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Contraceptive options

If you have had unprotected sex, your condom broke, or you missed taking your contraceptive pill during the last 72 hours, you should access emergency contraception as soon as possible if you haven't already. 

Although the most commonly used methods of contraception in Australia are condoms and the pill, there are many other options now available. 

Implant | InjectionsIntrauterine device (IUD)Vaginal Ring | Contraceptive pill | Condoms | Diaphragm | Sterilisation | Natural family planning 

 

The method you choose might be influenced by a variety of things, including your general health, your lifestyle, your childbearing intentions, your risk of contracting a sexually transmitted infection, whether you're living any intolerances or allergies you might have, and others. 

If you're in a committed relationship it's important to talk about contraception with your partner. If you are taking sole responsibility for contraception (for example, you're using an IUD or taking the pill), you might like to talk about how he can help share the financial burden. 

Sometimes you might not want others to know you are using contraception or might want a method that you feel others cannot mess/interfere with. The long acting reversible contraceptives may fit best for you. Find out more about these options below.

Sometimes you might need to try different methods before you find one that works well for you, or you may find that different methods are more suitable at different stages of your life.

The information below is an overview only. It can help to talk to your GP or a specialist sexual health doctor or nurse about your contraceptive options and what methods might suit you best. More details about each method are available over on the True (formerly Family Planning Qld) website. The Family Planning Alliance Australia website also has a very useful overview of the effectiveness of all available contraceptive methods - it's available to view or download as a pdf

 

Long Acting Reversible Contraceptives (LARCS)

LARCs are also sometimes referred to as 'set and forget' contraceptive methods. They last for 3 weeks to 10 years once they are inserted, depending on the method chosen. However, these methods do not protect against Sexually Transmitted Infections (STIs), so a barrier method may also be needed depending on your lifestyle or partner/s. 

While LARCS are generally very cost effective over the lifetime of the device, the upfront cost for the device itself and its insertion can make them out of reach for some women. We have a No Interest Loan Scheme that may be able to help if you are struggling to afford the cost of a LARC - check here for more details

LARC methods available in Australia are the Implanon (implant), Depo Provera (injection), the hormonal or copper IUD (intrauterine device), and the NuvaRing (contraceptive vaginal ring).

Implanon

  • What it is: Implanon is the brand name for the contraceptive implant available in Australia. The implant is small flexible rod slightly smaller than a matchstick, which is inserted under the skin - usually in the upper arm.
  • How it works: By slowly releasing the hormone progesterone to prevent pregnancy. Progesterone is one of the hormones used in the oral contraceptive pill.
  • How long it lasts: Three years once inserted. 
  • How effective it is: More than 99% effective.
  • Advantages: Cost effective over time; no potential for user error or interference. 
  • Disadvantages: Some women can experience unpredictable bleeding patterns; not all doctors and nurses are trained to do insertions. 
  • Is it detectable? The bandaging after insertion can make it obvious that it's been done, and it's possible to feel the rod under the skin. It's usually inserted in the upper arm but you may be able to ask your doctor to insert it somewhere less detectable. 
  • Can it be tampered with? If it's cracked while it's in place it could become less effective, so it may not be suitable for some women living with extreme physical violence and assault. 

Injection

 

  • What it is: The contraceptive injection is sold as Depo-Provera and Depo-Ralovera in Australia and is a three monthly injection of hormone by a nurse or doctor.
  • How it works: By preventing the egg from being released and the sperm from reaching the egg. 
  • How long it lasts: Twelve weeks. 
  • How effective it is: 99% perfect use, 94% typical use. 
  • Advantages: Lasts three months each time. 
  • Disadvantages: Bleeding can be unpredictable to start with; return to fertility may be delayed once usage stops; has been linked with weight gain and lowered bone density. 
  • Is it detectable? The only signs of use are the injection site on the day of each injection, and the end of regular menstruation. Women experiencing high levels of surveillance or monitoring may have issues due to things like Medicare records showing three-monthly visits and changes in menstrual patterns.  
  • Can it be tampered with? Once injected it cannot be tampered with for that 12 week period. 

Hormonal IUD 

 

  • What it is: Mirena is the name of the hormone-releasing IUD available in Australia. It is a small T-shaped plastic device inserted into the uterus, with a nylon string attached to it which comes out through the cervix; this allows women to be able to self-check the device is still in place (if the string can be felt) and also assists a doctor to remove it. It can be used by women who have not had children as well as those who have, and can be used while breastfeeding. 
  • How it works: By slowly releasing low doses of the hormone progesterone to prevent pregnancy. This changes the lining of the uterus, making it unsuitable for a pregnancy, and prevents sperm from reaching the egg. 
  • How long it lasts: Five years once inserted. 
  • How effective it is: More than 99% effective.
  • Advantages: Cost effective over time; no potential for user error or interference. 
  • Disadvantages: Not all doctors and nurses are trained to do insertions; upfront costs for insertion can be a barrier for some women. 
  • Is it detectable? The strings may be detectable inside the vagina, but can be trimmed shorter by a doctor (although this may make it more difficult to remove). Menstruation patterns may also be disrupted. 
  • Can it be tampered with? It could be potentially forcibly removed, especially if the strings are not cut off at the opening of the cervical canal.  

Copper IUD

 

  • What it is: Copper IUDs are small plastic devices with copper wire wrapped around the stem. A copper IUD is inserted into the uterus and has a nylon string attached to it which comes out through the cervix; this allows women to be able to self-check the device is still in place (if the string can be felt) and also assists a doctor to remove it. Like the Mirena, a copper IUD can be used by women who have or haven't had children, and who are breastfeeding. There are two types of copper IUD available in Australia
  • How it works: Copper IUDs do not have any hormones, but the copper makes the lining of the uterus unsuitable for a pregnancy and hostile to sperm.
  • How long it lasts: Five to ten years once inserted. 
  • How effective it is: 99% effective.
  • Advantages: Cost effective over time; no potential for user error or interference. 
  • Disadvantages: Not all doctors and nurses are trained to do insertions; not listed on the PBS so insertion can be expensive.
  • Is it detectable? The strings may be detectable inside the vagina, but can be trimmed shorter by a doctor (although this may make it more difficult to remove). Menstruation patterns may also be disrupted. 
  • Can it be tampered with? It could be potentially forcibly removed, especially if the strings are not cut off at the opening of the cervical canal. 


Vaginal ring

 

  • What it is: The contraceptive vaginal ring is sold as NuvaRing in Australia. It is a soft plastic ring self-inserted into the vagina, which remains there for three weeks, after which point you can remove it yourself and replace it with the next ring a week later.
  • How it works: By releasing low doses of oestrogen and progesterone (the two hormones used in the combined oral contraceptive pill).
  • How long it lasts: Each ring lasts three weeks. 
  • How effective it is: 99% perfect use, 91% typical use. 
  • Advantages: Can help regulate the menstrual cycle, reduce PMS and period pain; easier to use correctly than the combined pill). 
  • Disadvantages: Not suitable for women with some medical conditions; not listed on the PBS so more expensive than other combined contraceptive methods. 
  • Is it detectable? It's easily detected, although it can be removed for short periods of time (up to three hours) without becoming less effective, so it could be discreetly removed just before sex and reinserted immediately afterwards. 
  • Can it be tampered with? Easily removed so may not be suitable for women who have little control over if, when or how sex happens. Emergency contraception may need to be accessed in these circumstances. 

 

Other methods

Combined oral contraceptive pill

 

  • What it is: Pill containing the hormones oestrogen and progesterone, taken every 24 hours. 
  • How it works: The hormones prevent the egg from being released. 
  • How long it lasts: It must be taken at the same time each day. 
  • How effective it is: 99% perfect use; 92% typical use. 
  • Advantages: Can help regulate the menstrual cycle, reduce PMS and period pain. 
  • Disadvantages: Not suitable for women with some medical conditions; if pills are missed, extra contraceptive methods may be necessary as a backup. 
  • Is it detectable? Pills in their packaging can be easily recognisable. They could be removed from their packaging and hidden elsewhere to reduce this risk but this could alter their effectiveness if they're exposed to heat, light or moisture. 
  • Can it be tampered with? Pills can be easily disposed of by anyone with access to them. Instructions about what to do if a pill is missed are easily available online if it's unsafe to keep that information in printed form. 

Progesterone only contraceptive pill (mini pill) 

 

  • What it is: Pill containing the hormone progesterone, taken every 24 hours. 
  • How it works: The hormone prevents the egg from being released and thickens the cervical mucus, making it harder for the sperm to reach the egg. 
  • How long it lasts: It must be taken at the same time each day. 
  • How effective it is: 98% perfect use; 92% typical use. 
  • Advantages: Alternative to the combined pill for women who can't take oestrogen because of some medical conditions. 
  • Disadvantages: Not suitable for women with some medical conditions; if pills are missed or taken more than three hours late, extra contraceptive methods may be necessary as a backup. 
  • Is it detectable? Pills in their packaging can be easily recognisable. They could be removed from their packaging and hidden elsewhere to reduce this risk but this could alter their effectiveness if they're exposed to heat, light or moisture. 
  • Can it be tampered with? Pills can be easily disposed of by anyone with access to them. Instructions about what to do if a pill is missed are easily available online if it's unsafe to keep that information in printed form. 

 

Condoms

 

  • What it is:  Male condoms are most commonly made of latex (although polyurethane condoms are also available if you or your partner have allergies to latex), and are a thin sheath which fits over the penis during sex. Female condoms are also thin sheaths of polyurethane that act as a barrier between the penis and vagina during sex, but they are inserted into the vagina instead of over the penis. Female condoms have a soft flexible ring at each end, with one closed end and one open. The closed end is inserted into the vagina. 
  • How it works: Both male and female condoms prevent sperm from entering the vagina by trapping ejaculate.
  • How effective it is: Male condoms are 85-98% effective; female condoms vary from 80-95% effective. 
  • Advantages: Male and female condoms are also barrier methods, so they help prevent Sexually Transmitted Infections (STIs) as well as pregnancy; male condoms are readily available in Australia; both methods only need to be used during sex; can be used as a backup for other contraceptive methods. 
  • Disadvantages: Can reduce spontaneity.
  • Is it detectable? Condoms are one of the most obvious forms of contraception and need to be negotiated every time penetrative sex takes place. 
  • Can it be tampered with? Male partners can easily take control of this method so it is very open to sabotage; condoms may also be damaged or removed, or the male partner may not put one of after promising to. 


Diaphragm

 

  • What it is: A diaphragm is a silicone cap which is inserted into the vagina prior to sex, and covers the cervix. Diaphragms are available from family planning clinics, who can also show you how to insert it and ensure it is fitted correctly.
  • How it works: As a barrier to sperm entering the uterus.
  • How effective it is: 85-95% effective. 
  • Advantages: It can be inserted well before sex, so doesn't have the disruptive impact some people report with condoms. Side effects are rare and it is safe to use while breastfeeding as it's non-hormonal.
  • Disadvantages: Spermicide may be needed to ensure effectiveness; needs to be left in place for at least six hours after penetrative sex. 
  • Is it detectable? It may be detectable during sex, particularly by fingers but less so by penile penetration; shape is fairly distinguishable due to the lipped rim, so may be obvious to others when it's not in use. 
  • Can it be tampered with? Needs forward planning so may be not suitable for women who have little control over if, when or how sex happens; can easily be removed by another person before or during sex. 


Sterilisation (tubal ligation)

 

  • What it is: Surgical procedure to permanently clip, block, or tie the fallopian tubes so eggs and sperm can not meet. 
  • How it works: By preventing the egg and sperm from meeting. 
  • How long it lasts: Permanent. 
  • How effective it is: More than 99% effective.
  • Advantages: Permanent, s cost effective over time; doesn't interfere with hormones. 
  • Disadvantages: Expensive to have done privately and not widely available; public waiting lists are long and often have strict eligibility criteria, including a woman's age and childbearing history. 
  • Is it detectable? Depending on the method, there may be a need for incisions and anaesthesia, and/or a followup at three months, which may make it difficult to have done discreetly. Menstruation is maintained and there's no ongoing signs once the incision scars have healed. 
  • Can it be tampered with? No. 

Male sterilisation is also possible. The procedure is known as vasectomy, and is a simple and straightforward procedure which involves the cutting and tying of the vas deferens, the tubes which carry sperm, to prevent sperm being carried from the testes into the semen. The procedure does not affect the production of semen or impact on sexual function; men who have had a vasectomy should still experience sex and ejaculation in the way they did before the procedure. Vasectomies are usually performed under a local anaesthetic but can be carried out under sedation or general anaesthetic. They are generally much more broadly available than female sterilisation procedures, and can be performed by a specialist or through the public health system; some GPs and private health clinics may also provide vasectomies. Ask your GP or a sexual health clinic for more info. 


Fertility awareness based methods (FABM)

 

  • What it is: Tracking the menstrual cycle and avoiding sex on the days when pregnancy could result. There are different methods that are used to do this which are all classified as FABM. They require women to calculate 'fertile days' by counting the length of their cycle over time or by following signs that indicate ovulation (for example, temperature or mucous changes).
  • How it works: By avoiding sex, using alternatives to penis-in-vagina sex or using a barrier method during fertile days. 
  • How effective it is: Varies from 75-99% effective. 
  • Advantages: Doesn't require any device or access to medical care. 
  • Disadvantages: Requires training and practice for greatest effectiveness; alternatives to penis-in-vagina sex may have other risks of harm for women. FABMs require committment and consistency of use, and it can be difficult to predict ovulation even if you are confident with the method. It does not offer any protection against sexually transmitted infections.
  • Is it detectable? These methods, when used properly, require record keeping about cyclical changes. These could be concealed in code in a diary or on a fertility app but may still be risky for women experiencing high levels of surveillance. 
  • Can it be tampered with? Not be suitable for women who have little control over if, when or how sex happens. Emergency contraception may need to be accessed in these circumstances.

Lactational amenorrhea method (LAM)

The lactational amenorrhea method can be an effective form of contraception when used correctly. If you are solely breastfeeding an infant less than 6 months old (ie, your baby isn't receiving any supplementary feeding through formula), and menstruation has not recommenced since the birth, this may provide up to 98% effective contraceptive coverage. 

 

Last modified on: 02 March 2018
Contraception
02 March 2018