Choosing The Right Hormonal Contraception For You

How To Be In Control Of Your Hormonal Contraception


by Grazia |

Choosing which contraceptive method is right for you is a complex decision – you have to weigh up your family health history, lifestyle, and your own health, to find something that works for you.

We spoke to Shazia Malik, Consultant Obstetrician and Gynaecologist (and specialist in Reproductive Medicine) at the Portland Hospital for Women and Children, to help us understand our hormonal contraceptive choices.

Grazia Daily: How should we go about choosing a form of hormonal contraception that fits into our lives?

Shazia Malik: “There are lots of different factors that need to be considered when making a choice about any form of contraception. It is important that you discuss it either with your GP (if they specialise in women’s health), your local family planning clinic, or a gynaecologist if you have any specific medical concerns.”

“Whoever you go to see should take a detailed medical and family history first. This will screen for anything which might make certain contraceptives unsuitable or unsafe for you. They should then discuss your age, smoking history, sexual history and lifestyle. All of these factors come in to play when making the right choice for you. The ‘right’ contraceptive has to be individualised to each woman, at that specific time in her life.”

“The choices of hormonal contraception include the combined oral contraceptive pill, the progesterone only pill (mini pill), the progesterone injection (every 11 weeks), the ‘implant’ and the hormone coil (or IUS/Mirena), the contraceptive patch, and the contraceptive ring.”

GD: Every woman has different experiences with different forms of contraception. Should we not put too much store by online 'reviews' of other women’s experiences, or are they a good way of making an informed decision?

SM: “In my personal opinion, the internet is a fantastic resource for information – from accredited medical sources. And reading about common side-effects is helpful in making decisions. But that’s all – no two women are the same, and neither are their medical, personal or sexual histories - or needs. So an informed decision can only be taken once you have spoken with an expert in the field.”

GD: When you first start taking the pill, how long does it take for your body’s hormone levels to adjust to the extra oestrogen?

SM: “It can take 2-3 months before our bodies adjust – most symptoms, such as sore breasts, appetite changes, or tummy bloating, settle in that time.”

GD: Who is the progesterone-only pill suitable for?

SM: “It is the most suitable pill for women who cannot take oestrogen – for example, those who are breast-feeding, heavy smokers, women who have a family history of breast cancer, women in their 40s who have a family history of heart disease, those who suffer from focal migraines or a history of blood clots.”

“It is important that women who use the progesterone-only pill are able to reliably take it at around the same time every day, though, as this is important for it to be an effective contraceptive.”

GD: Break it down for us – what is the link between the pill or implant and weight gain?

SM: “This is a difficult one because it hasn't been studied extensively, but the studies that have been done show varying results. It is true to say that some women may notice greater weight gain than others – probably more with the injection than other forms of contraception. But it’s unpredictable. In most women, it isn’t related directly to their contraception (statistically at least). I warn my patients that they may notice an increased appetite, and to adjust their diet and exercise accordingly.”

GD: For how many years can you take these different forms of contraception before your body needs a break? Does it need a break?

SM: There isn’t one ‘right’ answer to this, as it’s different for each woman. You can take hormonal contraception as long as you need birth control or until you reach menopause, as long as you're generally healthy. This applies to combination and progesterone-only pills for women who are non-smokers, and to progesterone-only pills for younger women who are smokers.”

“Women who smoke and are on the combined pill should swap to an alternative without oestrogen certainly by the age of 40. Some research suggests that prolonged use of birth control pills increases the risk of cervical cancer. However, use of birth control pills also decreases the risk of other types of cancer, such as ovarian cancer and endometrial cancer.”

“The effect of birth control pills on breast cancer risk isn't clear. Some research indicates that birth control pills slightly increase the risk of breast cancer — but that 10 or more years after stopping the pill, a woman's breast cancer risk returns to the same level as if she had never taken it. Other studies don't support a link between birth control pills and breast cancer.”

“There is no need for a break, and in fact it can increase the risk of having an unwanted pregnancy. However, the longer you use any form of hormonal contraception, it does, in my experience, take longer for your menstrual cycle to get back to normal. So if you are planning a baby, it might be worth stopping hormones a few months before (but using another form of effective contraception until you are really ready to try!)”

“The progesterone injection can cause thinning of the bones if used for extended periods, so is not generally suited for long term use, unless there is no suitable alternative.”

GD: Can taking hormonal contraception help with acne? Are there any side effects to this?

SM: “The combined oral contraceptive pill is often helpful with acne – it does take a couple of months to notice an improvement, but lots of women notice that their skin is better. It is especially helpful for women with a condition called polycystic ovary syndrome (PCOS)."

“What some women find is that when they stop taking the pill, there is ‘rebound’ and their skin gets worse, but this usually settles again in a couple of months”

GD: Are there any side effects after we stop taking hormonal contraception?

SM: “As discussed above, cycle irregularities, skin and hair changes are common when we stop taking the pill, especially after a long time. For most women, this is temporary – however, if your periods have not returned in 4-6 months, you should see your GP (and do a pregnancy test!).”

“If you are trying for a baby, do go and see your doctor if your periods have not returned to normal within 6 months, or earlier if you are over 35.”

GD: In what cases do you recommend using condoms in conjunction with hormonal contraception?

“I think that any woman who is sexually active and not in a monogamous relationship should use condoms – and get regular STD checks. We are seeing increasing numbers of STDs, such as chlamydia, in all age groups but especially young women – so please protect your fertility and of course protect yourself from getting HIV or other STDs.”

“In women who are in a stable relationship, condoms are essential with missed pills, or when you take medicines such as antibiotics, which might affect your contraceptive protection. Also, if you have an upset tummy, the pill might not be as effective. Always check with a pharmacist or doctor if you are not sure.”

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