Contraception (Birth Control)

Disclaimer: Every individual responds differently to different types of contraception. For some, the side effects of a particular contraception may cause serious, long-term problems. The information on side effects is not exhaustive and it is recommended that you consult your qualified health care professional before using any of the forms of birth control listed below. If you are experiencing any side effects with your contraception, it is recommended you consult your health care provider immediately. 

Combined Hormonal Oral Contraceptive Pill (the Pill)

The Pill is made up of two hormones, oestrogen and progestogen. These hormones are similar to ones made in ovaries. There are numerous brands of the Pill available, with varying types and doses of these hormones. In Australia, most Pill packets contain 28 pills, which include either 4 or 7 non-hormonal pills made of sugars.

The two hormones work together to prevent pregnancy by stopping the ovaries from releasing an egg each month, and by making the mucus in the cervix thicker so that sperm can’t get into the uterus. When you take the non-hormonal pills you will get a withdrawal bleed like a period.

The Pill is 99.5% effective if used correctly. It can be less effective (around 93%) if you forget to take it here and there, run out of pills, or take it at varying times each day. Effectiveness may also be impacted by vomiting, diarrhoea, and some medications including epileptic medications or herbal remedies. The Pill does not protect you from STIs or BBVs, so it is recommended for use with a condom or other barrier. 

Things to consider and consult with your health-care professional about when thinking about the Pill: 

  • It’s not recommended if you are over 35 and smoke
  • It does not protect against STIs
  • It must be taken at same time each day
  • It can’t be used by people who cannot use oestrogen for medical reasons
  • It can have a small risk of blood clots
  • It carries a small risk of heart attack and stroke
  • People taking it can have spotting or break-through bleeding

Hormonal side effects can include: 

  • Headache
  • Nausea or bloating
  • Breast tenderness
  • Acne
  • Mood changes
  • Patchy brown marks on facial skin
  • Lowered interest in sex

Progestogen-only Pill (POP or “Mini-Pill”)

The progestogen-only pill is a form of oral contraception that must be taken every day at the same time to prevent pregnancy. It contains a very small amount of progestogen, which is similar to the natural hormone progesterone, which is produced within ovaries. 

The mini-pill comes in a pack with 28 pills. Every pill is a hormone pill and you don’t have a break between packs. 

The mini-pill mainly works by making the cervical mucus at the neck of the womb thicker, so that sperm cannot get through to meet an egg. For some people it also stops the release of an egg each month. 

If used correctly, the mini-pill can be 99.5% effective at preventing pregnancy. Typical use is 93% effective. It is necessary to take the pill at exactly the same time every day. Vomiting, diarrhoea, some epileptic medications or herbal remedies may make the mini-pill less effective. The mini-pill does not protect you from STIs or BBVs, so it is recommended for use with a condom or other barrier.

You may not be able to use the mini-pill if you:

  • Have breast cancer
  • Have severe liver disease
  • Have unusual vaginal bleeding
  • Use some medications or herbal remedies

Side effects: 

  • May impact frequency/heaviness/other symptoms of your period 
  • Headaches
  • Mood changes
  • Acne

Contraceptive Implant (Implanon)

Implanon is a small rod that is inserted under the skin of the inner upper arm. It stops pregnancy by continuously releasing the hormone etonogestrel, which resembles the hormone progesterone, into the body. The Implanon is effective for up to 3 years and must be replaced no later than three years after insertion. The device is very effective at preventing pregnancy (over 99% effective). It prevents pregnancy by stopping the ovaries from releasing an egg and causing changes to the cervical mucous membrane which makes it difficult for sperm to enter the womb.

Implanon is a useful form of contraception for people who cannot tolerate oestrogen-based contraception, such as ‘the Pill’. However, the Implanon can cause changes to your menstrual cycle, such as changes in frequency, duration and heaviness of your period, amongst other side effects.

Additionally, it is important to speak to your doctor or nurse about any previous or current conditions you may have before getting the Implanon as it may have interactions. Implanon does not protect you from STIs or BBVs.

If you are a concession card holder or eligible for the Medicare Safety Net, the price of the Implanon may be reduced or free. Some sexual health clinics may offer low cost or free Implanon insertion for sex workers.

Implanon may cause a number of side effects, including: 

  • Mood changes 
  • Nausea  
  • Changes to your period
  • Painful periods
  • Changes to your skin 
  • Sore or tender breasts
  • Bloating, cramping or abdominal pain 
  • Headaches
  • Weight gain, however, it is unclear whether it is due to the implant alone. Some resources suggest that the Implanon does not cause weight gain at all. 
  • Bruising, mild soreness and/or scarring at the site of the Implanon insertion. 
  • Increased risk of developing ovarian cysts that sometimes cause mild abdominal pain. They usually disappear on their own, however, occasionally they can lead to more serious problems. 

On rare occasions, the Implanon may move from its original positions and this may complicate the removal. The Implanon is not recommended for people experiencing certain conditions, illnesses or on particular medications, including herbal remedies, barbiturates, and HIV treatments. For these reasons, it is important that you inform your healthcare provider of any other health problems you are experiencing and medications you are using to determine whether Implanon is suitable for you. 

Consult your health care provider immediately if you become pregnant while using the Implanon as your risk of having an ectopic pregnancy is increased. It is also recommended that you inform your doctor if you are breast-feeding when using the Implanon as it may not be suitable in some circumstances. 

When you are using Implanon, you should arrange for regular check-ups with your healthcare provider. You should inform your health care provider of any changes to your health, particularly any side-effects listed above that you are experiencing. For more information on the potential side-effects of Implanon, see Implanon NXT. Alternatively, you can ask your health care provider or pharmacist for a Consumer Medicine Information leaflet.

IUDs (Intrauterine Device)

An IUD is a small contraceptive device that is inserted into your uterus to prevent unwanted pregnancies. There are two different types of IUDs available in Australia: the copper IUD and the hormonal IUD. IUDs are particularly suited for people who have difficulty with hormonal contraception, i.e. the Pill.

Both types of IUDs do not protect you against STIs or BBVs and can increase your chances of contracting PID in the first three weeks after insertion, as it can introduce bacteria into your cervix, though this is very rare. The string attached to the device provides infection with an ideal means of travelling up to the cervix and deep into the fallopian tubes, where they can attack the entire reproductive system. Sex workers who can get pregnant are generally advised against the use of IUDs alone. Make sure you get a vaginal/pelvic exam, and if necessary a Cervical Screening and STI test before having an IUD inserted. IUDs do not protect you from STIs or BBVs, and for this reason you should consider using condoms as well.

If you are a concession card holder or eligible for the Medicare Safety Net, the price of the IUD may be reduced. Some sexual health clinics may offer low cost or free IUD insertion for sex workers.

The hormonal and Copper IUDs have a number of side effects that may be experienced by some users: 

  • The IUD may expel itself from the uterus. This usually occurs during a period and you may not be aware that it is happening. Your doctor should inform you how to check that the IUD is still in place.
  • On rare occasions, IUDs can fail and allow a pregnancy to occur. If this happens, you must get immediate medical attention as there is an increased risk of complications, such as having a miscarriage or the fertilised egg implanting itself in the fallopian tubes (ectopic pregnancy). 
  • Within the first three weeks, there is a small risk of infection following insertion of the IUD. 
  • Some people experience irregular bleeding or periods that usually clear after three to five months. Eventually, hormonal IUDs significantly reduce the frequency of periods. For people using Copper IUDs, your regular bleeding pattern should return. However, for some, Copper IUDs may cause periods to become heavier and more painful. 
  • On rare occasions, the IUD may puncture the uterus wall when it is being inserted and cause problems. 
  • IUDs can increase your risk of developing pelvic infections. If untreated, pelvic infections can lead to a loss of fertility, amongst other problems. For this reason, it is important that you continue to protect yourself from STIs and BBVs and regularly get sexual health check-ups. 

The hormonal IUD can have additional side effects, including slightly increased likelihood of vaginal dryness, tender breasts, mood changes, flushing, headaches, nausea, and acne. For most IUD users, these side effects settle over time.

This is not an exhaustive list of side effects. It is recommended you discuss the potential side effects with your healthcare provider. If you are experiencing any side effects or have concerns about your IUD, it is recommended that you consult your healthcare provider immediately. 

Emergency Contraception (‘The Morning After Pill’)

Health providers have stopped using the term ‘morning after pill’, because the term implied that it could only be used the morning after. In fact, there are various emergency contraceptive options available. There are two types of over-the-counter, single dose contraceptive pills available, one of which you must take within 72 hours (three days) and the other you can take up to 120 hours (five days) after having unprotected sex. However, the sooner you take it, the more effective it is. It is recommended that you take the emergency contraception within 72 hours (three days). Emergency contraception works like the contraceptive pill, stopping sperm fertilising the egg and/or stopping a fertilised egg implanting in the womb. Like the contraceptive pill, there may be side effects like spotting, sore breasts, and nausea. Emergency contraception should only be used in ‘emergency’ situations, not as a regular means of preventing pregnancy. Alternatively, copper IUDs (Intrauterine Devices) are considered the most effective method of emergency contraception, with a failure rate less than 1% if inserted within 5 days of unprotected sex. Copper IUDs also provide long term contraception.

It is recommended that you tell your healthcare provider about any pre-existing conditions you may have or any other prescription or non-prescription, including herbal medications you are taking as the emergency contraceptive pill may interact with other conditions and medications. 

There are a number of different brands of emergency pills you can purchase over the counter. The emergency pill is generally considered very safe. However, some people may experience side-effects including: 

  • Changes to your mood 
  • Changes to your period   
  • Nausea
  • Abdominal discomfort 
  • Tender or sore breasts
  • Headaches 
  • Dizziness 

If you are interested in finding more information on a particular brand of emergency contraception, ask your pharmacist or health care professional for a Consumer Medicine Information leaflet on the medication. 

Injection 

The Contraceptive Injection is sold in Australia as Depo-ProveraTM or Depo-RaloveraTM. The Injection contains the hormone depot medroxyprogesterone acetate (DMPA), which is a synthetic form of progesterone. The Contraceptive Injection provides protection from pregnancy for approximately 3 months. It works by preventing an egg from being released from your ovaries. It can also thicken the fluid at the opening of your uterus, making it more difficult for sperm to get through. The Contraceptive Injection is between 99-94% effective at preventing pregnancy.  

Depo-ProveraTM or Depo-RaloveraTM is also prescribed by healthcare providers to treat other issues such as endometriosis and certain types of cancer. 

There are a number of conditions and medications that interact with the Contraceptive Injection. For this reason, it is advised that you discuss any existing conditions and medications you are taking with a healthcare professional before using the Injection. 

Common side effects of the Contraceptive Injection include: 

  • Changes in the frequency and heaviness of your period. However, long term use of the Contraceptive Injection usually makes bleeding patterns lighter and much less frequent. 
  • Difficulty becoming pregnant 12-18 months after your last Contraceptive Injection as it may take up to 18 months after your last Contraceptive Injection for your normal bleeding pattern to return. 
  • Reduction in bone density. However, this can be reversed after your stop using the Contraceptive Injection.  Because of reduction in bone density, it should not be used for more than 2 years unless closely monitored by your doctor.

There are also a number of rare side-effects associated with the Contraceptive Injection. For more information see Depo-ProveraTM and Depo-RaloveraTM.

Contraceptive Vaginal Ring

The contraceptive vaginal ring is a soft ring that contains the hormones oestrogen and progesterone. It is inserted into the vagina, and once the hormones are absorbed into your body, it prevents you from getting pregnant. The vaginal ring can remain in your vagina for three weeks. On the fourth week, it must be taken out for a week and replaced with a new one at the end of the week. The ring works in a similar way to the oral contraceptive pill, by stopping your ovaries from releasing an egg.

The NuvaRing is the only brand of vaginal ring available in Australian pharmacies. The vaginal ring is not subsidised by the Pharmaceutical Benefits Scheme, so it can be more expensive than other forms of contraception. Additionally, the ring has interactions with some types of medications, including herbal and non-prescription medications. The NuvaRing is not recommended for people over 35 who smoke and people living with conditions such as deep venous thrombosis, diabetes, lupus, heart disease, liver disease, and certain types of migraines. This is an incomplete list, and it is recommended that you talk to your doctor about your suitability for the vaginal ring before using this type of contraception. The vaginal ring does not protect you from STIs or BBVs.

NuvaRing has a number of common and uncommon side effects, including: 

  • Mood changes
  • Abdominal pain
  • Nausea
  • Bloating
  • Discomfort or irritation in the vagina due to the ring
  • Increased secretions from the vagina
  • Headaches or migraines 
  • Lower sex drive 
  • Breast pain 
  • Changes to your skin 
  • Increased appetite 
  • Changes to bleeding patterns (e.g. periods can become more painful, heavier, longer, more irregular, or stop altogether).

Rarer side effects include: 

  • Blood clots in veins or arteries. The risk of developing a blood clot is similar to the risk of developing it as a result of using other forms of combined hormonal contraceptives like the contraceptive pill. 
  • Allergic reactions, including hives, swelling of the face, lips, tongue, and throat causing difficulty in breathing or swallowing.  
  • Vaginal injury associated with ring breakage. 
  • Breast discharge. 
  • Discomfort for the partner, such as irritation, rash, and itching. 
  • The development of some types of cancers has been associated with the use of combined hormonal contraceptives such as the NuvaRing or ‘the Pill’.  

Not everyone who uses NuvaRing will experience side effects. If you are experiencing side effects, consult your health care provider. Click here for more information on the NuvaRing. Alternatively, you can ask your health care provider or pharmacist for a Consumer Medicine Information leaflet. 

Diaphragms

Diaphragms are round and made of latex with a circular spring. They cover the neck of the womb and extend behind the pubic bone and also protect the interior of the vaginal wall. They block the sperm from entering the uterus. There are two types of diaphragms: one that must be fitted by a doctor (also known as the traditional diaphragm) and one that you can insert yourself. The traditional diaphragm is being withdrawn from the Australian market. Alternatively, the diaphragm that you can insert yourself is currently available in Australia. There is only one size that is estimated to fit 80% of vaginas. We do not recommend the use of spermicides containing Nonoxynol-9 with the of a diaphragm because recent research shows it may increase your risk of contracting a STI or HIV. Lubricant can be used to help insert the diaphragm. The diaphragm is inserted into the vagina prior to intercourse and should not be taken out between sexual partners. In order for the diaphragm to be effective, it must be kept in the vagina 6 hours after intercourse to ensure that sperm is killed by normal vaginal secretion. Diaphragms can be left inside for up to 24 hours at a time.

The diaphragm should be checked if you lose or gain more than 3kg in weight and after an abortion, birth, miscarriage, or gynaecological surgery. If the diaphragm is uncomfortable for you or your sexual partner, if it moves during penetration, or if it increases constipation or Urinary Tract Infections, you should get it checked at your local sexual health clinic or doctor.

The diaphragm on its own does not protect you against HIV or other STIs, as the infection can still enter through tiny tears in the mucous membranes which line your vagina. For this reason, you should consider using condoms as well.

Spermicides

Spermicides are contraceptives, designed to prevent pregnancy by killing sperm. It used to be thought that an ingredient of spermicide (Nonoxynol-9) could also kill STIs, including HIV. However, studies indicate that Nonoxynol-9 can actually increase the risk of STI and HIV transmission, by causing sores and irritation inside the vagina, on the penis, or anus. Because of this, spermicides containing Nonoxynol-9 are not recommended for use in situations where the STI and HIV status of your sexual partner is unknown, such as in sex work. Where pregnancy is unlikely or impossible, spermicide has no benefit and is not recommended at all. Additionally, spermicides are not considered an effective contraceptive method when used alone.

Sterilisation 

There are two types of sterilisation procedures: Tubal Ligation and Vasectomy. 

Tubal Ligation

Tubal Ligation, also referred to as ‘having your tubes tied’, is a permanent form of contraception for people with fallopian tubes. The procedure is performed in hospital under general anaesthetic. Tubal Ligation usually uses keyhole surgery to clamp, cut or seal by heat the fallopian tubes to block the ovum from meeting the sperm, preventing a pregnancy from happening. In some instances, it may be necessary to make a larger incision in the abdomen to perform the operation. After a Tubal Ligation, the released eggs become trapped in the fallopian tubes where the body naturally dissolves them. The procedure does not affect the functioning of your ovaries, hormones or menstrual cycle and does not bring on menopause or impact your sex drive.  

Usually Tubal Ligation is a safe and simple procedure with a short recovery time. Some patients may experience nausea, shoulder pain, abdominal pain or discomfort, and cramping following the surgery. Possible risks of Tubal Ligation include: 

  • Allergic reaction to the anaesthetic.
  • Infection, inflammation, and on-going pain.
  • Very heavy bleeding. 
  • Infection in and around the area where the surgery was performed. 
  • Injury to other nearby organs during the operation, such as bowel or ureter.  

It is recommended that people who undergo Tubal Ligation surgery have regular check ups with their health care professional to manage any impacts of surgery. Tubal Ligation is considered 99% effective. There is a very small risk that the tubes could become unblocked, allowing the ovum and the sperm to meet and a pregnancy to occur. People who become pregnant after having a Tubal Ligation are at significantly higher risk of having an ectopic pregnancy. Even though Tubal Ligation is considered a permanent form of contraception, the procedure can be reversed. The success of the Tubal Ligation reversal is dependent on the age of the individual and the way the procedure was performed. Reversal of Tubal Ligation can also be very expensive. People who have had a Tubal Ligation reversal will have significantly more trouble becoming pregnant. There is also a higher risk of ectopic pregnancy after a Tubal Ligation reversal. However, Tubal Ligation does not prevent you from getting IVF or other forms of assisted pregnancy. 

Vasectomy

A Vasectomy involves cutting and sealing shut the tube that carries the sperm from the testes to the penis, preventing the sperm coming out in the ejaculate. It is generally a simple and safe procedure and is performed under local anaesthetic. A Vasectomy is considered a very effective form of contraception, with a failure rate of 1 in 1000. However, following a Vasectomy, you must wait several months and ejaculate a number of times to remove any sperm left behind in the tubes before a Vasectomy is effective in preventing pregnancy. A sperm test at least three months after surgery is required to determine whether the Vasectomy has successfully blocked the sperm. Vasectomies do not interfere with the production of sperm, hormones, your ability to get an erection or become aroused, or ejaculate. Some will experience swelling, pain and bruising in the penis and scrotum post-surgery. 

There are three different types of Vasectomy procedures: close-ended, open-ended and ‘no scalpel’ Vasectomy procedures. A close-ended Vasectomy involves blocking both ends of the tube that allows sperm to flow from the testes to the penis. This form of Vasectomy can sometimes lead to patients experiencing tenderness as a result of sperm build up where the testes meet the tube. An open-ended Vasectomy, on the other hand, blocks the tube closer to the penis, allowing sperm to flow further down the tube before it is trapped. The trapped sperm is naturally absorbed by the body. An open-ended Vasectomy prevents tenderness as a result of sudden sperm build-up near where the tube meets the testes. A ‘no scalpel’ procedure refers to a way of performing a Vasectomy by making only one incision to the body and no sutures are required. Usually, a Vasectomy is performed by making two incisions and sutures are required. The ‘no scalpel’ Vasectomy procedure generally has a shorter recovery time compared to the traditional Vasectomy procedure. 

Vasectomies are considered a permanent form of contraception; however, it can sometimes be reversed. Although it is sometimes possible to reconnect the tube from your testes to your penis, the success of the reversal is dependent on the type of Vasectomy you have and how long after your surgery you get the reversal. It may also be very expensive to get a Vasectomy reversal. It is possible to retrieve sperm directly from the testes with assistive reproductive techniques, such as IVF.