For women, birth control is one of the trickiest things to get right. That might be described as a bald statement – but it is true. Most of us with uteruses have been through the ringer with type after different type, trialling the various contraceptive methods and assessing their side effects.

Despite years of scientific studies, there is still a severe gap in the market for a pill which “unloads the gun instead of putting on a bullet proof vest.” That’s my boyfriend’s line. At one point, there was indeed a contraceptive pill produced for men, but the side effects of “mood changes and skin changes” were unacceptable. *Eye roll* 

Ever had an embedded coil? I’d take a pimple over that any day. But, for now, the wide array of products designed to stop your eggs from being fertilised must do – so let’s see what’s out there. In a manner of speaking. 
 
Hormonal Methods

Hormonal birth control encompasses the contraceptive pill, the bar, the patch, the ring, the contraceptive injection, and Intrauterine Devices (IUDs). In most cases, hormonal contraceptives combine two artificial hormones – oestrogen and progestogen. 

When taken/inserted/applied correctly, these hormones are absorbed into your body, stop ovulation, and prevent pregnancy approximately 99% of the time. The mucus at the neck of the uterus gets thicker, so it is difficult for sperm to enter the womb; and finally, the lining of the womb is thinned to prevent a fertilised egg from implanting in the uterus. 

IUDs are slightly different, but we’ll get to that later! 

The contraceptive pill is sometimes used from a young age to lessen heavy periods and improve acne. Ranging from the mini-pill to progestogen-heavy pills, there is a wide range of different hormone quantities involved, depending on the prescription. You have to to find which one works for you. There’s a significant range of potential side effects with the pill, which vary widely with different individuals. Plus, you have to be absolutely regular, never missing a day for the three weeks you take it every cycle (followed by a week off)...

The Contraceptive Implant (The Bar) is a small, flexible rod that’s inserted under the skin of your upper arm. Also known as LARC (Long Acting Reversivble Contraception), it lasts for up to three years. It is suitable for women who can’t use contraceptives containing oestrogen. Again, there’s a list of potential side effects, but amny agree that the benefits outweigh the potential cons. Only the individual can decide. 

The patch is like a small plaster. Patches are supplied in batches and each patch lasts – strictly – for seven days. You stick one patch a week onto your skin – where it isn’t hairy! – for three weeks. Then you take a break for a week – and start again. 

A vaginal ring is a small, flexible ring you insert into your vagina and leave for three weeks without a break. A bonus is that you don’t have to think about contraception for three weeks. But you have to insert and remove it yourself. Some people find this easier than others. 

The contraceptive injection is a dose of progesterone injected into your arm or bum, which is slowly absorbed from the muscle into the blood over 12 weeks. Advantages include: you only have to think about contraception every three months, it’s suitable for over 35s and/or if you smoke. However, if you experience side effects, these may continue for some time after you stop getting injections. It can take from six to twelve months for periods and fertility to return to normal.

 
Intrauterine System (IUS)/Coils

Coils are a longer-term type of contraception. Coil insertion isn’t a walk in the park, but rest assured, it’s not as bad as the TikToks make out! People have been doing it successfully for decades. Relax and trust the professionals – use your hot water bottle and painkillers afterwards if you feel you need them and you’ll be fine. 

The copper coil is a small T-shaped plastic frame with copper wire. It’s inserted into the uterus and lasts between five to ten years. A non-hormonal contraceptive, it works by altering the cervical mucus, stopping sperm from reaching and combining with eggs, or preventing a fertilised egg from settling in the womb. Copper coils can be used as an emergency contraceptive method, as it works immediately when inserted. It can make heavy or painful periods worse!

There are three different kinds of IUDs available in Ireland: Mirena, Kyleena and Jaydess. These devices are inserted the same way as the copper coil. The IUDs contain progestogen and work by stopping the sperm from reaching the egg, and thinning the lining of the womb to help prevent a fertilised egg from settling. This type of coil doesn’t work immediately – but on the plus side, it can make periods lighter, shorter and less painful.

 
Non-Hormonal Methods

A diaphragm (also known as a cap) is a soft silicone device inserted into the vagina to cover the cervix. They are typically “fitted” by a doctor – and are then inserted and removed before and after sex: please note, diaphragms must be left in place for at least 6 hours after sex, but must be removed before 24 hours. Using spermicide to cover the diaphragm helps it work more effectively. The diaphragm covers the cervix and stops sperm from reaching the egg. The spermicide is a gel that kills sperm.  You need to have a check-up at least once a year to make sure your diaphragm still fits – you may need a different size diaphragm if you put on, or lose, more than three kilos.  

An internal condom is thin plastic pouch, similar to the external condom. It is a non-hormonal, barrier contraceptive, inserted by the female into her vagina before sex, the outer ring remaining outside the vagina. The penis is then guided into the condom at the beginning of penetrative sex.

An external condom is put over an erect penis before sex, creating a barrier that stops sperm from entering your uterus. External condoms can be used for penetrative sex and oral sex. They prevent sexually transmitted infections, including HIV. Internal condoms are 95% effective and external condoms are 98% effective when used properly. 

Tubal ligation or vasectomies are a permanent form of contraception. Both are surgical and should be considered irreversible. 

Tubal ligation is a surgical procedure where a woman’s fallopian tubes are snipped or blocked, so eggs cannot travel down to meet sperm. A vasectomy is a surgical procedure carried out on men that stops sperm from getting into the man’s semen. The tubes that carry sperm from the testicles to the penis are cut, blocked, or sealed with heat. This means that when ejaculation occurs, the semen contains no sperm and the egg can’t be fertilised. Both tubal ligation and vasectomies are over 99% effective.

Cycle tracking/Natural family planning/Fertility awareness is where a female who needs to take contraceptive action will monitor and record her ‘fertility signals’ during their menstrual cycle to work out when she is most likely to get pregnant. Typically, there are three ‘signals’ you need to monitor: the length of your menstrual cycle; daily readings of your body temperature; and the ongoing daily changes to your cervical secretions (cervical mucus). There’s lots of detailed note-taking involved, as it’s best to record all three, to give a more accurate timeline of fertility.

Cycle-tracking has the benefit of being natural, but it requires a lot of work. It takes three to six menstrual cycles to learn the method, so it is not immediately effective. If cycle tracking is followed consistently and correctly, it can be up to 99% effective. But it does not ‘mix’ well with alcohol and fertility signals – which differ person to person – can also be affected by illness, stress and travel. Also, if you want to have sex during the timeframe when you might get pregnant, you’ll need to use contraception, such as a condom, diaphragm, or cap. According to the UK NHS, 1 to 9 women who use natural family planning will become pregnant within a year.

For further information check out sexualwellbeing.ie

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