Contraceptive Services
Our Practice provides full contraceptive services to all age groups and emergency contraception (see below). Outside these times emergency contraception is available at The Sidmouth Hospital MIU.
All the doctors provide contraceptive services with Dr Hadfield & Dr Hall undertaking insertion of IUCDs (coils).
The choice of contraception is very much a personal matter, although your doctor will offer you specific guidance as to your circumstances.
Barrier methods, notably the condom, are strongly advised in addition to taking the Pill where there is any doubt about the sexual history of the partner. Barrier methods, as well as providing a reasonably effective contraception, also prevent the transmission of infections between partners. In the younger age group there is a considerable risk of contracting infections if barrier methods are not used. These include chlamydia, which often remains undetected and is later associated with pelvic infection and subsequent infertility. The wart virus, which is not necessarily related to external warts, is significantly associated with the development of cervical cancer and is to a large degree prevented with condoms. Other diseases include Gonorrhea, Syphilis, Hepatitis B and the HIV virus.
PRESCRIBING TO UNDER 16s
Doctors will provide information and contraception to those under 16, which has been established by the 1985 House of Lords ruling in the Gillick case. The prescribing of such contraception is applicable providing the doctor feels that the patient is capable of understanding the nature and possible consequences of the procedure and includes the potential risks and benefits of contraception. The doctors normally encourage minors to discuss contraception with their parents, however, in practise this does not often occur and the rights of confidentiality remain just as strict respecting the patients confidence as if the patient were over 16.
METHODS OF CONTRACEPTION:-
EMERGENCY CONTRACEPTION
Emergency contraception uses a progesterone pill (Levonelle 1500) which is effective up to 72 hrs following unprotected intercourse (It is however most effective in the first 24 hours). It is available free of charge for women of any age from the Practice Nurses at the Health Centre without an appointment. It is also available from your GP, family planning clinic, the school nurse at Sidmouth College on Mondays between 8:30am and 9am, and recently from the Sidmouth Hospital MIU. It can be bought over the counter from pharmacies. Levonelle 1500 should not be used as regular contraception and it is strongly advised that you attend the Health Centre at a later time to receive ongoing contraception.
The other emergency contraception involves inserting a coil, and offers the only real advantage of effectiveness up to 5 days following unprotected intercourse.
THE COMBINED PILL
The combined pill contains an oestrogen and a progesterone in varying amounts, which suppress the menstrual cycle. As it is designed in 21 day packs it results in a regular withdrawal bleed on a monthly basis. It is the most effective and safe form of reversible contraception available, although it must often still be used in conjunction with a barrier method. Although there are minimal risks to taking the Pill it is still considerably safer for a sexually active woman to be on the Pill than take the risks of less effective contraception, which may result in risk and complications of pregnancy or termination.
When starting the Pill for the first time it should be started on the first day of the menstrual cycle and continued until the end of the packet, restarting again after the 7 day break. The exception being the "Every Day Pill" normally ending in the word ED. It is essential that no more than 7 days elapse before restarting the Pill.
REASONS FOR PILL FAILURE
1. Extending the Pill free week.
2. Missing Pills.
3. Failure to take extra precautions during episodes of either diarrhoea or vomiting.
4. Failure to take precautions for up to 7 days following a course of antibiotics.
If you forget your Pill and it is less than 12 hours, providing you take the Pill immediately there is no need to worry.
If, however, it is over 12 hours it is essential that you still take the Pill, but then use extra contraceptive methods, such as condoms for the next 7 days. You should then look at your packet of Pills to see how many more pills are left in the packet, if there are 7 or more pills, then finish the packet as usual. However, if there are less than 7 pills in the pack you must finish the pack and start the next pack immediately, without a break.
If you develop any of the following you should see your doctor immediately:-
1. Sharp chest pains, particularly on breathing.
2. Painful or swollen legs.
3. Breathlessness or coughing up blood.
4. Increasingly severe migraine episodes.
5. Slurring of speech, weakness or pins and needles of your arms and jaundice (going yellow).
Side effects are more common if you are overweight, you smoke or you have a family history of a thrombosis.
If you are going into hospital for an operation it is important that you stop the Pill at least 6 weeks beforehand and take adequate contraception.
THE MINI PILL
The Mini Pill is a progesterone only Pill (POP). It does not contain oestrogen and, therefore, does not have any of the risks of clotting in the veins or thrombosis and it is, therefore, safer for older women and women who smoke. It is, however, not normally as effective as a contraceptive. Between 1 and 4% of women taking this in a year will become pregnant. It is, therefore, more effective over the age of 40 as the fertility declines.
The progesterone works by thickening the cervical mucus and, therefore, preventing sperm entering the uterus. It does not prevent ovulation.
Its main disadvantages are that it does not regulate the cycle in the same way as a Combined Pill and it is common to have irregular bleeding or spotting, which may need to be assessed if this continues for more than 3 months. The 'older' preparations of the POP had to be taken within three hours of the planned time otherwise there was a high risk of failure, however the newer Cerrazete has a 12 hour window in which to take it, and is more effective as it frequently inhibits ovulation. Most women taking this will eventually stop having periods which is of no risk to health.
INJECTABLE CONTRACEPTIONS
These injections, normally using Depo-Provera, are given every 3 months and act in the same way as the Mini Pill, although they are far more effective in that they stop ovulation. The failure rate is approximately 1 per 100, or 1% failure per year. The Depo-Provera must be given every 3 months and it is essential that the injection date is not missed. It is ideal for those women who find it hard to remember to take the Pill regularly and need a reliable form of contraception.
It's main disadvantage relates to a potentially delayed fertility for up to a year following the injection, so it is not ideal for those couples wishing to start a family imminently. Occasionally there are reports of weight gain, headaches and in the initial stages bleeding irregularities. These usually settle or the periods cease completely after several injections.
INTERUTERINE DEVICES
These are small devices approximately one inch in size that are inserted into the uterus by your GP, which prevent the implantation of the pregnancy into the uterus. They are a reasonably reliable form of contraception having a failure rate of between 1 to 3 per 100, or 3%, although they do not prevent pregnancies in the fallopian tubes [ectopic pregnancies].
There are two forms of IUCD, the traditional copper containing IUCD, and more recently the hormonal IUCD called the MIRENA. The copper containing IUCD are used for general contraceptive purposes, whereas the Mirena, is used specifically to reduce menstrual loss often creating an absence of periods (amenorrhoea). The Mirena is now considered so effecive at reducing blood loss that it is used for control of heavy periods even when contraception is not required. It is probably more effective as a contraceptive with a lower risk of ectopic pregnancy. IUCDs, or coils, are ideal in women who have had pregnancies, as they are tolerated better, and there is less risk of sexually transmitted diseases. There is a small risk of pelvic infections and it is noted that the periods are frequently heavier and more painful with the traditional IUCD although these do improve with time.
The IUCD has the advantage that once inserted and tolerated it lasts for up to 5 years before it needs replacing.
DIAPHRAGMS OR CAPS
A diaphragm is a rubber barrier device that is inserted in the vagina over the cervix (the neck of the womb) to prevent sperm reaching the uterus. It must be inserted before intercourse and then removed 6 to 12 hours later. If it is used correctly with spermicide there is a failure rate of 2% per year. However, it does require some practise to use it appropriately.
It does, however, have the benefit of preventing sexually transmitted diseases and reduces the risk of developing cervical cancer, since it prevents sperm coming into contact with the cervix.
Caps can be fitted by either your GP or our specially trained practice nurses.
All the doctors provide contraceptive services with Dr Hadfield & Dr Hall undertaking insertion of IUCDs (coils).
The choice of contraception is very much a personal matter, although your doctor will offer you specific guidance as to your circumstances.
Barrier methods, notably the condom, are strongly advised in addition to taking the Pill where there is any doubt about the sexual history of the partner. Barrier methods, as well as providing a reasonably effective contraception, also prevent the transmission of infections between partners. In the younger age group there is a considerable risk of contracting infections if barrier methods are not used. These include chlamydia, which often remains undetected and is later associated with pelvic infection and subsequent infertility. The wart virus, which is not necessarily related to external warts, is significantly associated with the development of cervical cancer and is to a large degree prevented with condoms. Other diseases include Gonorrhea, Syphilis, Hepatitis B and the HIV virus.
PRESCRIBING TO UNDER 16s
Doctors will provide information and contraception to those under 16, which has been established by the 1985 House of Lords ruling in the Gillick case. The prescribing of such contraception is applicable providing the doctor feels that the patient is capable of understanding the nature and possible consequences of the procedure and includes the potential risks and benefits of contraception. The doctors normally encourage minors to discuss contraception with their parents, however, in practise this does not often occur and the rights of confidentiality remain just as strict respecting the patients confidence as if the patient were over 16.
METHODS OF CONTRACEPTION:-
EMERGENCY CONTRACEPTION
Emergency contraception uses a progesterone pill (Levonelle 1500) which is effective up to 72 hrs following unprotected intercourse (It is however most effective in the first 24 hours). It is available free of charge for women of any age from the Practice Nurses at the Health Centre without an appointment. It is also available from your GP, family planning clinic, the school nurse at Sidmouth College on Mondays between 8:30am and 9am, and recently from the Sidmouth Hospital MIU. It can be bought over the counter from pharmacies. Levonelle 1500 should not be used as regular contraception and it is strongly advised that you attend the Health Centre at a later time to receive ongoing contraception.
The other emergency contraception involves inserting a coil, and offers the only real advantage of effectiveness up to 5 days following unprotected intercourse.
THE COMBINED PILL
The combined pill contains an oestrogen and a progesterone in varying amounts, which suppress the menstrual cycle. As it is designed in 21 day packs it results in a regular withdrawal bleed on a monthly basis. It is the most effective and safe form of reversible contraception available, although it must often still be used in conjunction with a barrier method. Although there are minimal risks to taking the Pill it is still considerably safer for a sexually active woman to be on the Pill than take the risks of less effective contraception, which may result in risk and complications of pregnancy or termination.
When starting the Pill for the first time it should be started on the first day of the menstrual cycle and continued until the end of the packet, restarting again after the 7 day break. The exception being the "Every Day Pill" normally ending in the word ED. It is essential that no more than 7 days elapse before restarting the Pill.
REASONS FOR PILL FAILURE
1. Extending the Pill free week.
2. Missing Pills.
3. Failure to take extra precautions during episodes of either diarrhoea or vomiting.
4. Failure to take precautions for up to 7 days following a course of antibiotics.
If you forget your Pill and it is less than 12 hours, providing you take the Pill immediately there is no need to worry.
If, however, it is over 12 hours it is essential that you still take the Pill, but then use extra contraceptive methods, such as condoms for the next 7 days. You should then look at your packet of Pills to see how many more pills are left in the packet, if there are 7 or more pills, then finish the packet as usual. However, if there are less than 7 pills in the pack you must finish the pack and start the next pack immediately, without a break.
If you develop any of the following you should see your doctor immediately:-
1. Sharp chest pains, particularly on breathing.
2. Painful or swollen legs.
3. Breathlessness or coughing up blood.
4. Increasingly severe migraine episodes.
5. Slurring of speech, weakness or pins and needles of your arms and jaundice (going yellow).
Side effects are more common if you are overweight, you smoke or you have a family history of a thrombosis.
If you are going into hospital for an operation it is important that you stop the Pill at least 6 weeks beforehand and take adequate contraception.
THE MINI PILL
The Mini Pill is a progesterone only Pill (POP). It does not contain oestrogen and, therefore, does not have any of the risks of clotting in the veins or thrombosis and it is, therefore, safer for older women and women who smoke. It is, however, not normally as effective as a contraceptive. Between 1 and 4% of women taking this in a year will become pregnant. It is, therefore, more effective over the age of 40 as the fertility declines.
The progesterone works by thickening the cervical mucus and, therefore, preventing sperm entering the uterus. It does not prevent ovulation.
Its main disadvantages are that it does not regulate the cycle in the same way as a Combined Pill and it is common to have irregular bleeding or spotting, which may need to be assessed if this continues for more than 3 months. The 'older' preparations of the POP had to be taken within three hours of the planned time otherwise there was a high risk of failure, however the newer Cerrazete has a 12 hour window in which to take it, and is more effective as it frequently inhibits ovulation. Most women taking this will eventually stop having periods which is of no risk to health.
INJECTABLE CONTRACEPTIONS
These injections, normally using Depo-Provera, are given every 3 months and act in the same way as the Mini Pill, although they are far more effective in that they stop ovulation. The failure rate is approximately 1 per 100, or 1% failure per year. The Depo-Provera must be given every 3 months and it is essential that the injection date is not missed. It is ideal for those women who find it hard to remember to take the Pill regularly and need a reliable form of contraception.
It's main disadvantage relates to a potentially delayed fertility for up to a year following the injection, so it is not ideal for those couples wishing to start a family imminently. Occasionally there are reports of weight gain, headaches and in the initial stages bleeding irregularities. These usually settle or the periods cease completely after several injections.
INTERUTERINE DEVICES
These are small devices approximately one inch in size that are inserted into the uterus by your GP, which prevent the implantation of the pregnancy into the uterus. They are a reasonably reliable form of contraception having a failure rate of between 1 to 3 per 100, or 3%, although they do not prevent pregnancies in the fallopian tubes [ectopic pregnancies].
There are two forms of IUCD, the traditional copper containing IUCD, and more recently the hormonal IUCD called the MIRENA. The copper containing IUCD are used for general contraceptive purposes, whereas the Mirena, is used specifically to reduce menstrual loss often creating an absence of periods (amenorrhoea). The Mirena is now considered so effecive at reducing blood loss that it is used for control of heavy periods even when contraception is not required. It is probably more effective as a contraceptive with a lower risk of ectopic pregnancy. IUCDs, or coils, are ideal in women who have had pregnancies, as they are tolerated better, and there is less risk of sexually transmitted diseases. There is a small risk of pelvic infections and it is noted that the periods are frequently heavier and more painful with the traditional IUCD although these do improve with time.
The IUCD has the advantage that once inserted and tolerated it lasts for up to 5 years before it needs replacing.
DIAPHRAGMS OR CAPS
A diaphragm is a rubber barrier device that is inserted in the vagina over the cervix (the neck of the womb) to prevent sperm reaching the uterus. It must be inserted before intercourse and then removed 6 to 12 hours later. If it is used correctly with spermicide there is a failure rate of 2% per year. However, it does require some practise to use it appropriately.
It does, however, have the benefit of preventing sexually transmitted diseases and reduces the risk of developing cervical cancer, since it prevents sperm coming into contact with the cervix.
Caps can be fitted by either your GP or our specially trained practice nurses.