulants/). ### Wound infection or urinary tract infection (UTI) There\'s a small chance that your wound could get infected after the operation, or you could get a [UTI](https://www.nhs.uk/conditions/urinary-tract-infections-utis/). This is usually treated with antibiotics. ### Damage to a nerve, artery or organ During the operation itself, there's a small chance of damaging an organ such as your bowel or bladder, or a major blood vessel (artery) or nerve. The surgical team will usually repair this during surgery. ### Ectopic pregnancy If the sterilisation has not worked, you can get pregnant. If this happens, there's a higher chance of having an [ectopic pregnancy](https://www.nhs.uk/conditions/ectopic-pregnancy/). Urgent advice:Ask for an urgent GP appointment or get help from NHS 111 if: --------------------------------------------------------------------------- You've recently been sterilised and: - you have a high temperature or feel shivery - your wound is swollen and painful, or leaking blood or pus - one of your legs is swollen, throbbing and warm to the touch - you need to pee frequently or there\'s burning or stinging when you pee - you have abdominal pain and you\'re vomiting or have lost your appetite - you have difficulty breathing which comes on suddenly - you\'re coughing up blood - [**Vasectomy (male sterilisation)**](https://www.nhs.uk/contraception/methods-of-contraception/vasectomy-male-sterilisation/) A procedure that permanently stops sperm being ejaculated during sex What is a vasectomy? ==================== A diagram showing a side-on view of the penis and testicles and the tube that carries sperm from the testicles (sperm duct). Credit: Multimedia Team - nhs.uk - Vasectomy, also called male sterilisation, is a permanent method of contraception. - It's a procedure that stops sperm being ejaculated from the penis during sex. - It's usually carried out under local anaesthetic and takes around 30 minutes. It's common to feel some pain for 1 to 2 weeks afterwards. - Vasectomy is available on the NHS. There is usually a waiting list. - It may be possible to reverse a vasectomy, but this does not always work. Reversal is not usually available on the NHS. Information: A vasectomy does not stop you getting and passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs, including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). Complications of a vasectomy ============================ Side effects of a vasectomy --------------------------- A vasectomy is usually a very safe type of surgery and serious side effects are rare. Side effects include: - mild bruising and swelling of the testicles - a small yellow lump (or lumps) on the scrotum -- these lumps are made up of sperm (sperm granuloma) and are usually harmless - infection Bruising and swelling of the testicles should go away as your scrotum recovers from surgery. Sperm granulomas should also go away by themselves. Anti-inflammatory types of painkillers, such as ibuprofen, can help with pain caused by a granuloma. An infection will need treating with antibiotics. - [**[Diaphragm or cap]**](https://www.nhs.uk/contraception/methods-of-contraception/contraceptive-diaphragm-or-cap/) Put inside the vagina before sex to stop sperm getting into the womb What are diaphragms or caps? ============================ - Diaphragms and caps are types of contraception you put inside your vagina before sex. You need to use them with spermicide (gel, foam or cream that kills sperm). - Diaphragms and caps are discs or small domes made of thin, soft silicone or latex. They cover the cervix (entrance to the womb). - They prevent pregnancy by stopping sperm entering the womb. - Diaphragms and caps are not suitable for everyone. - Caps are smaller than diaphragms and you can leave them in for longer. - If correctly used diaphragms and caps are estimated to be between 92 and 96% effective. If not used correctly they are less effective. - You can compare different methods, including how well they work and side effects, when [choosing a method of contraception](https://www.nhs.uk/contraception/choosing-contraception/). Information: Diaphragms and caps do not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). Use a condom every time you have sex to protect you and your partner against STIs including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). How to use diaphragms or caps ============================= Getting a diaphragm or cap fitted --------------------------------- Diaphragms and caps come in different sizes. Caps are smaller than diaphragms. A doctor or nurse will check the size you need by feeling inside your vagina. You can have a friend, family member or other member of staff in the room with you if you want. The doctor or nurse will show you how to use the diaphragm or cap, and make an appointment for you to go back in a few weeks to check you\'re using it correctly. Using a diaphragm or cap ------------------------ Follow the instructions that come with the diaphragm or cap, and with the spermicide. To use a diaphragm or cap correctly: 1. Check the diaphragm or cap for holes before each time you use it. 2. Apply spermicide to the diaphragm or cap, following the instructions a nurse or doctor has given you. 3. Put the diaphragm or cap in your vagina up to 3 hours before sex, making sure it fits over your cervix. 4. Apply spermicide to the diaphragm or cap again every 3 hours until you have sex. 5. After sex, leave the diaphragm or cap in for at least 6 hours. 6. Remove the diaphragm or cap and wash it with soap and water. 7. Dry it carefully and keep it in its container in a cool, dry place. Do not leave a diaphragm in your vagina for more than 30 hours, or a cap for more than 48 hours. Do not use a diaphragm or cap during your period, as this may increase the risk of an infection called [toxic shock syndrome](https://www.nhs.uk/conditions/toxic-shock-syndrome/). ### Getting the diaphragm or cap replaced A diaphragm or cap usually lasts for 1 year before it needs to be replaced. You may need to get a different size of diaphragm or cap if: - you lose or gain more than 3kg in weight - you have a miscarriage or abortion - you give birth Contact a sexual health clinic or GP surgery about getting a replacement. ### After pregnancy If you were using a diaphragm or cap as your main method of contraception before giving birth, you will need to wait 6 weeks before you can start using it again. You should check with a sexual health clinic, doctor, nurse or midwife before using it as you may need a different size. You should use an alternative method of contraception, such as a condom, during this time. How well diaphragms and caps work --------------------------------- If used correctly diaphragms and caps are estimated to be between 92 and 96% effective. If not used correctly (for example, forgetting to add spermicide) they are less effective. ### Important If you notice a hole in your diaphragm or cap after sex, there may be a chance you could get pregnant. You may need Side effects and risks of the diaphragm or cap ============================================== Side effects ------------ Diaphragms and caps are very safe and serious side effects are rare. Side effects include: - [urinary tract infections](https://www.nhs.uk/conditions/urinary-tract-infections-utis/) (UTIs) - [toxic shock syndrome](https://www.nhs.uk/conditions/toxic-shock-syndrome/) (this is very rare) - skin irritation to you or your sexual partner caused by latex or spermicide If a diaphragm or cap is causing pain or irritation, contact a sexual health clinic or GP for advice. - [**[Natural family planning]**](https://www.nhs.uk/contraception/methods-of-contraception/natural-family-planning/) Includes tracking your menstrual cycle to avoid sex when you\'re most fertile Natural family planning ======================= Natural family planning is a way of preventing pregnancy. The 2 main types of natural family planning involve: - tracking periods to see when you're most fertile and avoiding sex or using condoms on those days (fertility awareness method) - breastfeeding your baby for up to 6 months to delay ovulation (lactational amenorrhoea method) Withdrawing the penis before ejaculation (sometimes called the withdrawal method) is not an effective way to avoid pregnancy and is not recommended. Information: Natural family planning does not stop you getting or passing on [sexually transmitted infections (STIs)](https://www.nhs.uk/conditions/sexually-transmitted-infections-stis/). You need to use a condom to protect yourself and others against STIs, including [HIV](https://www.nhs.uk/conditions/hiv-and-aids/). How well natural family planning works -------------------------------------- ### Effectiveness of fertility awareness method When used correctly all the time, fertility awareness methods are between 91% and 99% effective at preventing pregnancy. If you do not follow the instructions exactly, it is only 76% effective. This means 24 in 100 women will get pregnant when tracking their fertility for a year. ### Effectiveness of lactational amenorrhea method If you are breastfeeding and follow lactational amenorrhea method correctly all the time, it is more than 99% effective at preventing pregnancy. If you do not follow the instructions exactly, it's 98% effective and 2 in 100 women will get pregnant again within 6 months of giving birth. Information: [Find out how well each method of contraception works at preventing pregnancy](https://www.nhs.uk/contraception/choosing-contraception/how-well-it-works-at-preventing-pregnancy/) How to find out about natural family planning --------------------------------------------- You need an expert such as a fertility awareness practitioner or a midwife to teach you about natural family pla