The different types of contraception

A woman can get pregnant if a man's sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the cap.

The contraceptive cap is a circular dome made of thin, soft silicone. It's inserted into the vagina before sex, and covers the cervix so that sperm cannot get into the womb. You need to use spermicide with it (spermicide kills sperm). Spermicide comes as gel, creams, foams and pessaries.

The cap must be left in place for 6 hours after sex. After that time, you take out the cap and wash it. Caps are reusable. Some brands come in different sizes. They're designed so that you can choose the best one for yourself.

At a glance: facts about the cap

There are 2 types of cap available just now, Femcap and Caya. Femcap comes in 3 sizes. The size you use depends on whether you've been pregnant before. Caya comes in one size. Femcap and Caya are designed so you can fit them yourself.

There aren't many high-quality studies of caps. It's generally thought that when used correctly with spermicide, the cap is 92 to 96% effective at preventing pregnancy. This means that between 4 and 8 women out of every 100 who use a cap as contraception will become pregnant in a year.

In real world use at least 12 women in 100 a year become pregnant because people forget to use the cap or don't put it in properly (88% effective).

There are no serious health risks of using the cap.

A cervical cap can be inserted with spermicide any time before intercourse.

You should use more spermicide if the cap has been in place for 3 hours or more before sex, or if sex is repeated with the cap in place.

A cervical cap shouldn't be removed until at least 6 hours after the last time you had sex.

It can take time to learn how to use a cap.

If you have a baby, miscarriage or abortion, you may need to be fitted with a new size of cap.

By using condoms as well as a cap, you'll help to protect yourself against sexually transmitted infections (STIs).

How the cap works

A cap, like a diaphragm, is a barrier method of contraception. It fits inside your vagina and prevents sperm from passing through the entrance of your womb (the cervix).

About 80% of women find a cap that fits them. You can get a cap at some GP practices, sexual health clinics, and some young people's services.

To be effective in preventing pregnancy, the cap needs to be used in combination with spermicide, which is a chemical that kills sperm.

You only need to use a cap when you have sex. You must leave it in for at least 6 hours after the last time you have sex. You can leave it in for up to 48 hours.

For the best protection against STIs, it's advised that you use a condom as well.

Inserting a contraceptive cap

Caps come with instructions and are all inserted in a similar way.

1. With clean hands, fill one third of the cap with spermicide, but do not put any spermicide around the rim, as this will stop the cap staying in place.
2. Femcap has a groove between the dome and the rim – some spermicide should also be placed there.
3. Squeeze the sides of the cap together and hold it between your thumb and first two fingers.
4. Slide the cap into your vagina, upwards.
5. The cap must fit neatly over your cervix – it stays in place by suction.
6. Some women squat while they put their cap in, while others lie down or stand with one foot up on a chair – use the position that's easiest for you.
7. You can insert a cap up to 3 hours before you have sex – after this time, you'll need to take it out and put some more spermicide on it.

When you get a cap, practice using it before you rely on it for contraception. This gives you the chance to learn how to use it properly, see how it feels and find out if it's suitable for you. Until you're confident you're using the cap correctly, you might need to use additional contraception, such as condoms, when you have sex.

If you go back for a follow-up appointment with your doctor or nurse, wear the cap so they can check that it is the right size and you have put it in properly.

Removing a cap

A cap can be easily removed by gently hooking your finger under its rim, loop or strap and pulling it downwards and out. You must leave your cap in place for at least 6 hours after the last time you had sex. Sperm can survive up to 6 hours in the vagina so if the barrier is removed too early, you increase your chances of pregnancy.

You can leave a cap in for longer than this, but don't leave it in for longer than the recommended maximum time of 48 hours.

Looking after your cap

After use, you can wash your cap with warm water and mild, unperfumed soap. Rinse it thoroughly, then leave it to dry. You'll be given a small container for it, which you should keep in a cool, dry place. Never boil a cap.

Your cap may become discoloured over time, but this doesn't make it less effective.

Always check your cap for any signs of damage before using it.

Most women can use the same cap for a year before they need to replace it. You may need to get a different sized cap if you have a baby, miscarriage or abortion. If caps no longer fit, you could consider a diaphragm.

Who can use the cap

Most women are able to use contraceptive caps. However, they may not be suitable for you if you:

• have an unusually shaped or positioned cervix (entrance to the womb), or if you cannot reach your cervix
• have a sensitivity or an allergy to the chemicals in spermicide
• have ever had toxic shock syndrome (a rare, but life-threatening bacterial infection)
• currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap)
• are not comfortable touching your vagina

Spermicides that contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an STI. If you're at a high risk of getting an STI, for example, if you have multiple sexual partners, a cap may not be the best choice for you.

A cap may be less effective if:

• it's damaged – for example, it is torn or has holes
• it's not the right size for you
• you use it without spermicide
• you do not use extra spermicide with your cap every time you have more sex
• you remove it too soon (less than 6 hours after the last time you had sex)

If any of these things happen, or you have had sex without contraception, you may need emergency contraception.

You can use a cap after having a baby, but you may need a different size. It's recommended that you wait at least 6 weeks after giving birth before using a contraceptive cap. You can use a cap after a miscarriage or abortion, but you may need a different size.

Advantages and disadvantages of the cap

A cap has the following advantages:

• you only need to use it when you want to have sex
• you can put it in at a convenient time before having sex (do not forget to use extra spermicide if you have it in for more than 3 hours)
• there are no serious associated health risks or side effects

A cap has the following disadvantages:

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

Risks of the cap

There are no serious health risks associated with using a contraceptive cap.

Where you can get the cap?

You can buy a cap from your pharmacy or online. Other places where you can get a cap include:

• some GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people's services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you're safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

The combined oral contraceptive pill is usually known as the pill. It contains synthetic female hormones, oestrogen and progestogen. The hormones in the pill mimic the ones made naturally in the ovaries.

The hormones in the pill stop a woman's ovaries from releasing an egg (ovulating). They also make it difficult for sperm to reach an egg, or for an egg to implant itself in the lining of the womb.

The pill is usually taken to prevent pregnancy, but can also be used to treat:

• painful periods
• heavy periods
• premenstrual syndrome (PMS)
• endometriosis

At a glance: the combined pill

When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than 1 woman in 100 who use the combined pill as contraception will get pregnant in a year.

In real world use, about 8 in 100 women who use the combined pill a year become pregnant due to incorrect use such as forgetting to take pills (92% effective).

You need to take the pill every day for 21 days, then stop for 7 days, and during this week you have a period-type bleed. You'll still be protected against pregnancy during these 7 days. You start taking the pill again after 7 days.

You need to take the pill at the same time every day. If you don't, you could get pregnant. You can also get pregnant if you miss a pill, or vomit or have severe diarrhoea.

Minor side effects include mood swings, breast tenderness and headaches.

There is no evidence that the pill makes women gain weight.

There's a very low risk of serious side effects, such as blood clots and cervical cancer.

The combined pill is not suitable for women over 35 who smoke, or women with certain medical conditions.

The pill does not protect against sexually transmitted infections (STIs). Using a condom as well will help to protect you against STIs.

How the combined pill works

The pill prevents the ovaries from releasing an egg each month (ovulation). It also:

• thickens the mucus in the neck of the womb, so it's harder for sperm to reach an egg
• thins the lining of the womb, so there's less chance of a fertilised egg implanting into the womb and being able to grow

Although there are many different brands of pill, there are 3 main types.

Monophasic 21-day pills

This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. Microgynon, Rigevidon and Brevinor are examples of this type of pill.

Phasic 21-day pills

Phasic pills contain 2 or 3 sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills are taken for the next 7 days. Phasic pills need to be taken in the right order. Synphase and Logynon are examples of this type of pill.

Every day (ED) pills

There are 21 active pills and 7 inactive (dummy) pills in a pack. The 2 types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED and Logynon ED are examples of this type of pill.

Follow the instructions that come with your packet. If you have any questions about how to take the pill, ask your GP, nurse or pharmacist. It's important to take the pills as instructed. Missing pills or taking them at the same time as certain medicines may make them less effective.

How to take 21-day pills

1. Take your first pill from the packet marked with the correct day of the week, or the first pill of the first colour (phasic pills).
2. Continue to take a pill at the same time each day until the pack is finished.
3. Stop taking pills for 7 days (during these 7 days you'll get a bleed).
4. Start your next pack of pills on the eighth day, whether you are still bleeding or not. This should be the same day of the week as when you took your first pill.

How to take every day pills

1. Take the first pill from the section of the packet marked 'start'. This will be an active pill.
2. Continue to take a pill every day, in the correct order and preferably at the same time each day, until the pack is finished (28 days).
3. During the 7 days of taking the inactive pills, you'll get a bleed (like a period).
4. Start your next pack of pills after you have finished the first, whether you are still bleeding or not.

Starting the combined pill

Most women can start the pill at any time in their menstrual cycle. There is special guidance if you have just had a baby, abortion or miscarriage. You may need to use additional contraception during your first days on the pill. This depends on when in your menstrual cycle you start taking it.

If you start the combined pill on the first day of your period (day 1 of your menstrual cycle) you'll be protected from pregnancy straight away. You will not need any additional contraception.

If you start the pill on the fifth day of your period or before, you'll still be protected from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you'll need additional contraception, such as condoms, until you have taken the pill for 7 days.

If you start the pill on any other day of your cycle, you will not be protected from pregnancy straight away. You'll need additional contraception until you have taken the pill for 7 days.

Taking pill packs back-to-back (continuously)

For monophasic pills, you can run packs together.

What happens when I take the pill in the usual way?

When you take the combined pill it prevents ovulation (the release of an egg from your ovaries). There are also some changes in the lining of your womb in the 3 weeks that you take the pill. When you stop your pill for your 7 day break, the withdrawal of hormones allows the womb lining to break down so you have a period-like bleed. If you don’t have the 7 day break, the lining of the womb remains unchanged (blood does not build up).

If you do not want to have a bleed every month, you can safely continue your pill taking and have fewer bleeds. If you do this correctly, the pill remains as effective.

Can I run 2 strips together?

This would give you 7 to 8 bleeds each year instead of 13. Take 6 weeks of pills (2 foil strips in a row) then have a 7 day break. During the break you'll usually have a bleed. After your 7 day break, start a new strip on the same day of the week as you started the previous strips.

Can I run 3 strips together?

This would give you 5 bleeds a year. Take 9 weeks of pills (3 foil strips in a row) and then have a 7 day break. During the break you'll usually have a bleed. After your 7 day break start a new strip on the same day of the week as you started the previous strips.

Can I take my pill continuously?

Take your pill continuously until you have bleeding for 3 to 4 days then stop the pill (as long as you've taken the pill for at least 21 days continuously). You only need to be off the pill for 4 days but this does mean restarting your pills on a different day of the week so you may prefer just to have the 7 day break. Do not stop taking your pills for more than 7 days.

I have been taking the pills like this and I have some bleeding. What do I do?

This is not usually harmful, and if you have not missed pills or taken a break longer than 7 days, your pill will still be effective. Continue with your pills as normal. If your unpredictable bleeding persists, contact your GP or sexual health service for advice.

What to do if you miss a pill

If you miss a pill or pills, or you start a pack late, this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:

• when the pills are missed
• how many pills are missed

A pill is late when you have forgotten to take it at your usual time. You've missed a pill when it's more than 24 hours since the time you should have taken it. Missing one pill anywhere in your pack or starting the new pack one day late isn’t a problem. You'll still be protected against pregnancy (known as having contraceptive cover).

However, missing 2 or more pills, or starting the pack 2 or more days late (more than 48 hours late) may affect your contraceptive cover. In particular, if you make the 7-day pill-free break longer by forgetting 2 or more pills, your ovaries might release an egg and there is a risk of getting pregnant. This is because your ovaries are not getting any effect from the pill during the 7-day break.

If you miss a pill, follow this advice. If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.

If you have missed 1 pill, anywhere in the pack:

• take the last pill you missed now, even if it means taking 2 pills in one day
• continue taking the rest of the pack as usual
• you don’t need to use additional contraception, such as condoms
• take your 7-day pill-free break as normal

If you have missed 2 or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:

• take the last pill you missed now, even if it means taking 2 pills in one day
• leave any earlier missed pills
• continue taking the rest of the pack as usual and use an extra method of contraception for the next 7 days
• you may need emergency contraception
• you may need to start the next pack of pills without a break

Read further information on missed pills and extra pills

You may need emergency contraception if you've had unprotected sex in the previous 7 days and have missed 2 or more pills (you are taking your pill more than 48 hours late) in the first week of a pack.

Get advice from your contraception clinic, doctor or pharmacist about this. You can also phone 111.

Starting the next pack after missing 2 or more pills

If there are 7 or more pills left in the pack after the last missed pill:

• finish the pack
• have the usual 7-day break

If there are fewer than 7 pills left in the pack after the last missed pill:

• finish the pack and start the new one the next day, without having a break

Vomiting and diarrhoea

If you vomit within 2 hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception while you're ill and for 2 days after recovering.

Very severe diarrhoea (6 to 8 watery stools in 24 hours) may also mean that the pill doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for 2 days after recovering.

Speak to your GP or contraception nurse or phone 111 for more information, or if your sickness or diarrhoea continues.

Who can use the combined pill?

The combined pill is not suitable for everyone. If you're thinking of using it, your doctor or nurse will need to ask you about your health and your family’s medical history, to make sure it's right for you. It's very important to tell them about any illnesses or operations you've had, or medications you're currently taking.

You should not use the combined pill if you:

• are pregnant or think you may be pregnant
• are breastfeeding
• smoke and are 35 or over
• are 35 or over and stopped smoking less than a year ago
• are very overweight
• take certain medicines, such as some antibiotics, St John’s Wort or medicines used to treat epilepsy, tuberculosis (TB) or HIV

You will also not be able to use the combined pill if you have (or have had):

• thrombosis (blood clots) in a vein or artery
• a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
• migraine with aura (warning signs)
• breast cancer
• disease of the liver or gallbladder
• diabetes with complications, or diabetes for more than 20 years

After having a baby

If you have just had a baby and are not breastfeeding, you can start the pill on day 21 after the birth. You'll be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you'll need additional contraception (such as condoms) for the next 7 days.

If you're breastfeeding a baby less than 6 months old, taking the pill can reduce your flow of milk. It's recommended that you use a different method of contraception until you stop breastfeeding.

After a miscarriage or abortion

If you have had a miscarriage or abortion, you can start the pill up to 5 days after this and you'll be protected from pregnancy straight away. If you start the pill more than 5 days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for 7 days.

Advantages and disadvantages of the combined pill

Some advantages of the pill are that it:

• doesn't interrupt sex
• usually makes your bleeds regular, lighter and less painful
• reduces your risk of cancer of the ovaries, womb and colon
• can reduce symptoms of PMS
• can sometimes reduce acne
• may protect against pelvic inflammatory disease
• may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some disadvantages of the pill are:

• it can cause temporary side effects at first, such as headaches, nausea, breast tenderness and mood swings – if these do not go after a few months, it may help to change to a different pill
• it can increase your blood pressure
• it does not protect you against sexually transmitted infections
• breakthrough bleeding and spotting is common in the first few months of using the pill
• it has been linked to an increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer

The combined pill with other medicines

Some medicines interact with the combined pill and it doesn't work properly. Some interactions are listed on this page, but it is not a complete list. If you want to check your medicines are safe to take with the combined pill, you can:

• ask your GP, practice nurse, pharmacist or local sexual health clinic
• read the patient information leaflet that comes with your medicine

Antibiotics

The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the combined pill. Other antibiotics do not have this effect.

If you are prescribed rifampicin or rifabutin, you may need additional contraception (such as condoms) while taking the antibiotic. Speak to your doctor or go to the sexual health clinic for advice.

Epilepsy and HIV medicines, and St John's wort

The combined pill can interact with medicines called enzyme inducers. These speed up the breakdown of progestogen by your liver, reducing the effectiveness of the pill.

Examples of enzyme inducers are:

• the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
• St John's wort (a herbal remedy)
• antiretroviral medicines used to treat HIV

Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

Risks of taking the combined pill

There are some risks associated with using the combined contraceptive pill. However, these risks are small and, for most women, the benefits of the pill outweigh the risks.

Blood clots

The oestrogen in the pill may cause your blood to clot more readily. If a blood clot develops, it could cause deep vein thrombosis (clot in your leg), pulmonary embolus (clot in your lung), stroke or heart attack. The risk of getting a blood clot is very small. Your doctor will check if you have certain risk factors that make you more vulnerable before prescribing the pill.

The pill can be taken with caution if you have one of the risk factors below, but you should not take it if you have 2 or more risk factors. These include:

• being 35 years old or over
• being a smoker or having quit smoking in the past year
• being very overweight (in women with a BMI of 35 or over, the risks of using the pill usually outweigh the benefits)
• having migraines (you should not take the pill if you have severe or regular migraine attacks, especially if you get aura or a warning sign before an attack)
• having high blood pressure
• having had a blood clot or stroke in the past
• having a close relative who had a blood clot when they were younger than 45
• being immobile for a long time – for example, in a wheelchair or with a leg in plaster

Cancer

Research is ongoing into the link between breast cancer and the pill. Users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing endometrium (lining of the womb) cancer, ovarian cancer and colon cancer.

Where can you get the combined pill?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

Condoms are the most effective way of preventing sexually transmitted infections (STIs), including HIV. Condoms are also an effective method of contraception.

There are 2 types of condoms: condoms worn on the penis and condoms worn inside the vagina.

Condoms worn on the penis are made from very thin latex (rubber), polyisoprene or polyurethane. They're designed to stop a man's semen from coming into contact with his sexual partner.

Condoms are the only contraception that protect against STIs and pregnancy.

At a glance: condoms

If used correctly every time you have sex, condoms are extremely effective at preventing STIs. Condoms are also 98% effective at preventing pregnancy. This means that 2 out of 100 women using male condoms as contraception will become pregnant in a year.

In real world use, about 15 in every 100 women a year who use condoms as contraception become pregnant (85% effective). This is due to incorrect use, condoms bursting, or slipping off.

In most areas you can get free condoms from sexual health clinics and some GP practices, pharmacies or young people's clinics. In many areas you may be able to have free condoms delivered by post.

Oil-based products, such as moisturiser, lotion and Vaseline, can make latex and polyisoprene condoms less effective. Oil-based products are safe to use with condoms made from polyurethane.

Water and silicon-based lubricant, available in pharmacies and sexual health clinics, is safe to use with all condoms.

It's possible for a condom to slip off during sex. If this happens, you may need emergency contraception or Post Exposure Prophylaxis (PEP) for HIV, and to get checked for STIs.

Condoms need to be stored in places that aren't too hot or cold, and away from sharp or rough surfaces that could tear them or wear them away.

Putting on a condom can be an enjoyable part of sex. It doesn't have to feel like an interruption.

If you're sensitive to latex, you can use polyurethane or polyisoprene condoms instead.

A condom must not be used more than once. Use a new one each time you have sex.

Condoms have a use-by date on the packaging. Don't use out-of-date condoms.

Always use condoms that have the BSI kite mark and the CE mark on the packet. This means that they've been tested to high safety standards.

How a condom works

Condoms are a barrier method of protection. They can prevent the spread of STIs by stopping contact between the condom wearer's penis and a sexual partner's skin, especially the thin moist skin found on the tip of the penis, vulva, vagina and anus and any sexual fluids like semen or vaginal fluids. Condoms can prevent pregnancy by stopping sperm from reaching an egg by creating a physical barrier between them. Condoms can also protect against STIs if used correctly during vaginal, anal and oral sex.

It's important that the man's penis does not make contact with the woman's vagina or anus before a condom has been put on. This is because semen can come out of the penis before a man has fully ejaculated (come). If this happens, or if semen leaks into the vagina or anus while using a condom, seek advice as soon as possible.

You can get advice about emergency contraception from your GP, pharmacy or sexual health clinic. You can get advice about PEP to prevent HIV from your sexual health service or A&E.

You should also consider having an STI test.

How to use a condom

1. Take the condom out of the packet, taking care not to tear it with jewellery or fingernails – do not open the packet with your teeth.
2. Place the condom over the tip of the erect penis.
3. If there's a teat on the end of the condom, use your thumb and forefinger to squeeze the air out of it.
4. Gently roll the condom down to the base of the penis.
5. If the condom won't roll down, you're probably holding it the wrong way round. If this happens, throw the condom away because it may have sperm on it, and try again with a new one.
6. Apply plenty water or silicon-based lube if you are having anal sex or if you're having vaginal sex and need more lubrication.
7. After sex, withdraw the penis while it's still erect. Hold the condom onto the base of the penis while you do this.
8. Remove the condom from the penis, being careful not to spill any semen.
9. Throw the condom away in a bin, not down the toilet.
10. Make sure the man's penis does not touch his partner's genital area again.
11. If you have sex again, use a new condom.

Condoms with spermicide

Some condoms come with spermicide on them. Spermicide is a chemical that kills sperm. Spermicides that contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an STI. It's best to avoid using spermicide-lubricated condoms, or spermicide as an extra lubricant.

Who can use condoms?

Most people can safely use condoms. There are many different varieties and brands of male condom. It's up to you and your partner which type of condom you use.

Condoms may not be the most suitable method of contraception for everyone.

Some men and women are sensitive to the chemicals in latex condoms. If this is a problem, polyurethane or polyisoprene condoms have a lower risk of causing an allergic reaction.

Men who have difficulty keeping an erection may not be able to use male condoms. This is because the penis must be erect to prevent semen leaking from the condom, or the condom slipping off.

Advantages and disadvantages of condoms

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

Advantages

When used correctly every time you have sex, condoms are a reliable method of protecting both partners from STIs. They're also effective at preventing pregnancy.

You only need to use them when you have sex. They do not need advance preparation and are suitable for unplanned sex.

In most cases, there are no medical side effects from using condoms.

Condoms are easy to get hold of and come in a variety of shapes, sizes and flavours.

Disadvantages

Some couples find that using condoms interrupts sex. Communicating about sex with your partner can help avoid embarrassment and make sex better.

Condoms are very strong, but may split or tear if not used properly.

Some people may be allergic to latex, plastic or spermicides. You can get condoms that are less likely to cause an allergic reaction.

A man has to pull out after he has ejaculated and before the penis goes soft, holding the condom firmly in place.

If condoms aren't used properly, they can slip off or split. Practice and communication with your partner can help avoid this.

Can anything make condoms less effective?

Sperm can sometimes get into the vagina or anus during sex, even when using a condom. This may happen if:

• the penis touches the area around the vagina or anus before a condom is put on
• the condom splits or comes off
• the condom gets damaged by sharp fingernails or jewellery
• you use oil-based lubricants with latex or polyisoprene condoms – this damages the condom
• you're using medication for conditions like thrush, such as creams, pessaries or suppositories – this can damage latex and polyisoprene condoms and stop them working properly

Do not use 2 condoms at the same time as a form of 'double protection'. The friction is likely to break the condom.

As well as condoms, you can use other forms of contraception, such as the contraceptive pill, for extra protection against pregnancy. Other forms of contraception will not protect you against STIs. You'll still be at risk of STIs if the condom breaks.

Using lubricant

Condoms come ready lubricated to make them easier to use, but you may also like to use extra lubricant, or lube. This is particularly advised for anal sex, to reduce the chance of the condom splitting.

Any kind of lubricant can be used with condoms that are not made of latex. If you're using latex or polyisoprene condoms, do not use oil-based lubricants, such as:

• body oil or lotion
• petroleum jelly or creams (such as Vaseline)

This is because they can damage the condom and make it more likely to split.

If a condom splits or comes off

If the condom splits or comes off, you can get emergency contraception or STI testing at your GP or sexual health clinic. Emergency contraception can also be accessed at most pharmacies.

Depending on the type of pill, you need to take the emergency contraceptive pill up to 72 hours or up to 120 hours (5 days) after unprotected sex. The intrauterine device (IUD) can be used as emergency contraception up to 5 days after sex.

PEP for HIV is available from sexual health clinics and out of hours from A&E.

Risks of using condoms

For most people, there are no serious risks using condoms. Some people are allergic to latex condoms but you can get condoms that are less likely to cause an allergic reaction.

Where can you get condoms?

Everyone can get condoms for free, even if they are under 16. They're available from:

• your local free condom service provider
• sexual health clinics
• some GP practices
• some pharmacies

You can also buy condoms from:

• pharmacies
• supermarkets
• websites
• mail-order catalogues
• vending machines in some public toilets
• some petrol stations

If you buy condoms online, make sure that you buy them from a pharmacy or other legitimate retailer. Always choose condoms that carry the BSI kite mark and the European CE mark as a sign of quality assurance. This means they have been tested to the required safety standards.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

The contraceptive implant is a thin, flexible rod about 4cm long. It's inserted under the skin of your upper arm by a professional.

The implant stops the release of an egg from the ovary by slowly releasing progestogen into your body. Progestogen also thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through your cervix, and less likely for your womb to accept a fertilised egg.

At a glance: the implant

If implanted correctly, it's more than 99% effective. Fewer than 1 woman in 1,000 who have the implant as contraception for 3 years will get pregnant.

It's very useful for women who know they don't want to get pregnant for a while. Once the implant is in place, you don't have to think about contraception for 3 years.

It can be useful for women who can't use contraception that contains oestrogen.

It's very useful for women who find it difficult to take a pill at the same time every day.

If you have side effects or want to have a baby, the implant can be taken out.

Your natural fertility returns very quickly after removal.

When it's first put in, you may feel some bruising, tenderness or swelling around the implant.

In the first year after the implant is fitted, your periods may become irregular, lighter, heavier or longer. This usually settles down after a few months.

Your periods may stop (amenorrhoea). This isn't harmful.

Some medications can make the implant less effective. You should use extra contraception when taking these medications.

The implant does not protect against sexually transmitted infections (STIs). Use condoms as well as the implant to protect yourself against STIs.

There is no evidence to show that the implant causes weight gain.

How the implant works

The implant steadily releases the hormone progestogen into your bloodstream. Progestogen is like the natural hormone progesterone.

The continuous release of progestogen:

• stops a woman releasing an egg every month (ovulation)
• thickens the mucus from the cervix (entrance to the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg
• makes the lining of the womb thinner so that it is unable to support a fertilised egg

The implant can be put in at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant. In Scotland, Nexplanon is the only contraceptive implant currently in use.

Nexplanon is a small, thin, flexible tube about 4cm long. It's implanted under the skin of your upper arm by a doctor or nurse. A local anaesthetic is used to numb the area. The small wound made in your arm is closed with a dressing and does not need stitches. Nexplanon works for 3 years.

The implant can be removed at any time by a specially trained doctor or nurse. It only takes a few minutes to remove, using a local anaesthetic. As soon as the implant has been removed, you'll no longer be protected against pregnancy.

When it starts to work

If the implant is fitted during the first 5 days of your menstrual cycle, you'll be immediately protected against becoming pregnant. If it's fitted on any other day of your menstrual cycle, you will not be protected against pregnancy for up to 7 days. You should use another method during this time, such as condoms.

After giving birth

You can have the contraceptive implant fitted after you have given birth, usually after 3 weeks.

If it's fitted on or before day 21 after the birth, you'll be immediately protected against becoming pregnant.

If it's fitted after day 21, you'll need to use extra contraception, such as condoms, for the following 7 days.

It's safe to use the implant while you are breastfeeding.

After a miscarriage or abortion

The implant can be fitted immediately after a miscarriage or an abortion, and you'll be protected against pregnancy straight away.

Who can use the implant?

Most women can be fitted with the contraceptive implant. It may not be suitable if you don't want irregular bleeding, or if you have a hormone dependent cancer such as breast cancer.

Advantages and disadvantages of the implant

The main advantages of the contraceptive implant are:

• it works for 3 years
• it does not interrupt sex
• it's suitable if you can't use oestrogen-based contraception, such as the combined contraceptive pill, contraceptive patch or vaginal ring
• you don't have to remember to take a pill every day
• it's safe to use while you are breastfeeding
• your fertility should return to normal as soon as the implant is removed
• after the contraceptive implant has been inserted, you should be able to carry out normal activities

Disadvantages

Using a contraceptive implant may have some disadvantages. You should consider these carefully before deciding if it's right for you.

Your periods may change significantly while using a contraceptive implant. Around 20% of women using the implant will have no bleeding, but almost 50% will have infrequent or prolonged bleeding. Bleeding patterns often remain irregular.

These changes are not harmful. If the bleeding is a problem, your GP may be able to give you tablets to help.

Other side effects that some women report are:

• headaches
• acne
• nausea
• breast tenderness
• changes in mood
• loss of sex drive

These side effects usually stop after the first few months. If you have prolonged or severe headaches or other side effects, tell your doctor.

Will other medicines affect the implant?

Some medicines can reduce the implant's effectiveness. These include:

• medication for HIV
• medication for epilepsy
• complementary remedies, such as St John's Wort
• an antibiotic called rifabutin (which can be used to treat tuberculosis)
• an antibiotic called rifampicin (which can be used to treat several conditions, including tuberculosis and meningitis)

These are called enzyme-inducing drugs. If you are using these medicines for a short while, you should use extra contraception during the course of treatment and for 28 days afterwards. The extra contraception could be condoms, or a single dose of the contraceptive injection. The implant can remain in place if you have the injection.

If you're taking enzyme-inducing drugs long term, you may prefer another method of contraception.

Always tell your doctor that you are using an implant if you are prescribed any medicines. Ask your doctor or nurse for more details about the implant and other medication.

Risks of the implant

In rare cases, the area of skin where the implant has been fitted can become infected. If this happens, the area will be cleaned and may be treated with antibiotics.

Where can you get the implant?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse as not all practices fit implants
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people’s services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

The contraceptive injection releases the hormone progestogen into your bloodstream to prevent pregnancy. The 3 types are Depo-Provera, Sayana Press or Noristerat.

At a glance: the contraceptive injection

If used correctly, the contraceptive injection is 99% effective. This means than 1 woman in 100 who use the injection will become pregnant in a year.

In real world use about 6 women in 100 become pregnant in a year because people forget to get their next injection (94% effective).

The injection lasts for 8, 12 or 13 weeks (depending on the type). You don't have to think about contraception every day or every time you have sex.

It can be useful for women who might forget to take the contraceptive pill every day.

It can be useful for women who can't use contraception that contains oestrogen.

It's not affected by medication.

It may provide some protection against cancer of the womb and pelvic inflammatory disease.

Side effects can include weight gain, headaches, mood swings, breast tenderness, and irregular bleeding. The injection can't be removed from your body. So if you have side effects they'll last as long as the injection and for some time afterwards.

Your periods may become more irregular or longer, or stop altogether (amenorrhoea).

It can take up to 1 year for your fertility to return to normal after the injection wears off. So it may not be suitable if you want to have a baby in the near future.

Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones.

The injection does not protect against sexually transmitted infections (STIs). Use condoms as well as the injection to protect yourself against STIs.

How the injection works

There are 3 types of contraceptive injections in the UK.

Depo-Provera

This lasts for 12 weeks and 5 days and is usually given by a health professional into a muscle in your bottom. It sometimes may be given in a muscle in your upper arm.

Sayana Press

This lasts for 13 weeks. It's given under the skin (subcutaneously) in your abdomen or thigh and you'd normally learn to do this yourself.

Noristerat

This lasts for 8 weeks and is less frequently used. It's usually given by a health professional into a muscle in your bottom. It's usually used for short periods of time – for example, if your partner is waiting for a vasectomy.

The contraceptive injection steadily releases a progestogen hormone into your bloodstream. Progestogen is like the natural hormone progesterone, which is released by a woman's ovaries.

The continuous release of progestogen:

• stops a woman releasing an egg every month (ovulation)
• thickens the mucus from the cervix (neck of the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg
• makes the lining of the womb thinner, so that it is unable to support a fertilised egg

The injection can be given at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant.

When it starts to work

If you have the injection during the first 5 days of your cycle, you'll be immediately protected against pregnancy.

If you have the injection on any other day of your cycle, you will not be protected against pregnancy for up to 7 days. Use condoms or another method of contraception during this time.

After giving birth

You can have the contraceptive injection at any time after you have given birth, if you are not breastfeeding. If you are breastfeeding, the injection will usually be given after 6 weeks. It may be given earlier if necessary.

If you start injections on or before day 21 after giving birth, you'll be immediately protected against becoming pregnant.

If you start injections after day 21, you'll need to use extra contraception for the following 7 days.

It's safe to use contraceptive injections while you're breastfeeding.

After a miscarriage or abortion

You can have the injection immediately after a miscarriage or abortion. You'll be protected against pregnancy straight away.

If you have the injection more than 5 days after a miscarriage or abortion, you'll need to use extra contraception for 7 days.

Who can use the contraceptive injection?

Most women can be given the contraceptive injection.

It may not be suitable if you:

• think you might be pregnant
• want to keep having regular periods
• have bleeding in between periods or after sex
• have arterial disease or a history of heart disease or stroke
• have a recent blood clot in a blood vessel (thrombosis)
• have severe liver disease
• have breast cancer or have had it in the past
• have diabetes with complications
• have cirrhosis
• are at risk of osteoporosis

Advantages and disadvantages of the injection

The main advantages of the contraceptive injection are:

• each injection lasts for either 8, 12 or 13 weeks
• the injection does not interrupt sex
• the injection is an option if you cannot use oestrogen-based contraception, such as the combined pill, contraceptive patch or vaginal ring
• you do not have to remember to take a pill every day
• the injection is safe to use while you are breastfeeding
• the injection is not affected by other medicines
• the injection may reduce heavy, painful periods and help with premenstrual symptoms for some women
• the injection offers some protection from pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb

Using the contraceptive injection may have some disadvantages. You should consider these carefully before deciding if it's right for you.

Disrupted periods

Your periods may change significantly during the first year of using the injection. They'll usually become irregular and may be very heavy, or shorter and lighter, or stop altogether. This may settle down after the first year, but may continue as long as the injected progestogen remains in your body.

It can take a while for your periods and natural fertility to return after you stop using the injection. It takes around 8 to 12 weeks for injected progestogen to leave the body. You may have to wait longer for your periods to return to normal if you're trying to get pregnant.

Until you are ovulating regularly each month, it can be difficult to work out when you are at your most fertile. In some cases, it can take 3 months to a year for your periods to return to normal.

Weight gain

You may put on weight when you use the contraceptive injection, particularly if you're under 18 years old and are overweight with a BMI (body mass index) of 30 or over.

Other side effects that some women report are:

• headaches
• acne
• tender breasts
• changes in mood
• loss of sex drive

Depo-Provera, oestrogen and bone risk

Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones. It does not increase your risk of breaking a bone. This isn't a problem for most women, because the bone replaces itself when you stop the injection, and it doesn't appear to cause any long-term problems.

Thinning of the bones may be a problem for women who already have an increased risk of developing osteoporosis. For example, because they have low oestrogen, or a family history of osteoporosis. It may also be a concern for women under 18 because the body is still making bone at this age. Women under 18 may use Depo-Provera, but only after careful evaluation by a doctor or nurse.

Will other medicines affect the injection?

No – the contraceptive injection is not affected by other medication.

Risks of the contraceptive injection

There's a small risk of infection at the site of the injection. In very rare cases, some people may have an allergic reaction to the injection.

Between 1 in 10 and 1 in 100 women using Sayana Press get a dimple at the site of the injection.

Where can you get the contraceptive injection?

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. You can get contraception at:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people’s services (phone 0800 22 44 88 for further information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production. One method of contraception is the patch.

The contraceptive patch is a sticky patch, a bit like a nicotine patch, measuring 5cm by 5cm. It delivers hormones into your body through your skin. In the UK, the patch's brand name is Evra.

It contains the same hormones as the combined pill, and it works in the same way. This means that it:

• prevents ovulation (the release of an egg)
• thickens cervical mucus, which makes it more difficult for sperm to travel through the cervix
• thins the womb lining, making it less likely that a fertilised egg will implant there

At a glance: facts about the patch

When used correctly, the patch is more than 99% effective at preventing pregnancy.

In real world use, at least 8 women in 100 a year become pregnant because they forget to change the patch (92% effective).

Each patch lasts for 1 week. You change the patch every week for 3 weeks, then have a week off without a patch. You'll still be protected against pregnancy during this week.

You don't need to think about it every day, and it's still effective if you vomit or have diarrhoea.

You can wear the patch in the bath, in the swimming pool and while playing sports.

The patch can increase blood pressure, and some women get side effects such as headaches, which may be temporary.

Some women develop a blood clot when using the patch, but this is rare.

The patch may protect against ovarian cancer, womb cancer and colon cancer.

The patch may not be suitable for women who smoke and who are 35 or over, or who weigh 90kg (14 stone) or more.

The patch does not protect against sexually transmitted infections (STIs). Using a condom as well will help to protect you against STIs.

How the patch works

You can use the contraceptive patch on most areas of your body, as long as the skin is clean, dry and not very hairy. For example, your leg, arm or back.

You apply a new patch once a week (every 7 days) for 3 weeks, and then stop using the patch for 7 days. This is known as your patch-free week. During your patch-free week you will get a withdrawal bleed, like a period. This may not always happen.

After 7 patch-free days, you apply a new patch and start the 4-week cycle again. Start your new cycle even if you're still bleeding.

You should not stick the patch on:

• sore or irritated skin
• anywhere it may get rubbed off by tight clothing
• your breasts

When you first start using the patch, you can vary the position every time you use a new patch to reduce your risk of irritation.

When the patch starts to work

If you start using the patch on the first day of your period, it starts working straight away. This means you can have sex without getting pregnant.

If you start using it on any other day, you need to use an extra form of contraception, such as condoms, for the first 7 days.

You can talk to your doctor or nurse for more information about when the patch will start to work, and whether you need to use extra contraception.

What to do if the patch falls off

The contraceptive patch is very sticky and should stay on. It should not come off after a shower, bath, hot tub, sauna or swim, or after exercise.

If the patch does fall off, what you need to do depends on how long it has been off, and how many days you had a patch on before it came off.

If the patch has been off for less than 48 hours:

• stick your patch back on as soon as possible (if it's still sticky)
• if it's not sticky, replace it with a new patch (do not try to hold the old patch in place with a plaster or bandage)
• continue to use your patch as normal and change your patch on your normal change day

If the patch has been off for less than 48 hours before you replace it, you'll still be protected against pregnancy as long as the patch was on properly for 7 days before the patch came off. If this is the case, you do not need to use extra contraception.

If you have had a patch on for 6 days or less before it falls off, you may not be protected against pregnancy. You should use extra contraception, such as condoms, for 7 days.

If the patch has been off for 48 hours or more, or you're not sure how long it has been off:

• apply a new patch as soon as possible and start a new patch cycle (this will now be day 1 of your new cycle)
• use another form of contraception, such as condoms, for the next 7 days

If you had unprotected sex in the previous few days, you may need emergency contraception. Speak to your GP, nurse, local sexual health (GUM) clinic or pharmacist if you're concerned.

What to do if you forget to take the patch off

If you forget to take the patch off after week 1 or 2, what you need to do depends on how long you have forgotten it.

If it has been on for less than 48 hours longer than it should have been (8 or 9 days in total) – take off the old patch and put on a new one. Continue to use your patch as normal, changing it on your normal change day. You don’t need to use any extra contraception and you are protected against pregnancy.

If it has been on for 48 hours or more longer than it should have been (10 days or more in total), start a whole new patch cycle by applying a new patch as soon as possible. This is now week 1 of the patch cycle and you'll have a new day of the week as your start day and change day. Use another method of contraception, such as condoms, for the next 7 days. Ask your doctor or nurse for advice if you have had sex in the previous few days and were not using a condom, as you may need emergency contraception.

If you forget to take the patch off after week 3, take the patch off as soon as possible and start your patch-free break. Start a new patch on your usual start day, even if you are bleeding. This means that you will not have a full week of patch-free days. You'll be protected against pregnancy and do not need to use any extra contraception. You may or may not bleed on the patch-free days.

What to do if you forget to put a patch on after the patch-free week

If you forget to put on a patch at the end of the patch-free week, put a new one on as soon as you remember.

If you put the patch on 48 hours late or less (so the patch-free interval has been 9 days or less), you'll still be protected against pregnancy, as long as you wore the patch correctly before the patch-free interval.

If you put the patch on more than 48 hours late, so the interval has been 10 days or more, you may not be protected against pregnancy. You should use extra contraception, such as condoms, for 7 days. Ask your doctor or nurse for advice if you have had sex in the patch-free interval, as you may need emergency contraception.

Bleeding in the patch-free week

Some women don't always have a bleed in their patch-free week. This is nothing to worry about if you have used the patch properly and have not taken any medication that could affect it.

See your GP or nurse for advice if you are worried, or do a pregnancy test to check if you are pregnant. If you miss more than 2 bleeds, get medical advice.

Who can use the patch?

The contraceptive patch is not suitable for everyone. Your doctor or nurse will ask you about your health and your family’s medical history to make sure the patch is right for you. It's very important to tell them about any illnesses or operations you have had, or medications you are currently taking.

You should not use the patch if you:

• are pregnant or think you may be pregnant
• are breastfeeding
• smoke and are 35 or over
• are 35 or over and stopped smoking less than a year ago
• are very overweight
• take certain medicines, such as some antibiotics, St John’s Wort or medicines used to treat epilepsy, tuberculosis (TB) or HIV

You will also not be able to use the patch if you have (or have had):

• thrombosis (blood clots) in a vein or artery
• a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
• migraine with aura (warning signs)
• breast cancer
• disease of the liver or gallbladder
• diabetes with complications, or diabetes for more than 20 years

Advantages and disadvantages of the patch

If it's used properly, the contraceptive patch is more than 99% effective in stopping you from getting pregnant. This means that if 100 women use the patch according to the instructions, fewer than 1 will get pregnant in a year. Other advantages of the patch are:

• it's very easy to use
• it does not interrupt sex
• unlike the combined oral contraceptive pill, you do not have to think about it every day – you only have to remember to change the patch once a week
• the hormones from the contraceptive patch do not need to be absorbed by the stomach, so it's just as effective even if you vomit or have diarrhoea
• like the pill, it tends to make your periods more regular, lighter and less painful
• it can help with premenstrual symptoms
• it may reduce the risk of ovarian, womb and bowel cancer
• it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some potential disadvantages of the patch are that:

• it may be visible
• it can cause skin irritation, itching and soreness
• it does not protect you against STIs, so you may need to use condoms as well if you have a high risk of getting an STI – for example, if you have multiple sexual partners or are unsure of your partners sexual health
• some women get mild temporary side effects when they first start using the patch, such as headaches, nausea (sickness), breast tenderness and mood changes; these side effects usually settle down after a few months
• bleeding between periods (breakthrough bleeding) and spotting (very light, irregular bleeding) is common in the first few cycles of using the patch; this is nothing to worry about if you are using the patch properly, and you'll still be protected against pregnancy

Some medicines can make the patch less effective. If you are prescribed new medicine or are buying an over-the-counter medicine, ask the doctor or pharmacist for advice. You may need to use an extra form of contraception while you are taking the medicine, and for 28 days afterwards.

Risks of using the patch

There is a very small risk of some serious side effects when you use a hormonal contraceptive, such as the contraceptive patch or combined pill.

Blood clots

The patch slightly increases your chance of developing a blood clot. A blood clot can block a vein (venous thrombosis) or an artery (arterial thrombosis, which may lead to a heart attack or stroke). If you have had a blood clot before, do not use the patch.

Your risk of blood clots is higher during the first year of using the patch. Your risk is also higher if:

• you smoke
• you're very overweight
• you're immobile (unable to move) or use a wheelchair
• you have severe varicose veins
• a close family member had a venous thrombosis before they were 45 years old

The risk of arterial thrombosis is greatest if:

• you smoke
• you're diabetic
• you have high blood pressure (hypertension)
• you're very overweight
• you regularly have migraines with aura (warning signs)
• a close family member had a heart attack or stroke before they were 45

Cancer

Current research suggests that people who use oestrogen and progestogen contraception, such as the contraceptive patch, are at a slightly increased risk of breast cancer compared with people who do not use hormonal contraception. Further research is needed to provide more definitive evidence.

Research also suggests there is a small increase in your risk of developing cervical cancer with the long-term use of oestrogen and progestogen hormonal contraception.

For most women, the benefits of the patch outweigh the risks. Talk about all risks and benefits with your doctor or nurse before starting to use the patch. You will not be allowed to use the patch if you are considered to be at a higher risk of serious side effects.

Where you can get the contraceptive patch?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. When you first get the contraceptive patch you'll be given a 3 month supply to see how you get on with it. If there are no problems, you can be prescribed the patch for 6 months to a year.

Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse
• community sexual health clinics
• some young people’s services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man's sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production. One method of contraception is the diaphragm.

A diaphragm is a circle of silicone inserted into the vagina before sex to cover the cervix so that sperm can't get into the womb (uterus). You need to use spermicide with it (spermicides kill sperm).

The diaphragm must be left in place for at least 6 hours after sex. After that time, you take out the diaphragm and wash it (they're reusable). Diaphragms come in different sizes. You must be fitted for the correct size by a trained doctor or nurse.

At a glance: contraceptive diaphragm

When used correctly with spermicide, a diaphragm is 92 to 96% effective at preventing pregnancy. This means that between 4 and 8 women out of every 100 who use a diaphragm as contraception will become pregnant within a year.

In real world use about 16 women out of every 100 that use a diaphragm a year become pregnant. This is because people forget to use it or don’t put it in properly (84% effective).

Diaphragms may be more effective in women who haven't had a baby.

There are no serious health risks.

You only have to think about it when you have sex.

You can put a diaphragm in several hours before you have sex.

It can take time to learn how to use it.

Some women develop cystitis (a bladder infection) when they use a diaphragm. Your doctor or nurse can check the size – switching to a smaller size may help.

If you lose or gain more than 3kg (7lbs) in weight, or have a baby, miscarriage or abortion, you may need to be fitted with a new diaphragm.

By using condoms as well as a diaphragm, you'll help to protect yourself against sexually transmitted infections (STIs).

How the contraceptive diaphragm works

A diaphragm is a barrier method of contraception. It fits inside your vagina and prevents sperm from passing through the cervix (the entrance of your womb). Diaphragms are soft, thin domes made of silicone, and come in different shapes and sizes.

To be effective in preventing pregnancy, diaphragms need to be used with spermicide, a chemical that kills sperm.

You only have to use a diaphragm when you have sex, but you must leave it in for at least 6 hours after the last time you had sex. You can leave it in for longer than this, but do not take it out before.

When you first start using a diaphragm, a doctor or nurse will examine you and advise on the correct size to suit you. They'll show you how to put in and take out a diaphragm, and also how to use the spermicide, which must be applied every time you use the diaphragm.

A diaphragm provides less protection against STIs than a condom. Spermicides can irritate the skin in the vagina and make it easier for an STI to be passed from your partner. If you're at a high risk of getting an STI – for example, you or your partner has more than one sexual partner – you may be advised to use another form of contraception.

Inserting a diaphragm

Your doctor or nurse will show you how to put in a diaphragm. Diaphragms come with instructions and are all inserted in a similar way.

1. With clean hands, put a small amount of spermicide on each side of the diaphragm. Also putting a little spermicide on the rim may make the diaphragm easier to put in.
2. Put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers.
3. Slide the diaphragm into your vagina, upwards. This should ensure that the diaphragm covers your cervix.
4. Always check that your cervix is covered – it feels like a lump, a bit like the end of your nose.
5. If your cervix is not covered, take the diaphragm out by hooking your finger under the rim or loop (if there is one) and pulling downwards.
6. Some women squat while they put their diaphragm in; others lie down or stand with one foot up on a chair – use the position that's easiest for you.
7. You can insert a diaphragm up to 3 hours before you have sex – after this time, you will need to take it out and put some more spermicide on it.

You may be fitted with a temporary diaphragm by your doctor or nurse. This is for you to practice with at home. It allows you to learn how to use it properly, see how it feels and find out if the method is suitable for you. During this time, you're not protected against pregnancy and need to use additional contraception, such as condoms, when you have sex.

When you go back for a follow-up appointment with your doctor or nurse, wear the diaphragm so they can check that it is the right size and you have put it in properly. When you're happy that you can use a diaphragm properly, they'll give you one to use as contraception.

Removing a diaphragm

A diaphragm can be easily removed by gently hooking your finger under its rim and pulling it downwards and out. You must leave all types of diaphragm in place for at least 6 hours after the last time you had sex.

You can leave them in for longer than this, but do not leave them in for longer than the recommended time of 30 hours.

Looking after your diaphragm

After using, you can wash your diaphragm with warm water and mild unperfumed soap. Rinse it thoroughly, then leave it to dry. You will be given a small container for it, which you should keep in a cool, dry place. Never boil a diaphragm.

Your diaphragm may become discoloured over time, but this does not make it less effective.

Always check your diaphragm or cap for any signs of damage before using it.

You can visit your GP or nurse when you want to replace your diaphragm. Most women can use the same diaphragm for a year before they need to replace it. You may need to get a different size diaphragm if you gain or lose more than 3kg (7lb) in weight, or if you have a baby, miscarriage or abortion.

Who can use a diaphragm?

Most women are able to use a diaphragm. However, they may not be suitable for you if you:

• have an unusually shaped or positioned cervix (entrance to the womb), or if you cannot reach your cervix
• have weakened vaginal muscles (possibly as a result of giving birth) that cannot hold a diaphragm in place
• have had a bladder prolapse repair
• have a sensitivity or an allergy to latex or the chemicals in spermicide
• have ever had toxic shock syndrome (a rare but life-threatening bacterial infection)
• have repeated urinary tract infections (UTI) (infection of the urinary system, such as the urethra, bladder or kidneys)
• currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap)
• are not comfortable touching your vagina
• have a high risk of getting an STI – for example, if you have multiple sexual partners or are unsure of your partners sexual health

Spermicides which contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an infection.

A diaphragm may be less effective if:

• it's damaged – for example, it is torn or has holes
• it's not the right size for you
• you use it without spermicide
• you do not use extra spermicide with your diaphragm every time you have more sex
• you remove it too soon (less than 6 hours after the last time you had sex)

If any of these things happen, or you have had sex without contraception, you may need to use emergency contraception.

You can use a diaphragm after having a baby, but you may need a different size. It's recommended that you wait at least 6 weeks after giving birth before using a diaphragm. You can use a diaphragm after a miscarriage or abortion, but you may need a different size.

Advantages and disadvantages of a diaphragm

Advantages of a diaphragm are:

• you only need to use a diaphragm when you want to have sex
• you can put it in at a convenient time (but do not forget to use extra spermicide if you have it in for more than 3 hours) before having sex
• there are no serious associated health risks or side effects

Disadvantages of a diaphragm are:

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

Risks of a diaphragm

There are no serious health risks associated with using a contraceptive diaphragm.

Where can you get a diaphragm?

Most types of contraception are free in the UK. Contraception is free to everyone through the NHS. Places where you can get contraception include:

• some GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people's services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the female condom.

Female condoms are made from thin, soft plastic called polyurethane. Some male condoms are made from this too. Female condoms are worn inside the vagina to prevent semen getting to the womb.

When used correctly, they help to protect against pregnancy and sexually transmitted infections (STIs), including HIV. Condoms are the only contraception that protect against pregnancy and STIs.

At a glance: facts about the female condom

If used correctly and consistently, female condoms are 95% effective. This means that 5 out of 100 women using female condoms as contraception will become pregnant in a year. In real world use, about 21 women a year out of 100 who use female condoms become pregnant. This is because people forget to use it or don’t put it in properly (79% effective).

Using female condoms protects against both pregnancy and STIs, including HIV.

A female condom needs to be placed inside the vagina before there's any contact between the vagina and the penis.

Female condoms need to be stored in places that aren't too hot or too cold, and away from sharp or rough surfaces that could tear them or wear them away.

Always use condoms that have the CE mark on the packet. This means they've been tested to European safety standards.

A female condom can get pushed too far into the vagina, but it's easy to remove it yourself.

Female condoms may not be suitable for women who are not comfortable touching their genital area.

Do not use a female condom more than once. If you have sex again, use a new female condom.

How female condoms work

The female condom is worn inside the vagina to stop sperm getting to the womb.

It's important to use condoms correctly, and to make sure the penis doesn't make contact with the vagina before a condom has been put in. This is because semen can come out of the penis before a man has fully ejaculated (come). A female condom can be put in up to 8 hours before sex.

How to use a female condom

1. Take the female condom out of the packet, taking care not to tear the condom – do not open the packet with your teeth.
2. Squeeze the smaller ring at the closed end of the condom and insert it into the vagina.
3. Make sure that the large ring at the open end of the female condom covers the area around the vaginal opening.
4. Make sure the penis enters into the female condom, not between the condom and the side of the vagina.
5. Remove the female condom immediately after sex by gently pulling it out – you can twist the large ring to prevent semen leaking out.
6. Throw the condom away in a bin, not down the toilet.

Who can use female condoms?

Most people can safely use condoms. However, they may not be the most suitable method of contraception for women who do not feel comfortable touching their genital area.

Advantages and disadvantages of female condoms

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

Advantages

Advantages of female condoms are:

• they help to protect against many STIs, including HIV
• when used correctly and consistently, condoms are a reliable method of preventing pregnancy
• you only need to use them when you have sex – they do not need advance preparation and are suitable for unplanned sex
• in most cases, there are no medical side effects from using condoms
• they can be inserted up to 8 hours before sex, and mean that women share the responsibility for using condoms with their partner
• any kind of lubricant can be used with female polyurethane condoms

Disadvantages

Disadvantages of female condoms are:

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

Can anything make condoms less effective?

Sperm can sometimes get into the vagina during sex, even when using a condom. This may happen if the:

• penis touches the area around the vagina before a condom is put in
• female condom gets pushed too far into the vagina
• man’s penis enters the vagina outside the female condom by mistake
• condom gets damaged by sharp fingernails or jewellery

Although female condoms (when used correctly) offer reliable protection against pregnancy, using an extra method of contraception will protect you against pregnancy if the female condom fails. If a female condom slips or fails, you can use emergency contraception to help to prevent pregnancy.

If you've been at risk of unintended pregnancy, you're also at risk of catching an STI, so have a check-up at a:

• GP practice
• local sexual health clinic

Risks of using a female condom

There are no serious risks associated with using female condoms.

Where can you get female condoms?

Everyone can get condoms for free, even if they are under 16. They are available from the following places in your local area:

• your local free condom service provider
• sexual health clinics
• some GP practices
• some pharmacies

Some places might only offer male condoms. You can ask the staff whether they provide free female condoms.

You can also buy male and female condoms from:

• pharmacies
• supermarkets
• websites
• mail-order catalogues
• vending machines in some public toilets
• some petrol stations

If you buy condoms online, make sure you buy them from a pharmacist or other legitimate retailer. Always choose condoms that carry the European CE mark or British BSI Kitemark as a sign of quality assurance.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is female sterilisation.

Female sterilisation blocks the fallopian tubes, which link the ovaries to the womb (uterus). This prevents the woman’s eggs from reaching sperm and becoming fertilised. Eggs will still be released from the ovaries as normal, but they'll be absorbed naturally into the woman's body.

Sterilisation is an operation. It's usually carried out under general anaesthetic.

At a glance: facts about female sterilisation

Female sterilisation is more than 99% effective, and only 1 woman in 200 will become pregnant in her lifetime after having it done.

You don't have to think about it every day, or every time you have sex, so it doesn't interrupt or affect your sex life.

You'll still have periods after being sterilised.

You'll need to use contraception until a week after the operation is done or until your next period, depending on which method you use.

As with any surgery, there's a small risk of complications. These include internal bleeding, infection or damage to other organs.

There's a small risk that the operation won't work. Blocked tubes can rejoin immediately or years later.

If the operation fails, this may increase the risk of ectopic pregnancy.

The sterilisation operation is difficult to reverse and isn't available on the NHS.

Female sterilisation doesn't protect against sexually transmitted infections (STIs). You should use condoms if you have a high risk of getting an STI – for example, if you have multiple sexual partners.

How female sterilisation works

Female sterilisation blocks the fallopian tubes. This means a woman's eggs cannot meet sperm, and fertilisation can't happen.

How female sterilisation is carried out

Female sterilisation is usually a minor operation, with most women returning home the same day.

Tubal occlusion

A laparoscopy (keyhole surgery) is the most common method of female sterilisation. The surgeon makes a small cut in your abdominal wall near your belly button and inserts a laparoscope. A laparoscope is a small telescope that contains a tiny light and camera. The camera allows the surgeon to see your fallopian tubes clearly.

A less common way to do female sterilisation is a mini-laparotomy. This is a small incision, usually less than 5cm (2 inches), just above the pubic hairline. Your surgeon can then access your fallopian tubes through this incision. A laparoscopy is usually the preferred option because it's faster. But a mini-laparotomy may be recommended in some cases.

Your surgeon will discuss what is best with you.

Blocking the tubes

The fallopian tubes can be blocked by either:

• applying clips – plastic or titanium clamps are closed over the fallopian tubes
• tying and cutting the tube – this destroys 3 to 4cm (1-1.5 inches) of the tube (usually only used when sterilisation is done at caesarean section)

Removing the tubes (salpingectomy)

If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

Before the operation

If you decide to be sterilised, your GP will usually discuss it with you and refer you to a specialist for treatment. This will usually be a gynaecologist at your nearest NHS hospital. A gynaecologist is a specialist in the female reproductive system.

Your consultation will give you a chance to talk about the operation in detail. You can talk about any doubts, worries or questions that you might have.

Your GP shouldn't refuse to refer you for the procedure, even if they do not believe that it's in your best interest.

If you choose to have a sterilisation, you'll be asked to use contraception until the day of the operation. You'll be asked to continue using contraception until your next period if you're having your fallopian tubes blocked (tubal occlusion).

Sterilisation can be performed at any stage in your menstrual cycle.

Before you have the operation, you'll be given a pregnancy test to make sure that you're not pregnant.

Recovering after the operation

Once you've recovered from the anaesthetic, passed urine and had something to eat, you'll be allowed to go home. If you leave hospital within hours of the operation, ask a relative or friend to pick you up, or take a taxi.

The healthcare professionals treating you in hospital will tell you what to expect and how to care for yourself after surgery. They may give you a contact number to call if you have any problems or any questions.

If you've had a general anaesthetic, do not drive a car for 48 hours afterwards. This is because even if you feel fine, your reaction times and judgement may not be back to normal.

How you will feel

It's normal to feel unwell and a little uncomfortable for a few days if you've had a general anaesthetic. You may have to rest for a couple of days. Depending on your general health and your job, you can normally return to work 5 days after tubal occlusion. You should avoid heavy lifting for about a week.

You may have some slight vaginal bleeding. Use a sanitary towel rather than a tampon until this has gone. You may also feel some pain, similar to period pain. You may be prescribed painkillers for this. If the pain or bleeding gets worse, seek medical attention.

Caring for your wound

You'll have a wound with stitches where the surgeon made the incisions (cuts) into your tummy. Some stitches are dissolvable and disappear on their own, others will need to be removed. If your stitches need removing, you'll be given a follow-up appointment.

If there's a dressing over your wound, you can normally remove this the day after your operation. After this, you will be able to have a bath or shower as normal.

Having sex

Your sex drive and enjoyment of sex will not be affected. You can have sex as soon as it's comfortable to do so after the operation.

You'll need to use contraception until your first period to protect yourself from pregnancy.

Sterilisation will not protect you from STIs. So continue to use barrier contraception such as condoms if you have a high risk of getting an STI. For example, if you have multiple sexual partners or are unsure of your partner's sexual health.

Who can have it done?

Almost any woman can be sterilised, including women that have not had children. Sterilisation should only be considered by women who do not want any more children, or do not want children at all. Once you are sterilised it's very difficult to reverse the process. So it's important to consider the other options available before making your decision. Sterilisation reversal is not available on the NHS.

Research has shown that people who are sterilised before they're 30 are more likely to regret the operation. So women under the age of 30 are particularly advised to consider all other options and be sterilised only if they're sure it's right for them.

Advantages and disadvantages of female sterilisation

Advantages of female sterilisation are that:

• it can be more than 99% effective at preventing pregnancy
• tubal occlusion (blocking the fallopian tubes) and removal of the tubes (salpingectomy) should be effective immediately – you should continue to use contraception until your next period
• it will not affect your sex drive
• it will not affect the spontaneity of sexual intercourse or interfere with sex
• it will not affect your hormone levels

Disadvantages of female sterilisation are that it:

• does not protect you against STIs, so you should still use a condom if you are unsure about your partner's sexual health
• is very difficult to reverse a tubal occlusion and reversal operations are rarely funded by the NHS

Salpingectomy is not reversible. IVF may be an alternative way to get pregnant, but would have to be paid for privately.

Risks of female sterilisation

With tubal occlusion, there is a very small risk of complications. These include internal bleeding and infection or damage to other organs.

It's possible for sterilisation to fail. The fallopian tubes can rejoin and make you fertile again, although this is rare. About 1 in 200 women become pregnant in their lifetime after being sterilised.

If you do get pregnant after the operation, there's an increased risk that it will be an ectopic pregnancy.

If you miss a period, take a pregnancy test immediately. If the pregnancy test is positive, you must see your GP so that you can be referred for a scan to check if the pregnancy is inside or outside your womb.

The risk of complications are:

• the operation cannot be completed because of unexpected findings or difficulties, for example not being able to get into the abdomen (tummy) or not being able to find the fallopian tubes (the surgeon may make a larger cut in the abdomen to complete the operation) – 1 in 180
• perforation (making a hole) in the uterus by one of the instruments – 6 in 1000
• injuries to the bowel, bladder or blood vessels – 3 in 1000 (up to 15 in 100 injuries are not diagnosed at the time of the procedure)
• regret about being sterilised
• hernia at incision (this is a bulge in the skin where the operation was done and there may be bowel in the bulge) – 1 in 100 keyhole procedures
• shoulder tip pain due to the carbon dioxide put into the abdomen during the procedure to help see the fallopian tubes – up to 1 in 10
• death as a result of complications – 1 in 12,000

Where can you get contraception?

Most types of contraception are available free in the UK. Contraception is free to everyone through the NHS. You can get contraception, and information and advice about contraception, at:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people’s services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

An IUD is a small T-shaped plastic and copper device that’s inserted into your womb (uterus) by a specially trained doctor or nurse.

The IUD works by stopping the sperm and egg from surviving in the womb or fallopian tubes. It may also prevent a fertilised egg from implanting in the womb.

The IUD is a long-acting reversible contraceptive (LARC) method. This means that once it's in place, you don't have to think about it each day or each time you have sex. There are several types and sizes of IUD.

You can use an IUD whether or not you've had children.

At a glance: facts about the IUD

There are different types of IUD, some with more copper than others. IUDs with more copper are more than 99% effective. This means that fewer than 1 in 100 women who use an IUD will get pregnant in one year. IUDs with less copper will be less effective.

An IUD works as soon as it's put in, and lasts for 5 to 10 years, depending on the type.

It can be put in at any time during your menstrual cycle, as long as you're not pregnant.

It can be removed at any time by a doctor or nurse and you'll quickly return to normal levels of fertility.

Changes to your periods are common in the first 3 to 6 months after an IUD is put in. For example, your periods may be heavier, longer or more painful. But they're likely to settle down after this. You might get spotting or bleeding between periods.

There's a very small chance of infection within 20 days of the IUD being fitted.

There's a risk that your body may expel the IUD.

If you get pregnant, there's an increased risk of ectopic pregnancy. But because you're unlikely to get pregnant, the overall risk of ectopic pregnancy is lower than in women who don't use contraception.

Having the IUD put in can be uncomfortable. Ask the doctor or nurse about pain relief.

An IUD may not be suitable for you if you've had previous pelvic infections.

The IUD does not protect against sexually transmitted infections (STIs). Use condoms as well as the IUD, to protect yourself against STIs.

How an IUD works

The IUD is like the IUS (intrauterine system) but works in a different way. Instead of releasing the hormone progestogen like the IUS, the IUD releases copper. Copper changes the make-up of the fluids in the womb and fallopian tubes, stopping sperm surviving there. IUDs may also stop fertilised eggs from implanting in the womb.

There are types and sizes of IUD to suit different women. IUDs need to be fitted by a doctor or nurse at your GP practice or sexual health clinic.

An IUD can stay in the womb for 5 to 10 years, depending on the type. If you're 40 or over when you have an IUD fitted, it can be left in until you reach the menopause or until you no longer need contraception.

Having an IUD fitted

An IUD can be fitted at any time during your menstrual cycle, as long as you're not pregnant. You'll be protected against pregnancy straight away.

Before you have an IUD fitted, you'll have an internal examination to find out the size and position of your womb. This is to make sure that the IUD can be put in the correct place.

You may also be tested for infections, such as STIs. It's best to do this before an IUD is fitted so that you can have treatment (if you need it) before the IUD is put in. Sometimes, you may be given antibiotics at the same time as the IUD is fitted.

The fitting process can be uncomfortable and sometimes painful. You may get cramps afterwards. You can ask for a local anaesthetic or painkillers before having the IUD fitted. An anaesthetic injection itself can be painful, so many women have the procedure without.

You may get pain and bleeding for a few days after having an IUD fitted. Discuss this with your doctor or nurse beforehand.

The IUD needs to be checked by a doctor after 3 to 6 weeks. Speak to your doctor or nurse if you have any problems before or after this first check or if you want the IUD removed.

See your GP or go back to the clinic where your IUD was fitted as soon as you can if you have:

• pain in your lower abdomen
• a high temperature
• a smelly discharge

These signs may mean you have an infection. You should also speak to your GP if you think you're pregnant.

It's important that the IUD threads are checked about 6 weeks after it's put in. Most people do this themselves, but you can ask a doctor or nurse to check it for you if you don't want to do it.

How to tell whether an IUD is still in place

An IUD has 2 thin threads that hang down a little way from your womb into the top of your vagina. The doctor or nurse who fits your IUD will teach you how to feel for these threads and check that it's still in place.

Check your IUD is in place a few times in the first month, and then after each period or at regular intervals.

It's very unlikely that your IUD will come out. But if you can't feel the threads, or if you think the IUD has moved, you may not be fully protected against getting pregnant. See your doctor or nurse straight away and use an extra method of contraception, such as condoms, until your IUD has been checked. If you've had sex recently, you may need to use emergency contraception.

Your partner shouldn't be able to feel your IUD during sex. If they can feel the threads, get your doctor or nurse to check that your IUD is in place. They may be able to cut the threads to a shorter length. If you feel any pain during sex, go for a check-up.

Removing an IUD

An IUD can be removed at any time by a doctor or nurse.

If you're not going to have another IUD put in and you don't want to get pregnant, use another method of contraception (such as condoms) for 7 days before you have the IUD removed. This is to stop sperm getting into your body. Sperm can live for up to 7 days in the body and you could become pregnant once the IUD is removed.

As soon as an IUD is taken out, your normal fertility should return.

Who can use an IUD?

Most women can use an IUD. This includes women who have never been pregnant and those who are HIV positive. Your doctor or nurse will ask about your medical history to check if an IUD is the most suitable form of contraception for you.

You should not use an IUD if you have:

• an untreated STI or a pelvic infection
• any unexplained bleeding from your vagina – for example, between periods or after sex, until this has been investigated

You should not be fitted with an IUD if there's a chance that you're already pregnant or if you or your partner are at risk of catching STIs. If you or your partner are unsure, go to your GP or a sexual health clinic to be tested.

Using an IUD after giving birth

An IUD can usually be fitted 4 to 6 weeks after giving birth (vaginal or caesarean). You'll need to use alternative contraception from 3 weeks (21 days) after the birth until the IUD is fitted. In some cases, an IUD can be fitted within 48 hours of giving birth and at the time of a caesarian section. An IUD is safe to use when you're breastfeeding and it won't affect your milk supply.

Using an IUD after a miscarriage or abortion

An IUD can be fitted straight away or within 48 hours after an abortion or miscarriage by a doctor or nurse, as long as you were pregnant for less than 24 weeks. If you were pregnant for more than 24 weeks, you may have to wait a few weeks before having an IUD fitted.

Advantages and disadvantages of an IUD

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

Advantages of an IUD

Advantages of an IUD are that:

• most women can use it, including women who have never been pregnant
• once it's is fitted, it works straight away and lasts for up to 10 years (depending on type) or until it's removed
• it doesn't interrupt sex
• it can be used if you're breastfeeding
• your normal fertility returns as soon as the IUD is taken out
• it's not affected by other medicines
• it does not contain hormones

Disadvantages of an IUD

Disadvantages of an IUD are that:

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

Risks of an IUD

Complications after having an IUD fitted are rare. Most will appear within the first year after fitting.

Perforation of the womb

In rare cases an IUD can perforate (make a hole in) the womb or cervix when it's put in. This happens in fewer than 1 in 1,000 insertions. If the doctor or nurse fitting your IUD is experienced, the risk is extremely low. If perforation occurs, you may need surgery to remove the IUD.

Perforation can cause pain in the lower abdomen but is usually painless. It doesn't usually cause any other symptoms. The first sign is usually that the threads cannot be felt. Although the usual reason for this is that the threads have curled up into the cervix.

Contact your GP or sexual health if you can’t feel the threads after having an IUD fitted.

Pelvic infections

Pelvic infections may occur in the first 21 days after the IUD has been inserted. The risk of infection from an IUD is extremely small. Fewer than 1 in 100 women who are at low risk of STIs will get an infection. Contact the service who put it in for you if you have:

• an unusual discharge
• persistent abdominal pain
• bleeding

Expulsion or displacement

5 in every 100 IUDs are ejected (expelled) by the womb. This is more likely to happen soon after it has been fitted. But it can happen later, which is why you should check the threads once a month. Your doctor or nurse will teach you how to check the threads.

An IUD can move inside the womb. This is called displacement. This can cause spotting between periods and lower abdominal pains like cramp. If you get this speak to your GP or sexual health clinic. There can be other causes which can be checked.

Ectopic pregnancy

If the IUD fails and you become pregnant, your IUD should be removed as soon as possible if you're continuing with the pregnancy. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUD, so an early ultrasound is advisable. You should contact your local early pregnancy unit or GP as soon as possible if you have a positive pregnancy test and an IUD in place. If you have an IUD and severe abdominal pain, a pregnancy test should be done.

Where can you get an IUD?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get an IUD include:

• some GP practices – talk to your GP or practice nurse
• sexual health clinics

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents or carer, as long as they believe you fully understand the information you're given, and your decisions.

Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

An IUS is a small, T-shaped plastic device that is inserted into your womb (uterus) by a specially trained doctor or nurse.

The IUS releases a progestogen hormone into the womb. This thickens the mucus from your cervix, making it difficult for sperm to move through and reach an egg. It also thins the womb lining so that it's less likely to accept a fertilised egg. It may also stop ovulation (the release of an egg) in some women.

The IUS is a long-acting reversible contraceptive (LARC) method. It works for between 3 and 6 years, depending on the type, so you don't have to think about contraception every day or each time you have sex. Three brands of IUS are used in the UK – Mirena, Levosert and Jaydess. There are several brands of IUS available. For example, Benilexa, Levosert, Jaydess, Kyleena and Mirena. Mirena, Levosert and Benilexa have the same amount of horomone (52mcg) in them. Kyleena has less and Jaydess has the least.

You can use an IUS whether or not you've had children.

At a glance: facts about the IUS

It's more than 99% effective. Less than 1 in every 100 women who use a 52mcg IUS will get pregnant in 5 years, and less than one in 100 who use Jaydess will get pregnant in 3 years.

It can be taken out at any time by a specially trained doctor or nurse and your fertility quickly returns to normal.

The IUS can make your periods lighter, shorter or stop altogether, so it may help women who have heavy periods or painful periods. Jaydess is less likely than a 52mcg IUS to make your periods stop altogether.

It can be used by women who can't use combined contraception (such as the combined pill) – for example, those who have migraines.

Some women may experience mood swings, skin problems or breast tenderness. These usually settle in a few weeks.

There's a small chance of getting an infection in the womb after it's inserted. This shows up within 3 weeks after it goes in.

It can be uncomfortable when the IUS is put in, although painkillers can help with this.

The IUS can be fitted at any time during your monthly menstrual cycle, as long as you're definitely not pregnant. Ideally, it should be fitted within 7 days of the start of your period, because this will protect against pregnancy straight away. You should use condoms for 7 days if the IUS is fitted at any other time.

The IUS does not protect against sexually transmitted infections (STIs). Use condoms as well as the IUS, to protect yourself against STIs.

How an IUS works

The IUS works in a different way to the IUD (intrauterine device). Rather than releasing copper like the IUD, the IUS releases a progestogen hormone. This is like the natural hormone progesterone that's produced in a woman's ovaries.

Progestogen thickens the mucus from the cervix (opening of the womb), making it harder for sperm to move through it and reach an egg. It also causes the womb lining to become thinner and less likely to accept a fertilised egg. In some women, the IUS also stops the ovaries from releasing an egg (ovulation), but most women will continue to ovulate.

If you're 45 or older when you have the IUS fitted, it can be left until you reach menopause or you no longer need contraception.

Having an IUS fitted

An IUS can be fitted at any stage of your menstrual cycle, as long as you're not pregnant. If it's fitted in the first 7 days of your cycle, you'll be protected against pregnancy straight away. If it's fitted at any other time, you need to use another method of contraception (such as condoms) for 7 days after it's fitted.

Before you have an IUS fitted, you'll have an internal examination to determine the size and position of your womb. This is to make sure that the IUS can be positioned in the correct place.

You may also be tested for any existing infections, such as STIs. It's best to do this before an IUS is fitted so that any infections can be treated. You may be given antibiotics at the same time as an IUS is fitted.

It takes about 10 to 20 minutes to insert an IUS.

The fitting process can be uncomfortable or painful for some women, and you may also experience cramps afterwards.

You can ask for a local anaesthetic or painkillers before having the IUS fitted. Discuss this with your GP or nurse beforehand. An anaesthetic injection itself can be painful, so many women have the procedure without one.

It's important that the IUS threads are checked about 6 weeks after it is put in. Most people do this themselves, but you can ask a doctor or nurse to check it for you if you don't want to do it.

Also speak to your GP if you or your partner are at risk of getting an STI, as this can lead to infection in the pelvis.

See your GP or go back to the clinic if you have:

• pain in your lower abdomen
• a high temperature
• smelly discharge

This may mean you have an infection. You should also speak to your GP if you think you're pregnant.

How to tell if an IUS is still in place

An IUS has 2 thin threads that hang down a little way from your womb into the top of your vagina. The GP or clinician that fits your IUS will teach you how to feel for these threads and check that the IUS is still in place.

Check your IUS is in place a few times in the first month and then after each period at regular intervals.

It's unlikely that your IUS will come out, but if you can't feel the threads or if you think the IUS has moved, you may not be fully protected against pregnancy. See your doctor or nurse straight away and use extra contraception, such as condoms, until your IUS has been checked. If you've had sex recently, you may need to use emergency contraception.

Your partner shouldn't be able to feel your IUS during sex. If they can feel the threads, get your GP or clinician to check that your IUS is in place. They may be able to cut the threads a little. If you feel any pain during sex, go for a check-up with your GP or clinician.

Removing an IUS

Your IUS can be removed at any time by a doctor or nurse.

If you're not going to have another IUS put in and you don't want to become pregnant, use another contraceptive method (such as condoms) for 7 days before you have the IUS removed. Sperm can live for 7 days in the body and could fertilise an egg once the IUS is removed. As soon as an IUS is taken out, your normal fertility should return.

Who can use an IUS?

Most women can use an IUS, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUS is the most suitable form of contraception for you.

Your family and medical history will determine whether or not you can use an IUS. For example, this method of contraception may not be suitable for you if you have:

• breast cancer, or have had it in the past 5 years
• cervical cancer
• liver disease
• unexplained vaginal bleeding between periods or after sex
• arterial disease or history of serious heart disease or stroke
• an untreated STI or pelvic infection
• problems with your womb or cervix

An IUS may not be suitable for women who have untreated STIs. A doctor will usually give you a check-up to make sure you don't have any existing infections.

Using an IUS after giving birth

An IUS can be fitted 4 weeks after giving birth or during a caesaraen section. You can discuss this with your midwife during your pregnancy. You'll need to use alternative contraception from 3 weeks (21 days) after the birth until the IUS is put in. In some cases, an IUS can be fitted within 48 hours of giving birth. It's safe to use an IUS when you're breastfeeding, and it won't affect your milk supply.

Using an IUS after a miscarriage or abortion

An IUS can be fitted by an experienced doctor or nurse straight after miscarriage or abortion. Discuss this with the staff looking after you.

Advantages and disadvantages of an IUS

Advantages of an IUS are that:

• it works for 3 to 6 years
• it's one of the most effective forms of contraception available
• it doesn't interrupt sex
• it may be useful if you have heavy or painful periods because your periods usually become much lighter and shorter, and sometimes less painful – they may stop completely after the first year of use
• it can be used safely if you're breastfeeding
• it's not affected by other medicines
• it may be a good option if you can't take the hormone oestrogen, which is used in the combined contraceptive pill
• your fertility will return to normal when the IUS is removed

Disadvantages of an IUS are that:

• some women won't be happy with the way that their periods may change – for example, periods may become lighter and more irregular or, in some cases, stop completely; your periods are more likely to stop completely with a 52mcg IUS than with Jaydess
• irregular bleeding and spotting are common in the first 6 months after having an IUS fitted – this is not harmful and usually decreases with time
• some women experience headaches, acne and breast tenderness after having the IUS fitted
• an IUS doesn't protect you against STIs, so you may also have to use condoms when having sex – if you get an STI while you have an IUS fitted, it could lead to pelvic infection if it's not treated
• most women who stop using an IUS do so because of vaginal bleeding and pain, although this is uncommon
• hormonal problems can also occur

Risks of an IUS

Complications are rare.

Perforation of the womb

In rare cases an IUS can perforate (make a hole in) the womb or cervix when it's put in. This happens in fewer than 1 in 1,000 insertions. If the doctor or nurse fitting your IUS is experienced, the risk of perforation is extremely low. If perforation occurs, you may need surgery to remove the IUS.

Perforation can cause pain in the lower abdomen but is usually painless. It doesn't usually cause any other symptoms. The first sign is usually that the threads cannot be felt. Although the usual reason for this is that the threads have curled up into the cervix.

Contact your GP or sexual health if you can’t feel the threads after having an IUS fitted.

Pelvic infections

Pelvic infections may occur in the first 21 days after the IUS has been inserted. The risk of infection from an IUS is extremely small. Fewer than 1 in 100 women who are at low risk of STIs will get an infection. Contact the service who put it in for you if you have:

• an unusual discharge
• persistent abdominal pain
• bleeding

Expulsion or displacement

5 in every 100 IUS are ejected (expelled) by the womb. This is more likely to happen soon after it has been fitted. But can happen later, which is why you should check the threads once a month. Your doctor or nurse will teach you how to check the threads.

An IUS can move inside the womb. This is called displacement. This can cause spotting between periods and crampy lower abdominal pains. If you get this speak to your GP or sexual health clinic. There can be other causes which can be checked.

Ectopic pregnancy

If the IUS fails and you become pregnant, your IUS should be removed as soon as possible if you're continuing with the pregnancy. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUS, so an early ultrasound is advisable. You should contact your local early pregnancy unit or GP as soon as possible if you have a positive pregnancy test and an IUS in place. If you have an IUS and severe abdominal pain a pregnancy test should be done.

Where can you get an IUS?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get an IUS include:

• some GP practices – talk to your GP or practice nurse
• sexual health clinics

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you're safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production.

The progestogen-only pill (POP) is a method of contraception. It contains the hormone progestogen but doesn't contain oestrogen. You need to take the progestogen-only pill at or around the same time every day.

The progestogen-only pill thickens the mucus in the cervix, which stops sperm reaching an egg. It can also stop ovulation, depending on the type of progestogen-only pill you take. Newer progestogen-only pills contain desogestrel.

At a glance: facts about the progestogen-only pill

If taken correctly, it can be more than 99% effective. This means that fewer than 1 woman in 100 who use the progestogen-only pill as contraception will get pregnant in one year.

In real life use about 8 women in 100 will get pregnant in year because they forget to take it (92% effective).

You take a pill every day, with no break between packs of pills.

The progestogen-only pill can be used by women who can't use contraception that contains oestrogen. For example, because they have high blood pressure, have had previous blood clots, are overweight or smoke after the age of 35.

You must take the progestogen-only pill at the same time each day. If you take it more than 3 hours late (or 12 hours late if you take a desogestrel pill, such as Cerazette) it may not be effective.

If you’re sick (vomit) or have severe diarrhoea, the progestogen-only pill may not work.

Some medicines may affect the progestogen-only pill's effectiveness. Ask your doctor for details.

Your periods may stop or become lighter, irregular or more frequent.

Side effects may include spotty skin and breast tenderness. These should clear up within a few months.

The progestogen-only pill doesn’t protect against sexually transmitted infections (STIs). Use condoms as well as the progestogen-only pill to protect yourself against STIs.

How the progestogen-only pill works

The progestogen-only pill works by thickening the mucus in the neck of the womb, so it's harder for sperm to penetrate into the womb and reach an egg.

The progestogen-only pill can prevent ovulation (the release of an egg from your ovaries each month). Non-desogestrel pills stop ovulation about 60% of the time. Desogestrel pills stops ovulation in 97% of menstrual cycles. This means that if you're using a 12-hour progestogen-only pill, you won't release an egg in 97 cycles out of 100.

Using the progestogen-only pill

There are 2 different types of progestogen-only pill:

• 3-hour progestogen-only pill must be taken within 3 hours of the same time each day – for example Norgeston and Noriday
• 12-hour progestogen-only pill (desogestrel pill, such as Cerazette) must be taken within 12 hours of the same time each day

It's important to follow the instructions that come with your pill packet. Missing pills or taking the pill alongside other medicines can reduce its effectiveness.

There are 28 or 35 pills in a pack of progestogen-only pills. You need to take 1 pill every day, within either 3 or 12 hours of the same time each day, depending on which type you are taking. There’s no break between packs of pills. When you finish one pack, you start the next one the next day.

Starting the first pack of pills

1. Choose a convenient time in the day to take your first pill.
2. Continue to take a pill at the same time each day until the pack is finished.
3. Start your next pack of pills the following day. There is no break between packs of pills.

You can start the progestogen-only pill at any time in your menstrual cycle.

If you start the progestogen-only pill on day 1 of your menstrual cycle (the first day of your period) it will work straight away and you'll be protected against pregnancy. You won’t need extra contraception.

If you start the progestogen-only pill on day 5 of your menstrual cycle or earlier (the fifth day after the start of your period or before) you'll be protected from pregnancy straight away unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you'll need extra contraception, such as condoms, until you have taken the pill for 2 days.

If you start the progestogen-only pill on any other day of your cycle, you will not be protected from pregnancy straight away. You'll need extra contraception until you have taken the pill for 2 days.

After having a baby

If you have just had a baby, you can start the progestogen-only pill on day 21 after you give birth. You'll be protected against pregnancy straight away.

If you start the progestogen-only pill more than 21 days after giving birth, you'll need extra contraception (such as condoms) until you have taken the pill for 2 days.

After a miscarriage or abortion

If you have had a miscarriage or abortion, you can start the progestogen-only pill up to 5 days afterwards and you'll be protected from pregnancy straight away.

If you start the pill more than 5 days after a miscarriage or abortion, use extra contraception until you have taken the pill for 2 days.

What to do if you miss a pill

If you forget to take a progestogen-only pill, what you should do depends on:

• the type of pill you are taking
• how long ago you missed the pill
• how many pills you have forgotten to take
• whether you have had sex without using another form of contraception during the previous 7 days

3-hour progestogen-only pill

If you're taking the 3-hour progestogen-only pill and have taken it:

• less than 3 hours late – take the late pill as soon as you remember and take the remaining pills as normal, even if that means taking 2 pills on the same day
• more than 12 hours late – take the late pill as soon as you remember (if you have missed more than 1, take only 1) and take the remaining pills as normal, even if that means taking 2 pills on the same day

In either case, use extra contraception such as condoms for 2 days. If you had sex around the time you missed your pill, you may need emergency contraception. Get advice from your pharmacy or local sexual health clinic.

12-hour progestogen-only pill

If you're taking the 12-hour progestogen-only pill and have taken it:

• less than 12 hours late – take the late pill as soon as you remember and take the remaining pills as normal, even if that means taking 2 pills on the same day
• more than 12 hours late – take the late pill as soon as you remember (if you have missed more than 1, take only 1) and take the remaining pills as normal, even if that means taking 2 pills on the same day

In either case, use extra contraception such as condoms for 2 days. If you had sex around the time you missed your pill, you may need emergency contraception. Get advice from your pharmacy or local sexual health clinic.

Vomiting and diarrhoea

If you vomit within 2 hours of taking a progestogen-only pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you don’t take the replacement within 3 hours (or 12 hours for the 12-hour pill) of your normal time, use extra contraception, such as condoms, for 2 days.

If you continue to be sick, keep using another form of contraception while you’re ill and for 2 days after recovering.

Very severe diarrhoea (6 to 8 watery stools in 24 hours) may also mean that the pill doesn’t work properly. Keep taking your pill as normal, but use extra contraception, such as condoms, while you have diarrhoea and for 2 days after recovering (7 days if you are taking a 12-hour pill).

Speak to your GP or contraception nurse or phone 111 or our Sexual Health Line on 0800 22 44 88 if you are unsure whether you are protected against pregnancy, or if your sickness or diarrhoea continues.

Who can use the progestogen-only pill?

The progestogen-only pill is suitable for almost everyone, even if they have health conditions. It's not advised if you have had a hormone-dependent cancer such as breast cancer. You'll be asked about any health conditions to check the progestogen-only pill is suitable for you.

If you are healthy and there are no medical reasons why you should not take the progestogen-only pill, you can take it until your menopause or until you are 55.

Breastfeeding

The progestogen-only pill is safe to use if you are breastfeeding. Small amounts of progestogen may pass into your breast milk, but this is not harmful to your baby. The progestogen-only pill does not affect the way your breast milk is produced.

Pregnancy

Although it is very unlikely, there is a very small chance that you could become pregnant while taking the progestogen-only pill. If this happens, there is no evidence that the pill will harm your unborn baby. If you think you may be pregnant, speak to your GP or visit your local sexual health clinic.

Get medical advice if you have a sudden or unusual pain in your abdomen (tummy), or if your period is much shorter or lighter than usual. It is possible that these are warning signs of an ectopic pregnancy, although this is rare.

Advantages and disadvantages of the mini pill

Some advantages of the progestogen-only pill include:

• it does not interrupt sex
• you can use it when breastfeeding
• it is useful if you cannot take the hormone oestrogen, which is in the combined pill, contraceptive patch and vaginal ring
• you can use it at any age – even if you smoke and are over 35
• it can reduce the symptoms of premenstrual syndrome (PMS) and painful periods

Some disadvantages of the progestogen-only pill include:

• you may not have regular periods while taking it – your bleeding may be lighter, more frequent or may stop altogether, and you may get spotting between periods
• it doesn't protect you against STIs so you may need to use condoms if you are at high risk of getting an STI, for example, if you have more than one sexual partner or you are not certain of your partner's sexual health
• you need to remember to take it at or around the same time every day
• some medications, including certain types of antibiotic, can make it less effective

The progestogen-only pill is generally well tolerated and side effects are rare. Some side effects can include:

• acne
• breast tenderness and breast enlargement
• an increased or decreased sex drive
• mood changes
• headache and migraine
• nausea or vomiting
• cysts (small fluid-filled sacs) on your ovaries (these are usually harmless and disappear without treatment)

These side effects are most likely to occur during the first few months of taking the progestogen-only pill. They generally improve over time and should stop within a few months.

If you have any concerns about your contraceptive pill, see your GP, practice nurse, pharmacist or sexual health clinic. They may advise you to change to another pill or a different form of contraception.

The progestogen-only pill with other medicines

Some medicines can reduce the progestogen-only pill's effectiveness. These include:

• some medication for HIV
• some medication for epilepsy
• complementary remedies, such as St John's Wort
• rifabutin (which can be used to treat tuberculosis)
• rifampicin (which can be used to treat several conditions, including tuberculosis and meningitis)

These are called enzyme-inducing drugs. If you are using these medicines for a short while (for example, rifampicin to protect against meningitis), it's recommended that you use extra contraception during the course of treatment and for 28 days afterwards.

Women taking enzyme-inducing drugs in the long term may wish to consider using a method of contraception that isn't affected by their medication. Always tell your doctor that you are using the progestogen-only pill if you are prescribed any medicines.

Ask your doctor or nurse for more details about the progestogen-only pill and other medication.

Risks of taking the progestogen-only pill

The progestogen-only pill is very safe to take. However, as with the combined contraceptive pill, there are certain risks. These risks are small. For most women, benefits of the progestogen-only pill outweigh the risks.

Ovarian cysts

Some women can develop fluid-filled cysts on their ovaries. These are not dangerous and do not usually need to be removed. These cysts usually disappear without treatment. In many cases, the cysts do not cause symptoms, although some women experience pelvic pain.

Breast cancer

Research is continuing into the link between breast cancer and the progestogen-only pill. Women who use any type of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with people who don’t use hormonal contraception. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Where can you get the progestogen-only pill?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• pharmacies – they can give an initial 3-month supply
• some young people’s services

Some brands of the desogestrel progestogen-only pill are available to buy in a pharmacy without a prescription. They can also be bought from online pharmacies. Look for the NHS internet pharmacy logo before buying.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors, nurses and pharmacists have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the vaginal ring.

The vaginal ring is a small, soft plastic ring that you place inside your vagina. It’s about 4mm thick and 5.5cm in diameter. You leave it in your vagina for 21 days. Then you remove it and throw it in the bin (not down the toilet) in a special disposal bag. Seven days after removing the ring, you insert a new one for the next 21 days.

The ring releases oestrogen and progestogen. This prevents ovulation (release of an egg), makes it difficult for sperm to get to an egg and thins the womb lining, so it’s less likely that an egg will implant there.

At a glance: facts about the vaginal ring

If used correctly, the vaginal ring is more than 99% effective. This means that fewer than 1 woman out of every 100 who use the vaginal ring as contraception will become pregnant in one year.

In real world use at least 9 women in 100 a year become pregnant (91% effective).

One ring will provide contraception for a month, so you don’t have to think about it every day.

It doesn’t interrupt sex, because you can have sex with the ring in place.

Unlike the pill, the ring is still effective if you have vomiting or diarrhoea.

The ring may ease premenstrual symptoms. Bleeding will probably be lighter and less painful.

Some women have temporary side effects. These include more vaginal discharge, breast tenderness and headaches.

A few women may develop a blood clot (thrombosis) when using the ring, but this is rare.

The ring can sometimes come out on its own, but you can rinse it in warm water and put it back in as soon as possible. You might need emergency contraception, depending on how long it has been out.

The vaginal ring doesn’t protect against sexually transmitted infections (STIs). By using condoms as well as the ring, you’ll protect yourself against STIs.

How the ring works

The ring continually releases oestrogen and progestogen, which are synthetic versions of the hormones that are naturally released by the ovaries. This:

• reduces ovulation
• thickens vaginal mucus, which makes it more difficult for sperm to get through
• thins the lining of the womb so that an egg is less likely to implant there

Using the vaginal ring

You can start using the vaginal ring at any time during your menstrual cycle. You leave it in for 21 days, then remove it and have a 7-day ring-free break. You’re protected against pregnancy during the ring-free break. You then put a new ring in for another 21 days.

You'll be protected against pregnancy straight away if you insert it on the first day of your period (the first day of your menstrual cycle). You won't be protected from pregnancy if you start using it at any other time in your menstrual cycle. You'll need to use extra contraception (such as condoms) for the first 7 days

You can discuss this with your doctor or nurse to decide when might be the best time for you to start using the ring.

Inserting the ring

1. Save the foil pouch the ring comes in to put the ring in when you throw it away.
2. With clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina.
3. Gently push the ring up into your vagina until it feels comfortable.

Unlike a diaphragm or cap, the ring does not need to cover your cervix (the entrance to your womb) to work.

If you can feel the ring and it's uncomfortable, push it a bit further into your vagina. There isn’t a right or wrong place for it to be, as long as it isn’t uncomfortable.

You should be able to check that the ring is still there using your fingers. If you can’t feel it, but you’re sure it’s there, see your doctor or nurse. The ring cannot get 'lost' inside you.

After the ring has been in your vagina for 21 days (3 weeks), you remove it. This should be on the same day of the week that you put it in.

Removing the ring

1. With clean hands, put a finger into your vagina and hook it around the edge of the ring.
2. Gently pull the ring out.
3. Put it in the foil pouch provided and throw it in the bin – don’t flush it down the toilet.

Removing the ring should be painless. If you have any bleeding or pain, or you can’t pull it out, tell your doctor or nurse immediately.

When you’ve taken the ring out, you don’t put a new one in for 7 days (1 week). This is the ring-free interval. You might have a period-type bleed during this time. You'll still be protected against pregnancy during these 7 days.

After 7 days without a ring in, you need to insert a new one. Put the new ring in even if you’re still bleeding. Leave this ring in for 21 days, then repeat the cycle.

You can have sex and use tampons while the ring is in your vagina. You and your partner may feel the ring during sex, but this isn’t harmful.

If you forget to take the ring out

If you forget to take the ring out after 21 days, what you should do depends on how much extra time the ring has been left in.

If the ring has been in for up to 7 days after the end of week 3:

• take the ring out as soon as you remember
• don’t put a new ring in – start your 7-day interval as normal
• begin your new ring after your 7-day interval as normal
• you’re still protected against pregnancy, and you don’t need to use extra contraception

If the ring has been in for more than 7 extra days (more than 4 weeks in total):

• take the ring out as soon as you remember
• put a new ring in straight away

Use extra contraception (such as condoms) until the new ring has been in for 7 days.

Speak to your doctor or nurse about when you should use extra contraception.

You may need emergency contraception if you had sex in the days before changing the rings over. Talk to your doctor or nurse.

If you forget to put a new ring in

Put a new ring in as soon as you remember, and use extra contraception, such as condoms, for 7 days.

You may need emergency contraception if you had sex before you remembered to put the new ring in, and the ring-free interval was 48 hours or more longer than it should have been (9 days or more in total). If this is the case, talk to your doctor or nurse.

If the ring comes out by itself

Sometimes the ring may come out on its own. This is called expulsion. This is most likely to happen after or during sex, or when you're constipated. What you should do depends on how long the ring is out for, and whether you’re in the first, second or third week of using it.

If the ring is out for more than 3 hours, you will not be protected against pregnancy. Discuss this with your GP or nurse.

If the ring is out for more than 3 hours in the first or second week of using it, rinse it and put it back in. You need to use additional contraception for 7 days. You may need emergency contraception if you have had sex in the last few days – talk to your doctor or nurse.

If the ring is out for more than 3 hours in the third week of using it, don’t put it back in. Dispose of it in the normal way. You now have 2 options, either:

• you can put a new ring in straight away – you may not have a period-type bleed, but you may have spotting
• don’t put a ring in and have a 7-day interval – you’ll have a period-type bleed, and you should put a new ring in 7 days after the old one came out (you can only choose this option if the ring was in continuously for the previous 7 days)

Whichever option you choose, you need to use extra contraception until the ring has been in for 7 days in a row. You should also talk to your doctor or nurse if you’ve had sex in the last few days, as you may need emergency contraception.

Who can use the vaginal ring?

The vaginal ring is not suitable for everyone. If you're thinking of using it, your doctor or nurse will need to ask you about your health and your family’s medical history, to make sure the ring is suitable for you. It's very important to tell them about any illnesses or operations you have had, or medications you are currently taking.

You should not use the ring if you:

• are pregnant or think you may be pregnant
• are breastfeeding
• smoke and are 35 or over
• are 35 or over and stopped smoking less than a year ago
• are very overweight
• take certain medicines such as some antibiotics, St John’s Wort or medicines used to treat epilepsy, tuberculosis (TB) or HIV

You will also not be able to use the ring if you have (or have had):

• thrombosis (blood clots) in a vein or artery
• a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
• migraine with aura (warning signs)
• breast cancer
• disease of the liver or gallbladder
• diabetes with complications, or diabetes for more than 20 years

If you don’t smoke and there are no medical reasons why you can’t use the ring, you can use it until you are 50 years old.

After giving birth

You can start using the vaginal ring 21 days after giving birth, and you'll be protected against pregnancy straight away.

If you start the ring more than 21 days after giving birth, you need to use extra contraception for 7 days after you insert the ring.

After miscarriage or abortion

You can start using the ring immediately after a miscarriage or abortion, and it'll work straight away. You don’t need to use extra contraception.

Advantages and disadvantages of the ring

Some of the advantages of the vaginal ring include:

• it doesn’t interrupt sex
• it’s easy to put in and remove
• you don’t have to think about it every day
• the ring is not affected if you vomit or have diarrhoea
• it may help with premenstrual symptoms
• period-type bleeding usually becomes lighter, more regular and less painful
• it may reduce the risk of cancer of the ovary, uterus and colon
• it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some of the disadvantages of the vaginal ring include:

• it may not be suitable if you don’t feel comfortable inserting or removing it from your vagina
• spotting and bleeding while the ring is in your vagina can occur in the first few months
• it may cause temporary side effects, such as increased vaginal discharge, headaches, nausea, breast tenderness and mood changes
• the ring does not protect against STIs

The vaginal ring with other medicines

Some medicines may interact with the vaginal ring, meaning it doesn’t work properly. If you want to check that your medicines are safe to take with the vaginal ring, you can:

• ask your GP, practice, pharmacist or sexual health clinic
• read the patient information leaflet that comes with your medicine

The vaginal ring can interact with medicines called enzyme inducers. These speed up breakdown of progestogen by your liver, reducing the effectiveness of the ring.

Examples of enzyme inducers are:

• the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
• St John’s Wort (a herbal remedy)
• some antiretroviral medicines used to treat HIV
• antibiotics called rifampicin and rifabutin, which can be used to treat illnesses including tuberculosis (TB) and meningitis

Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

Risks of using the vaginal ring

There are some serious side effects, but these are not common. They include:

• developing a blood clot in a vein or artery
• having a heart attack or stroke

Research into the risk of breast cancer and hormonal contraception is complex and contradictory. It suggests that all women who use hormonal contraception appear to have a small increased risk of being diagnosed with breast cancer, compared with women who don’t use hormonal contraception.

Research suggests there is a small increase in the risk of developing cervical cancer with longer use of oestrogen and progestogen hormonal contraception. Some research suggests a link between oestrogen and progestogen hormonal contraception and a very rare liver cancer.

Where can you get the vaginal ring?

Most types of contraception are available for free in the UK. Contraception is free to everyone through the NHS. Places where you can get contraception include:

• some GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is vasectomy (male sterilisation).

Vasectomy is a minor operation that stops men being able to get a woman pregnant. The tubes that carry sperm from a man's testicles to the penis are cut blocked or sealed. Vasectomy is usually carried out under local anaesthetic, and takes about 15 minutes.

This prevents sperm from reaching the seminal fluid (semen), which is ejaculated from the penis during sex. There will be no sperm in the semen, so a woman's egg can't be fertilised. The man can still ejaculate.

At a glance: facts about vasectomy

In most cases, vasectomy is more than 99% effective. Out of 2,000 men who are sterilised, 1 will get a woman pregnant during the rest of his lifetime.

Male sterilisation is considered permanent. Once it's done, you don't have to think about contraception again.

You need to use contraception for at least 8 weeks after the operation, because sperm stay in the tubes leading to the penis.

Up to 3 semen tests are done after the operation, to make sure that all the sperm have gone.

Your scrotum (ball sack) may become bruised, swollen or painful. Some men have ongoing pain in their testicles.

As with any surgery, there's a slight risk of infection.

Reversing the operation isn't easy, and is not available on the NHS.

Vasectomy doesn't protect against sexually transmitted infections (STIs). Use a condom to protect yourself and your partner against STIs.

How vasectomy works

Vasectomy works by stopping sperm from getting into a man’s semen. This means that when a man ejaculates, the semen has no sperm and a woman’s egg cannot be fertilised.

How vasectomy is carried out

Vasectomy is a quick and relatively painless surgical procedure. The vas deferens (tubes that carry sperm from a man's testicles to the penis) are cut, blocked or sealed with heat. In most cases, you'll be able to return home the same day.

Most vasectomies are carried out under local anaesthetic. This means that only your scrotum and testicles will be numbed, and you'll be awake for the procedure. You will not feel any pain but it may feel slightly uncomfortable.

Less often, a general anaesthetic may be used. This means that you'll be asleep during the procedure. A general anaesthetic may be used if you are allergic to local anaesthetic or have a history of fainting easily. Most people will only need a local anaesthetic.

Depending on where you live in Scotland, you may get a vasectomy at:

• your local GP practice
• a hospital as a day-patient appointment
• a sexual health clinic

You can also go to a private clinic.

No-scalpel vasectomy

This is a newer technique but is now the commonest method. No-scalpel vasectomy is carried out under local anaesthetic.

The doctor will feel the vas deferens underneath the skin of your scrotum and then hold them in place using a small clamp. A special instrument makes a tiny puncture hole in the skin of the scrotum. This allows the surgeon to access the vas deferens without needing to cut the skin with a scalpel. The vas deferens are then closed either by being tied or sealed with heat.

During a no-scalpel vasectomy, there will be little bleeding and no stitches. The procedure is less painful and less likely to cause complications than a conventional vasectomy.

Conventional vasectomy

During a conventional vasectomy, the skin of your scrotum is numbed with local anaesthetic. The doctor makes 2 small cuts, about 1cm long, on each side of your scrotum.

The incisions allow your surgeon to access the vas deferens. Each tube is cut and a small section removed. The ends of the tubes are then closed, either by tying them or sealing with heat.

The incisions are stitched, usually using dissolvable stitches, which will disappear naturally within about a week.

Before you decide to have a vasectomy

Your doctor will ask about your circumstances and give information and counselling before agreeing to the procedure.

You should only have a vasectomy if you're certain that you do not want to have any, or any more, children. If you have any doubts, consider another method of contraception until you're completely sure.

You shouldn't make the decision about having a vasectomy after a crisis or a big change in your life. For example, if your partner has just had a baby, or has just terminated a pregnancy.

If you have a partner, discuss it with them before deciding to have a vasectomy.

You can have a vasectomy at any age. If you're under 30, particularly if you do not have children, your doctor may be reluctant to perform the procedure. This is because people under 30 have higher rates of regret about having the procedure.

A doctor has the right to refuse to carry out the procedure if they do not believe that it is in your best interests. You have the right to ask for a second opinion.

How do I get the operation?

Speak to your GP or ask at your local sexual health clinic about vasectomies in your area. They can tell you what the local arrangements are.

Recovering after the operation

It’s common to have some mild discomfort, swelling and bruising of your scrotum for a few days after the vasectomy. If you have pain or discomfort, you can take painkillers, such as paracetamol. Contact your GP for advice if you're still experiencing considerable pain after taking painkillers.

It’s common to have blood in your semen in the first few ejaculations after a vasectomy. This isn’t harmful.

Underwear

Wearing close-fitting underwear, such as Y-fronts, during the day and at night will help to support your scrotum. It'll also help ease any discomfort or swelling. Make sure you change your underwear every day.

Hygiene

It's usually safe for you to have a bath or shower after your operation. Check with your doctor what is suitable for you. Make sure you dry your genital area gently and thoroughly.

Returning to work

Most men will be fit to return to work 1 or 2 days after their vasectomy. But you should avoid sport and heavy lifting for at least 1 week after the operation. This is to minimise the risk of developing complications. If any symptoms continue after a few days, speak to your GP.

Having sex

You can have sex again as soon as it's comfortable to do so. It's best to wait for a couple of days. You'll still have sperm in your semen immediately after the operation, as it takes time to clear the remaining sperm in your tubes. It takes an average of 20 to 30 ejaculations to clear the tubes of sperm. You'll need to use another method of contraception until you're told that it's OK to stop.

Once the operation has been carried out successfully and semen tests have shown that there is no sperm present, long-term partners may not need to use other forms of contraception.

A vasectomy does not protect against HIV infection or any other STIs, so you should still use condoms with any new partner.

How will I know if my vasectomy has worked?

After the vasectomy, there will be some sperm left in the upper part of the vas deferens tubes. It can take more than 20 ejaculations to clear these sperm from the tubes so, during this time, there is still a risk of pregnancy.

Until it has been confirmed that your semen is free of sperm, you should continue to use another form of contraception.

At least 8 weeks after the procedure, you'll need to produce a sample of semen, which will be tested for sperm. This will also help to identify the rare cases in which the tubes naturally rejoin themselves. Once tests have confirmed that your semen is free of sperm, the vasectomy is considered successful. You can stop using extra contraception.

A few men continue to have small numbers of sperm in their system, but these sperm do not move. They are known as non-motile sperm. If you're one of these men, your doctor will discuss your options with you. The chances of making your partner pregnant may be low enough to consider the vasectomy successful. Or you may be advised to have further tests or consider other options.

Is reversal possible?

It's possible to have a vasectomy reversed but this is not always successful. You have a better chance if it is done soon after the vasectomy.

Reversal is not available on the NHS and the operation is expensive if done privately. If a reversal is carried out within 10 years of your vasectomy, the success rate is about 55%. This falls to 25% if your reversal is carried out more than 10 years after your vasectomy.

Even if a surgeon manages to join up the vas deferens tubes again, pregnancy may still not be possible. This is why you should be certain before going ahead with the vasectomy. Your doctor can help you to make your decision.

Advantages and disadvantages of vasectomy

Advantages of a vasectomy are:

• the failure rate is only 1 in 2,000 – out of 2,000 men who have a vasectomy, only 1 will get a woman pregnant in the rest of his lifetime
• there are rarely long-term effects on your health
• it does not affect your hormone levels or sex drive
• it will not affect the spontaneity of sex or interfere with sex
• it may be chosen as a simpler, safer and more reliable alternative to female sterilisation

Disadvantages of a vasectomy are:

• it doesn’t protect against STIs
• it’s difficult to reverse, and reversal may not be available on the NHS
• you need to use contraception after the operation until tests show your semen is free of sperm – if your semen contains sperm, you could make your partner pregnant
• complications can occur

Risks of vasectomy

Most men feel sore and tender for a few days after the operation, and will usually experience some bruising and swelling on or around their scrotum.

However, in some cases, a vasectomy can cause more serious problems.

Haematoma

A haematoma is when blood collects and clots in the tissue surrounding a broken blood vessel. Following a vasectomy, you may develop a haematoma inside your scrotum.

Haematomas are mostly small (pea-sized), but can occasionally be large (filling the scrotum). Rarely, they can be very large. This can cause your scrotum to become very swollen and painful. In severe cases, you may need further surgery to treat the blood clot.

Sperm granulomas

When the tubes that carry sperm from your testicles are cut, sperm can sometimes leak from them. In rare cases, sperm can collect in the surrounding tissue, forming hard lumps that are known as sperm granulomas.

Your groin or scrotum may become painful and swollen either immediately or a few months after the procedure. The lumps are not usually painful. They can often be treated using anti-inflammatory medication, which your GP will prescribe. If the granulomas are particularly large or painful, they may have to be surgically removed.

Infection

After a vasectomy, you may be at risk of developing an infection as a result of bacteria entering through the cuts made in your scrotum. After the operation, it's important to keep your genital area clean and dry to keep the risk of infection as low as you can.

Long-term testicle pain

Some men get pain in one or both of their testicles after a vasectomy. It can happen immediately, a few months or a few years after the operation. It may be occasional or quite frequent, and vary from a constant dull ache to episodes of sharp, intense pain. For most men, however, any pain is quite mild and they do not need further help for it.

Long-term testicular pain affects around 1 in 10 men after vasectomy. The pain is usually the result of a pinched nerve or scarring that occurred during the operation. You may be advised to undergo further surgery to repair the damage and to help minimise further pain.

Testicles feeling full

After a vasectomy, some men may develop the sensation that their testicles are 'fuller' than normal. This is usually caused by the epididymis becoming filled with stored sperm. The epididymis is the long, coiled tube that rests on the back of each testicle. It helps to transport and store sperm.

Any such feelings should pass naturally within a few weeks. However, speak to your GP if you are still experiencing fullness after this time.

Fertility

In a very small number of vasectomy cases, the vas deferens reconnects over a period of time. This means that the vasectomy will no longer be an effective form of contraception. However, it is rare for this to happen.

Common questions about vasectomy

[DETAILS COMPONENTS]

Can I have the operation if I am single?

Yes, but if you're under 30 many surgeons are reluctant to do it in case your circumstances change and you regret it later.

Will it affect my sex drive?

No. After a successful vasectomy, your testicles will continue to produce the male hormone (testosterone). Your sex drive, sensation and ability to have an erection won’t be affected. The only difference is that there will be no sperm in your semen. Your body still produces sperm, but they are absorbed without harm.

Is there any risk of vasectomy causing cancer?

Although prostate cancer and testicular cancer can occur in men who have had a vasectomy, research suggests that vasectomy does not increase your risk of cancer.

Can I use IVF to father a child?

If you have a vasectomy, and then decide later that you want a child, there may be the option of doing so by IVF (in vitro fertilisation). To do this, a surgeon would retrieve sperm from your testicles and use this to fertilise your partner’s egg. However IVF:

• may not be available on the NHS
• can be expensive when done privately
• is not always successful

Can I store sperm in a sperm bank, just in case?

You could but, as with IVF, sperm stored in a sperm bank cannot be relied on to bring about a pregnancy. It can also be expensive as it's not available on the NHS. If you're not sure about wanting children in the future, don't have a vasectomy.

Where can you get contraception?

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. You can get contraception, and information and advice about contraception, at:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraception and STI testing services
• some young people’s services (phone 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you're safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.

Natural family planning is a method that teaches you at what time during your menstrual cycle you can have sex without contraception, with a reduced risk of pregnancy. The method is sometimes called fertility awareness.

It works by plotting the times of your cycle when you’re fertile and when you’re not. You learn how to use and record fertility signals to identify when it’s safer to have sex. Fertility signals include your body temperature and cervical secretions (fluids or mucus). Natural family planning is more effective when more than one fertility signal is monitored.

You can't learn natural family planning from a book, app or website. It has to be learned from a specialist teacher.

At a glance: facts about natural family planning

If the instructions are properly followed, natural family planning methods can be up to 99% effective, depending on what methods are used. This means that 1 woman in 100 who uses natural family planning will get pregnant in a year.

It'll be less effective if it's not used according to the instructions. It may only be around 75% effective because of mistakes.

There are no physical side effects. You can use it to plan when you get pregnant.

You have to keep a daily record of your fertility signals. For example, your temperature and vaginal discharge. It takes 3 to 6 menstrual (monthly) cycles to learn the method.

Your fertility signals can be affected by factors such as illness, stress and travel.

If you want to have sex during the time when you might get pregnant, you need to use a condom, diaphragm or cap.

By using condoms as well, you'll help to protect yourself against sexually transmitted infections (STIs).

How natural family planning works

The aim of natural family planning is to prevent pregnancy by avoiding sex, or using barrier methods of contraception, during the woman's fertile time. Natural family planning involves using your body's signs and symptoms to assess if you're currently fertile and likely to get pregnant if you have sex.

It's important that you are taught natural family planning by a qualified teacher. You can check the availability of instructors in your local area by visiting the Fertility UK website.

The information in this section is designed to serve as an overview only. It's not a substitute for proper instruction and training.

There are different fertility indicators you can use in combination to increase the effectiveness of natural family planning. For example:

• daily readings of your body temperature
• changes to your cervix – such as discharge, and changes in its position (higher or lower)
• the length of your menstrual cycle

Your menstrual cycle

Your menstrual cycle lasts from the first day of your period until the day before your next period starts. The length of a menstrual cycle can vary. It can be different with each cycle. Anything from 24 to 35 days is common. It could be longer or shorter than this. The average length of the menstrual cycle is 28 days.

Ovulation

During your menstrual cycle:

• hormones are released to stimulate your ovaries
• a tiny egg stored in one of your ovaries begins to grow and mature
• when the egg is mature, it’s released from your ovary (ovulation) and travels down the fallopian tube

Occasionally a second egg is released within 24 hours of the first egg.

Ovulation occurs roughly halfway through your menstrual cycle. It's usually around 10 to 16 days before the start of your next period. Ovulation could happen earlier or later than this, depending on the length of your cycle.

When calculating your fertile time, you need to take into account the uncertainty over exactly when you ovulate.

For pregnancy to happen, sperm needs to meet the egg to fertilise it. Sperm can live in a woman's body for up to 7 days after sex.

The length of a menstrual cycle can vary over time. To make sure your calculations are as precise as possible, you'll need to measure your menstrual cycle over the course of 12 months.

Calculating the length of your cycle is not a reliable way of working out your fertile time. It should not be used on its own as a fertility indicator.

The temperature indicator

There's a small rise in body temperature after ovulation takes place.

You'll need to use either a digital thermometer or a thermometer specifically designed for natural family planning. These are available from pharmacies. Ear or forehead thermometers are not accurate enough to be used in this way.

The temperature method involves taking your temperature every morning before you get out of bed. This should be done before eating or drinking anything, before smoking, and ideally at the same time every morning. Look out for 3 days in a row when your temperature is higher than all of the previous 6 days. The increase in temperature is very small, usually around 0.2C (0.4F). It's likely that you're no longer fertile at this time.

Cervical indicators

There's a change in the amount and consistency of the discharge from your cervix during different times in your menstrual cycle. You can also notice that the cervix feels a bit higher or lower in the vagina at different times of the cycle.

You can check this by gently placing your middle finger into your vagina and pushing it up to around your middle knuckle. For the first few days after your period, you'll probably find that your vagina is dry and you cannot feel any mucus.

As the levels of hormones rise to prepare your body for ovulation, you'll probably find that your cervix is now producing mucus that is:

• moist and sticky
• white and creamy

This is the start of the fertile period of your menstrual cycle. Immediately before ovulation the mucus will get:

• wetter
• clearer
• slippery, a bit like raw egg white

This is when you're at your most fertile.

The mucus should then soon return to being thicker and sticky. After 3 days you should no longer be fertile.

Combining fertility awareness methods

It's best to combine all indicators to give you a more accurate picture of when you are likely to be most fertile.

You can use fertility charts to record information from all 3 methods, which you can then track over the course of each menstrual cycle. You can download fertility charts from Fertility Education and Training, with information on how to use them.

There are also apps you can download for smartphones or software for your computer that allow you to track this information.

How effective natural family planning is

If natural family planning methods are used according to instructions, they can be up to 99% effective. This means that 1 out of 100 women using natural family planning correctly will get pregnant. It takes commitment and practice to use natural family planning this effectively.

Taking into account that people can make mistakes, forget instructions or other problems, in reality, natural family planning can be around 75% effective. This means that 25 out of 100 women using natural family planning may get pregnant.

If you decide to use natural family planning, you can reduce your risk of accidental pregnancy by making sure you are taught natural family planning by a suitably qualified teacher. Then, make sure you follow their instructions and advice.

Who can use natural family planning

Most women are able to use natural family planning. However, there are some circumstances where it is not recommended as a form of contraception, or as your only form of contraception. You might want to consider a different method if:

• you have a medical condition that makes becoming pregnant dangerous – such as poorly controlled high blood pressure or heart disease
• there could potentially be a health risk to the baby if you got pregnant – for example, if you are dependent on drugs or alcohol, or taking medications known to cause birth defects
• you're having irregular periods, so predicting your fertile time may be hard or impossible
• you have a temporary condition that is disrupting the normal signs of fertility, such as pelvic inflammatory disease (PID), a sexually transmitted infection (STI) or bacterial vaginosis; you would have to wait until the infection passed before using natural family planning
• you have a long-term condition (or other underlying factors) that is disrupting the normal signs of fertility, such as liver disease, an over or underactive thyroid gland, cervical cancer or polycystic ovary syndrome (PCOS)
• you're taking a medication known to disrupt the normal production of cervical mucus, making fertility awareness methods difficult to use – this can include lithium (used to treat a number of serious mental health conditions, such as bipolar disorder) and some older types of antidepressants
• you have an increased risk of catching an STI – for example, you have multiple sexual partners

Things that affect your fertility signs

Some factors can disrupt normal fertility signs, for example if you:

• have irregular periods
• have recently stopped taking hormonal contraception
• have recently had a miscarriage or an abortion
• have recently given birth and are breastfeeding
• regularly travel through different time zones
• have an infection in your vagina such as thrush or an STI

Other factors that affect your body's natural signs include:

• altering how and when you take your temperature
• drinking alcohol
• taking certain medication
• illness
• some long-term conditions

Advantages and disadvantages of natural family planning

Advantages of natural family planning are:

• it does not cause any side effects
• it's acceptable to all faiths and cultures
• most women can use natural family planning, providing they're properly trained by a teacher in fertility awareness, and keep accurate records
• once you have learned the techniques, there should be no further need for input from health professionals
• natural family planning can be used to avoid pregnancy or to become pregnant, according to your wishes
• it does not involve chemicals or physical products
• it can help you recognise normal and abnormal vaginal secretions, so you can be aware of possible infection
• it involves your partner in the process, which can help increase feelings of closeness and trust

Disadvantages of natural family planning are:

• it does not protect against STIs such as chlamydia or HIV
• you'll need to avoid sex, or use contraception such as condoms, during the time you might get pregnant, which some couples can find difficult
• if you do decide to abstain, there can sometimes be up to 16 days during which you cannot have sex, depending on your cycle
• it can be much less effective than other methods of contraception
• depending on how accurately it's used, as many as 1 in 4 women using natural family planning may get pregnant
• it will not work without the continuing commitment and co-operation of both you and your partner
• it can take several menstrual cycles before you become confident in identifying your fertile time – during this time, you'll have to use barrier contraception, such as condoms
• you'll need to keep a daily record of your fertility signs
• it's not suitable if you have persistent irregular periods

Factors such as stress, illness, travel, lifestyle and use of hormonal treatments can disrupt your fertility signs. This includes oral emergency contraception. If you use the emergency contraceptive pill, you'll need to wait for 2 complete cycles before relying on natural family planning again

Lactational amenorrhoea method (LAM)

Women don't have periods while they're breastfeeding. This is known as lactational amenorrhoea. So breastfeeding can be used as a form of contraception. This is known as the lactational amenorrhoea method (LAM). LAM works for 6 months after a baby is born as long as the baby is fully breastfed and the woman does not have a period.

The fertility signals used in natural family planning methods are not reliable in women who are breastfeeding.

Women who are fully (or nearly fully) breastfeeding can use the LAM for the first 6 months after their baby is born, as long as:

• the woman has complete amenorrhoea (no periods at all)
• she's fully or very nearly fully breastfeeding (this means that the baby is only getting breast milk – no formula at all and only water, juice or vitamins given infrequently in addition to breastfeeds); breastfeeding day and night; no long intervals between feeds day or night (for example more than 4 hours during day and more than 6 hours at night)
• the baby is less than 6 months old

When used correctly and consistently, 1 in 200 women who use LAM will get pregnant in the first 6 months. However, take care to use the method correctly. Don't feed your baby other foods because this may reduce your lactation.

LAM becomes unreliable when:

• other foods or liquids are substituted for breastmilk
• your baby reaches 6 months old

After having a baby, it's possible to get pregnant before your periods start again. This is because you ovulate around 2 weeks before your period. For further information, talk to your health visitor, midwife or doctor. You can also read about breastfeeding in the pregnancy and baby guide.

Withdrawal (pulling out, 'being careful' Coitus interruptus)

This requires the male partner to withdraw the penis from the woman’s vagina before he ejaculates (comes).

It’s not a reliable method as fluid with sperm in it (per-cum) leaks from the penis before ejaculation.

With perfect use, 4% of women will have an unintended pregnancy at 1 year. With typical use, this increases up to 22%.

Withdrawal, if practiced correctly, may work for some couples, particularly as a backup to other methods of contraception, including the use of fertility indicators.

Where to get contraception

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

• most GP practices – talk to your GP or practice nurse
• community contraception clinics
• some genitourinary medicine (GUM) clinics
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people's services (phone our Sexual Health Line on 0800 22 44 88 for further information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents or carer as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.