Posted in contraception

Feeling Hormonal…

*** n.b. This is intended to give people some idea of how contraception works, for educational purposes. It is not medical advice. I would STRONGLY encourage anyone thinking of starting contraception to talk this through with a healthcare professional, who can give you detailed and individualised advice***

A big (and varied) type of contraceptives are ones that rely on hormones. A hormone is a chemical that is made by one part of the body and is carried by the blood to another part of the body, where it has some sort of effect. Insulin is a type of hormone – produced in the pancreas, it helps our bodies store the sugars that we eat for when we need them later. People with uteruses also make special hormones that control their fertility cycle – when they release an egg from their ovaries and when their period comes.

Remember, people with uteruses can’t get pregnant all the time – but for a few days when they are ovulating, which is just a fancy word for when they have released an egg. If this egg meets a sperm before it deteriorates and is shed with a period, then it can implant (‘dig into’) the uterus and eventually develop in to a baby.

So hormonal contraception is only for people with uteruses to take. And it affects their cycle, so there isn’t this a bit where they are capable of getting pregnant. Exactly how that happens depends on what kind of hormones are in a particular type of contraception, and how they are delivered in to the body (more on that later). But they can do things like stop ovulation from happening, help keep a layer of mucus over the entrance to the womb so sperm can’t get in, or keep the lining of the uterus (the endometrium) very thin, so an egg can’t implant and grow there.

A very simple way of getting hormones in to the body is swallowing them as medicines – the contraceptive pill. There are two main types – the combined pill and the progesterone only pill. They need to be taken regularly (sometimes every day) at about the same time of day, to work.

Pills are usually available from a doctor – for example a GP, or one you could see at a sexual health clinic. In the UK, you can also get the progesterone pill from some pharmacies without a prescription, by talking to the Pharmacist instead.

Which pill to choose can depend on a few things, like whether or not certain illnesses are common in your family. It’s a good idea to make an appointment with a healthcare worker who can talk you through this if you’re considering the pill, so that they can go through this with you.

The Contraceptive Pill. Image Credit: Anastasia Szakowski, via Flickr.com.

‘Birth control pills’ were some of the earliest types of contraception available that also worked really well. Because it can be tricky to remember to take them though, there are lots of other ways of getting contraceptive hormones in to the body without having to remember to take them every day.

Hormonal IUSs (‘intrauterine systems’) are small plastic devices that are put in the uterus. They contain hormones, which they slowly release into the body over 3-5 years (depending on what type). Because it stays in the body for a long time, you don’t have to remember to take it and it is *very* unlikely to fail as contraception.

The same can be said of the hormonal implant. This is a rod, about the size of a match, that is made from slightly bendy material and also contains hormones that are slowly released in to the body over several (three) years. It is usually placed in the arm, just under the skin. People that have them can usually feel them through the skin, but don’t notice them all the time.

As they last for several years, the implant and the IUS are sometimes described as ‘long-acting’. They are also described as ‘reversible’ because if and when they are removed from the body, they no longer have an effect and that person is likely to be able to get pregnant again. Because they go inside the body, they need to be put in and taken out by a healthcare professional – usually a doctor or a nurse.

Hormonal injections are also given by healthcare professionals and not something you can give yourself at home! This is where a dose of hormones is injected in to the body and lasts for several weeks (eight to 13, depending on the type of injection). If you want to keep using them as contraception, you need to be able to keep going back for appointments to have another one after this. They aren’t reversible, but do wear off if you stop having the injections.

Last but not least, there are two types of hormonal contraception that you don’t need to remember every day and you can give yourself at home – although you would still need to talk to a doctor or nurse to get them in the first place.

The first is a vaginal ring – a flexible ring that is inserted in to the vagina. The muscles that make up the walls of the vagina then hold this ring in place. It is usually kept in for three weeks then removed for several days, before being re-inserted. A user can put it in and take it out themselves, much like they would a tampon!

Vaginal Ring. Image credit: Anastasia Szakowski, via Flickr.com

Another hormonal device that someone can set-up themselves in the contraceptive patch. This is a big plaster-like device, that releases hormones through your skin. It is removed and replaced every week – for as long as you need contraception for.

So – there are lots of different ways of getting hormones in to the body! These can be really popular because they tend to be very effective, especially if they are released by a means where you don’t have to remember every day.

Hormonal contraception doesn’t create a barrier between a penis and a vagina during PIV sex, so it isn’t a kind of protection. This means that, although it can make it very unlikely that you will get pregnant from this type of sex, it doesn’t stop STIs (sexually transmitted infections) from being passed from person to person. For this reason, some people might choose to use something like condoms as well as hormonal contraception. Even though condoms are also contraception, they don’t work quite as well at preventing pregnancy as the methods we’ve described here.

One negative aspect of hormonal contraception is that it can have side effects – it can effect the body in unpleasant and unwanted ways. Lots of people seem to report that they have negative effects on mood, for example.

Not all of the side effects are bad – some can be welcome, for example they can cause good skin changes, or make periods less heavy.

And of course bodies work differently – one person can get on really well with a particular type of hormonal contraception, whilst another doesn’t at all.

Because healthcare professionals try to help lots of people, then can sometimes forget these individual responses. You know your body best though. If you are ever struggling with the side-effects of any type of contraception, it’s completely your choice if you want to stop using it – even if a doctor or nurse thinks that it’s ‘good’ or suggests that you should try it for longer and ‘see how it goes’. Ultimately it’s your decision. It’s fine to ask for a second opinion (ask to see another health worker) if you feel you aren’t being listened to. It’s your body, after all!

References:

Contraception, Sexwise.org.uk.

Your Contraception Guide, www.NHS.uk

What are the side effects of the birth-control pill? Planned Parenthood.

Robinson et al., 2004.

Posted in contraception, Genitals: A User's Guide, Uncategorized

Put a Ring On (?/In) It!

Last week I was interviewed for Cosmopolitan about ‘femidoms’ or internal condoms. These are one of a handful of contraceptives that often get talked about in sex ed classes, but appear to be less commonly in use.

Another type of contraception that this can be said about is the vaginal ring.

It gets its name from it’s shape – it’s a ‘ring’ made from a soft rubber like materials, about 5 cm across. It is inserted in to the vagina by the user and once inserted sits just below the cervix.

It’s another type of hormonal contraceptive – which means it protects against pregnancy by affecting the womb, ovaries and the fertility cycle.

It contains the same hormones as the combined pill – oestrogen and progesterone. Because of this, it works in a very similar way:

  1. Stops the ovaries from releasing an egg.
  2. Helps make the lining of the womb stay thin, rather than building up (a thick womb lining is needed for a fertilised egg to implant in and grow).
  3. Helps create a thick ‘plug’ of mucus in the cervix – the entrance to the womb. This helps stop sperm from entering the womb from the vagina in the first place and coming in to contact with an egg.

Also like the combined pill, the vaginal ring is used for three weeks and then not for one week – usually with a ‘withdrawal bleed’ in this week off. The main difference is that whilst the pill is delivered to your system by swallowing a pill, the vagina ring releases these hormones in to your system slowly over time.

After the week off, a new one is inserted. This is done by the user – so no need to attend a clinic or other appointment to get it fitted by a health professional, like with other contraceptive methods such as the coil.

From speaking to friends about their personal and professional experiences it seems like the vaginal ring isn’t something that is as easy to get hold of as other forms of contraception, at least in the UK!

Pros and cons

Because it doesn’t form a barrier between the vagina and the penis, it doesn’t protect against STIs. The vaginal ring is a form of contraception (helps reduce the risk of pregnancy) but not protection (doesn’t help reduce the likelihood of passing on infections through sex).

Some people may find it difficult to use – it involves being quite comfortable with your anatomy, slightly more so than a tampon.

On the other hand – it works very well. If used correctly, the vaginal ring is more than 99% effective. For comparison, this is more effective than condoms (98% effective). It only needs removing and replacing every four weeks – unlike the pill, which you need to think about every day.

For further details see:

NHS Contraception advice 

 

Posted in contraception, Genitals: A User's Guide

Learning for Pleasure

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I joined the lovely voluntary organisation Sexplain (‘Bringing sexual and relationship education into the 21st Century’) as a volunteer facilitator based on two things.  The first was an array of terrible personal experiences of Sex Ed over two decades ago during my time at school.  The second was professional surprise at how little people (particularly those with vulvas!) appeared to know about the intimate parts of their own bodies when I started working on a Gynaecology ward.

One of the things that I found a little unrelenting about my own school SRE learning experiences was how much the emphasis around sex was ‘not getting pregnant’.  It’s all very well to encourage and teach healthy sexual practices.  However, I feel the message went beyond this.   In my classroom, romantic intimacy amounted to sex and sex meant penetrative, penis-in-vagina sex only.  Pleasure, consent and masturbation were not on the curriculum.  Sex was problematic, dangerous, risky – never ‘fun’ or ‘fulfilling’.  The ultimate hazard was pregnancy and STIs.  Nothing good could come out of sex but if for some reason you found yourself having it, the ultimate consideration was to NOT GET PREGNANT.

It turns out that this world view prepared us badly for adult reality.  We learnt how effective a condom was versus a diaphragm, but not how to procure or negotiate the use of either.   We learnt that STIs cause discharge from orifices that we had only a crude understanding of.

Another classroom illusion that was challenged, by both my personal life and professional experience, was that there is a ‘perfect’ choice of contraception for each person.  For many, contraception can be a compromise, a ‘best match’, or a pragmatic move.  It can take in to account what you feel able to negotiate with a sexual partner.  Or what you can afford or have the time and resources to obtain.  Or choosing something you feel is a bit shoddy, but doesn’t leave you with the terrible side-effects of some methods.

I created ‘contraception top trumps’ because I wanted to look at contraception not as a set of absolutely rational, clear-cut decisions (you fulfil criteria x so you should use y) but as a work in progress.  You can learn about and develop an approach to contraception, depending on what is important to you… and unfortunately there’s an element of luck to the whole thing.

I’ve published a printable pdf of contraception top trumps – I would advise printing four pages to an A4 sheet for large print cards and eight for more portable ones!

The link above is for a smartened up and downloadable version of the top trumps game I published earlier this year here on this blog. One of the lovely things about doing this was the interesting and open conversations this prompted with friends.  For example -the one person who confessed she’d had a blazing row with her GP about removing the hormonal implant because she couldn’t cope with the emotional changes that came once it was fitted and had been told simply to ‘persevere’. Or the friend informed that they couldn’t have the copper coil fitted because ‘she hadn’t had children’.  Or the disbelieving faces that meet you when you look at failure rates of condoms, many peoples’ go-to!   Please download, play, share and learn these with whoever you can and start  your own conversations.

REFERENCES:

All statistics on effectiveness and general information are taken from the NHS contraception guide.

My estimate of 20% effectiveness from ‘a wing and a prayer’ was based on a statistic I saw that said 80% of couples having sex regularly would conceive within one year. So it’s probably a bit low for one single instance of sex.  However, I can’t for the life of me find that and the current online NHS advice on infertility suggests that 84% of such couples would conceive within a year, suggesting a figure of 16%.  Either way, it’s not a great method and is incredibly less reliable than actively doing something.  I just wanted to show that it was not guaranteed that you would get pregnant every time you had sex, even once, which is definitely the impression that I got from Miss Hargreaves in Year 9…