Around menopause Expand Any contraception containing oestrogen is not recommended as health risks outweigh the benefits. The levonorgestrel-releasing IUD (Mirena) can be used for contraception, to control heavy menstrual bleeding and to balance the low dose oestrogen used in hormone replacement therapy (HRT).
After a miscarriage or termination of pregnancy Expand Following a miscarriage or termination, your normal menstrual cycle can resume almost immediately, meaning that it is possible for you to become pregnant again within a few weeks. If you don’t want to get pregnant straight away you will need to think about your contraceptive options. When choosing contraception, some of the factors that you need to think about are your age, lifestyle, finances, previous contraception and what you think is suitable and acceptable for you. There are many contraceptive options available other than the pill or condoms, and some may be more appropriate to your individual needs than others.
After childbirth Expand After childbirth you will need to choose an effective contraceptive method if you don’t want to get pregnant straight away. The method of contraception you use depends on what you and your partner prefer, your medical history, any problems you had in your pregnancy and if you are breastfeeding. If a woman is breastfeeding contraceptive methods that contain oestrogen are not recommended. It is usually advised that you wait until the baby is six months old before you start using contraception that contains oestrogen. This is because oestrogen may reduce your milk flow. However, you can consider using them when your baby is at least six weeks old and at least half bottle fed. Breastfeeding is 98% effective in preventing pregnancy, but only if: you haven't had a period since your baby was born your baby is less than six months old your baby is only breastfed and not having any other food or drink This protection reduces significantly after six months and once periods return or the baby starts to have any other food or drink, you will need to use contraception if you don't want to get pregnant. The following types of contraception are considered safe when breast feeding: the progestogen only pill, condoms, the diaphragm, injection, implant, intrauterine devices and emergency contraception. There are many myths about when and what contraceptives can and cannot be used after a pregnancy. Most contraceptive methods can be started immediately. If you choose an contraceptive implant, it can be inserted on the same day as the delivery or before you leave the hospital. An IUD can be inserted at the 6-wek check-up or any time after that provided a pregnancy is excluded.
Can I miss periods on the pill? Expand Some women choose to skip their period by not taking the break between the last hormone pill, and the first hormone pill of the new packet (skipping the sugar pills). It is safe to do this. Talk to your doctor, nurse or other healthcare provider, or ring the True clinic.
Do I need to stop the pill at 35 years? Expand Most women can use the contraceptive pill up to the age of 50 years. However, there are increased risks for women over 35 years and smoking would be a contraindication to continue the pill after this time. A discussion with your doctor about contraception after 35 years age is advised.
How soon will my fertility return after an IUD? Expand An IUD may last for five to ten years (depending on the type) but can be removed at any time. After removal your fertility will return within a month.
Can I have an IUD as emergency contraception? Expand Yes, the copper IUD can be used as emergency contraception if inserted up to five days after unprotected sexual course. This is more effective than the emergency contraceptive pill (the “morning after pill”). It also provides ongoing contraception. The Mirena™ cannot be used as emergency contraception.
Can I use an IUD after I have had a baby? Expand Yes, you can use an IUD after having had a baby. This can be fitted from six weeks after the birth, regardless of whether you have had a vaginal or caesarean delivery. IUDs are safe for breastfeeding women to use. It will be important to check that you are not pregnant before the IUD is fitted.
Can I use an IUD for heavy periods? Expand The Mirena™ releases a low dose of the hormone progestin. The Mirena™ was originally developed to treat heavy periods in addition to providing contraception. The Mirena™ can be a good choice for women, as it can decrease heavy periods. Heavy bleeding can be due to hormones or other gynaecological problems. Before you have an IUD inserted it is important to be sure you have none of these gynaecological problems. Your doctor will arrange a check-up and may want to arrange other tests before you have a Mirena.
What is the best contraception to prevent a sexually transmitted infection (STI)? Expand The condom is the only method of contraception that helps prevent STIs. Using a condom before genital contact offers protection against many STIs.
What is the best contraception to prevent a pregnancy? Expand The contraceptive method that has the same efficacy for perfect use and typical use is long acting reversible contraceptives (LARC). The best LARCs are the intrauterine devices (IUDs) and the progestogen implant (Implanon).
How effective is the Pill? Expand The Pill is 99% effective when taken correctly. This means that if 100 women take the Pill, 1 woman could become pregnant in a year, but it is less effective than this if not taken according to instructions. The typical effectiveness rate in studies of women using the Pill is 91%. This rate reflects the fact that the Pill may not always be taken consistently.
What are the disadvantages of female sterilisation? Expand Usually requires a general anaesthetic The general risks for a surgical procedure are bleeding and infection; specific for this procedure would be damage to other structures inside the abdomen. Periods may become heavier if the woman has previously been on the COCP If pregnancy does occur there is an increased risk of this being an ectopic pregnancy (pregnancy in the Fallopian tube)
What are the possible serious risks of taking the Pill? Expand While serious risks are extremely rare in healthy women taking the Pill, it is important to note the following: Thrombosis is a rare but very serious complication which occurs when blood clots form in major blood vessels. This can occur spontaneously, after an operation or accident, on the COCP, during and after pregnancy. Warning signs of a thrombosis are severe sudden chest pain, shortness of breath, severe pain or swelling in one leg, sudden blurred vision or loss of sight, or sudden severe headache. If you have any of these symptoms contact your doctor or go to your nearest emergency department immediately. It is important to understand how big the risk is for you. The information below shows the risk in women in different situations, from women who are not pregnant and not taking the pill (two women in every 10,000 in one year) to the highest level of risk, for women after they have had a baby (200 times more than the lowest level, and 60 times more than the lowest risk level for a woman on the pill). For every 10,000 women in one year, thrombosis occurs in: 2 women not using the Pill/ring and who are not pregnant 6-12 women using the vaginal ring 29 women during pregnancy 300-400 women soon after having a baby For the COCP, the risk of thrombosis varies with the type of progesterone: 5-7 women using 1st generation pills (the pills that have been in use for the longest time – containing levonorgestrel or norethisterone 9-12 women using other pills If blood clots are a specific concern for you, visit your doctor who can assess your particular risk based on your personal and family health history, as there are specific blood disorders that might increase the risk of thrombosis.
What are the possible side effects of taking the Pill? Expand The Pill has few side effects. Some side effects tend to settle within 2 or 3 months of starting the Pill. During this time some women may experience: nausea breast tenderness or enlargement mood changes breakthrough bleeding headache Other possible side effects that may occur over time include: Skin changes including acne or chloasma (brown discoloration on the face) Change is sexual response Weight gain: studies suggest this is not related to the pill
What are the advantages of the Pill as a method of contraception? Expand Very effective method of contraception when taken every day Readily accessible by most women Fertility returns soon after stopping the pill Control over bleeding so that it can be predictable
What are the disadvantages of the Pill as a method of contraception? Expand Must be taken on a daily basis Efficacy depends on the reliability of the woman in taking it as directed Needs to see a doctor for review and prescriptions The cost of the pill varies with the type The pill gives no protection against sexually transmitted infections (STIs) Some rare but potentially serious side effects Some risks associated with Pill use in a number of health conditions, limiting its safety and ability to be used in these situations
What are the possible health benefits of the Pill? Expand Lighter periods Less period pains Can improve acne Useful for gynaecological conditions: premenstrual syndrome, endometriosis, recurrent ovarian cysts Can reduce or assist with symptoms of the perimenopause and polycystic ovarian syndrome Reduced risk of cancer of the uterus, bowel and ovary May decrease the odds of developing bacterial vaginosis (imbalance of natural organisms in the vagina and vulva potentially leading to symptoms)
Can all women take the pill? Expand Most women can safely take the Pill. Your doctor will review the suitability of the method with you before prescribing the pill. Your doctor will ask about your own and your family history: A history of blood clots or current health conditions and inherited conditions that might increase your chance of a blood clot Certain types of migraine A history of stroke or heart problems or risk factors for a cardiovascular problem: smoking, overweight, high blood pressure, high cholesterol Gall bladder or liver disease Diabetes Breast cancer Unexplained vaginal bleeding - this must be investigated before starting the pill Cervical cancer screening status History of polycystic ovarian syndrome Medications – prescribed and over-the-counter The possibility of current pregnancy and past pregnancies and their outcomes Breast feeding Plans for future pregnancies
Starting the Pill Expand After the review by your doctor, you will be able to fill your prescription. Australian pill packets contain both hormonal 'active' pills and 'inactive' pills. ‘Inactive’ pills are sometimes called the ‘sugar pills’. Your doctor will explain starting the Pill with you, based on the particular Pill being prescribed for you, as all packages look different. Key points: If you start on an 'active' pill on any of the first 5 days of your cycle (day 1 of the cycle is the day your period starts) then you are protected against pregnancy immediately Starting the first packet of the Pill at any other time in your menstrual cycle, you will be protected from pregnancy only after you have taken 7 hormone 'active' pills
What else should I know about the Pill? Expand The Pill needs to be taken at a regular time every day. It can be useful to link pill taking with other activities that are part of your daily routine. A monthly bleed occurs during the 'inactive’ pills and many women prefer to have this regular period. However, if you do not want to have a monthly bleed, you can safely take the hormone pills continuously – missing out the ‘sugar’ pills of each pack. The pill can be stopped for a ‘period’ at any time of your choosing. If you decide to take the pill continuously, without a break, and you start to bleed, then stop the pill for 3 days and then restart the pill. To renew your pill prescription you will need to see a doctor at least once a year. The pill may not be effective if: Your pill is late Vomiting occurs within 2-3 hours of taking the pill Severe diarrhea occurs Other medications are taken Some non-prescribed medications, for example St John’s wort (hypericum), can interfere with the action of the pill For some medications, you cannot rely on the Pill for prevention of pregnancy while on the medication and then for the next 7-28 days of ‘active’ hormone pills. Check with your doctor for any of these issues.
Do I need Emergency Contraception if I have missed a pill? Expand Emergency Contraception may be required if you miss pills and sexual activity occurs without a condom being used. Emergency Contraception should particularly be considered for pills missed in the first week of ‘active’ pills, ie, the first 7 hormone pills taken after the 7 day break on the ‘inactive’ pills. Emergency Contraception is most effective when taken within 24 hours, but may be taken up to 120 hours (5 days) after unprotected sexual intercourse. It is available without a prescription from pharmacies, general practitioners (GPs), Sexual Health or True clinics.
Christine Ip BE(Chem)(Hons), MBus(Acc), GAICD Expand Christine is a senior commercial and financial manager with over 20 years of experience in strategy, complex problem solving and value creation across multiple industries in the private and public sectors. She is a Director in the Client Division of Queensland Treasury Corporation, leading a team of finance and accounting professionals to secure the State’s financial success through business optimisation, infrastructure development and financing. Christine is motivated to contribute to the for-purpose sector. She has built an extensive network supporting the development of women in business. Special responsibilities: Member-Audit & Finance Committee, Member Governance and remuneration Committee (from 31 March 2021)
Tania Hillman B.Com. CA Expand Tania is a chartered accountant with over 19 years of commercial experience. Starting her career within public practice before transitioning into commercial accounting, she has extensive experience in tax, international accounting standards, regulatory standards and financial markets. Tania is the financial controller for GO1, an established leader in online learning and education, and a member of the Chartered Accountants Australia and New Zealand Corporate Advisory Panel. A strong advocate of lifelong learning, Tania has been fortunate to work with organisations dedicated to helping others through education and is proud to support True. Special responsibilities: Member, Audit and Finance Committee