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Sexual Health and Family Planning ACT - Contraception

'Super gonorrhoea' resistant to all routine antibiotics

Super gonorrhoeaTwo people in Australia have been diagnosed with the “super gonorrhoea” infection recently reported for the first time, which has highlighted growing concerns about antibiotic overuse.

Two people in Australia have been diagnosed with the “super gonorrhoea” infection recently reported for the first time, which has highlighted growing concerns about antibiotic overuse. A Queensland Health spokesperson on Tuesday confirmed two cases of gonorrhoea resistant to multiple antibiotics were detected in the past month; one in Queensland and one in Western Australia.

Contraceptive Implant (The rod)

WHAT IS THE CONTRACEPTIVE IMPLANT?

The contraceptive implant, often called ‘the rod’ is a small flexible plastic rod that contains a progestogen hormone. It is inserted under the skin on the underside of the upper arm where it slowly releases a small amount of this hormone over three years.

HOW DOES IT WORK?

The contraceptive implant mainly works by stopping the egg being released from the ovary (ovulation). This prevents pregnancy occurring. It also increases the thickness of mucus in the cervix which make it hard for any sperm to travel through and fertilise an egg.

HOW LONG DOES IT LAST?

The contraceptive implant is effective for three years, but can be removed earlier if you wish.

HOW EFFECTIVE IS IT?

The contraceptive implant is a very effective contraceptive method and is 99.95% effective at preventing pregnancy.

WHO CAN USE THE CONTRACEPTIVE IMPLANT?

The contraceptive implant is suitable for most women to use. Your doctor will be able to help you decide if it is suitable for you. There are some women for who it is not suitable, these include the following:

  • Women who might be pregnant.
  • Women who have had breast cancer or reproductive organ cancers.
  • Women with severe liver disease.
  • Women who have undiagnosed abnormal vaginal bleeding.
  • Women on certain medications which may interfere with the action of Implanon.

ADVANTAGES OF THE CONTRACEPTIVE IMPLANT

  • It gives you 3 years of highly effective contraception with no need to do anything on a daily basis.
  • It gives you contraceptive cover straight away if it is inserted in the first five days of your cycle.
  • It can be removed if side effects are not acceptable or if you wish to become pregnant.
  • Normal fertility returns quickly after removal.
  • It is a low-cost method of contraception.
  • It can be used by breastfeeding women.

DISADVANTAGES OF THE CONTRACEPTIVE IMPLANT

The disadvantages of the contraceptive implant are:

  • It requires a minor surgical procedure to insert and remove it.
  • It does not provide protection against sexually transmissible infections.

POSSIBLE SIDE EFFECTS

The most common side effect of the contraceptive implant are changes to menstrual bleeding, these changes can include:

  • No bleeding.
  • Infrequent spotting or bleeding.
  • Prolonged or frequent spotting or bleeding.

OTHER POSSIBLE SIDE EFFECTS INCLUDE:

  • Headache.
  • Breast discomfort.
  • Acne may develop or worsen, although some women may find that acne improves.
  • Local reactions at the site of the insertion (see possible risks).
  • Some women report weight changes or mood changes, but available evidence does not support the idea that the implant causes these.
  • Progestogen hormones can be associated with development of cysts on the ovary, but these types of cyst usually disappear spontaneously, and rarely cause symptoms or need treatment.

WHEN AND HOW IS IT INSERTED AND REMOVED?

The implant is inserted by a doctor or nurse who has been specially trained to do this procedure. The insertion is a simple procedure which involves a small amount of local anaesthetic to numb the skin, then the implant is inserted just under the skin in the inner aspect of your upper arm. A crepe bandage will be placed around that part of your arm for 24 hours to reduce swelling and bruising and also to reduce any risk of infection.

The implant is usually inserted in the first five days of your period but it can be inserted at other times if there is no chance that you could be pregnant. When it is inserted within the first 5 days of your period it is effective immediately. When it is inserted at other times in your cycle it will take 7 days to be effective. It is safe to have it inserted following the birth of a baby.

The implant can be left in place for three years, after this time it will need to be replaced. It can be removed earlier if desired. Removal is usually a simple procedure which involves a small amount of local anaesthetic to numb the skin before a very small incision is made and the implant removed.

POSSIBLE RISKS

Possible risks of insertion are unusual, and include:

  • Bruising, soreness, infection.
  • Possible scarring at the site of the insertion.
  • Possible difficulty removing the implant.
  • Allergy to the anaesthetic or to the implant itself.

WHERE CAN I GET THE CONTRACEPTIVE IMPLANT?

The contraceptive implant is available through family planning clinics, including SHFPACT, as well as through GPs and gynaecologists.


CONTRACEPTIVE IMPLANT BROCHURE PDF

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Last updated Nov2019

Hormone Releasing Intrauterine Device IUD

WHAT IS A HORMONE RELEASING IUD?

The hormone-releasing IUD is a small plastic device which is inserted into the uterus (womb) by a doctor and is used to prevent pregnancy. It contains a hormone called levonorgestrel in its stem. Levonorgestrel is a type of progestogen. A very small amount of this hormone is released continuously over 5 years.

HOW DOES IT WORK?

The hormone-releasing IUD works mainly by preventing fertilisation. It does this by thickening the mucus in the cervix to prevent sperm penetration; interfering with sperm movement, and thinning the lining of the uterus.

HOW EFFECTIVE IS IT?

The hormone-releasing IUD is 99.8% effective at preventing pregnancy.

HOW LONG DOES IT LAST?

It is effective for 5 years.

WHAT ARE THE ADVANTAGES OF A HORMONE RELEASING IUD?

  • It is a highly effective contraceptive (99.8%).
  • It does not require any day to day action.
  • It is long-acting.
  • The effect is rapidly reversible after removal.
  • It is a very cost-effective method over time.
  • It can be used by breastfeeding women. 
  • It decreases menstrual bleeding and pain(many women experience very light periods or no periods).

WHAT ARE THE DISADVANTAGES?

  • It must be inserted and removed by a doctor.
  • As with any procedure, there is always a small risk of complications.
  • The insertion procedure can be uncomfortable.
  • IUDs provide no protection against sexually transmissible infections(STIs).
  • You may experience light bleeding and spotting for 3 to 6 months after insertion.
  • Your periods may be irregular.
  • Some women may have factors in the shape of their uterus that prevent IUD insertion, and this may not be apparent until insertion is attempted.

WHAT ARE THE POSSIBLE PROBLEMS WHICH MAY OCCUR WITH A HORMONERELEASING IUD?

  • There is a small risk of pregnancy occurring with an IUD (less than 1 in 100). If pregnancy does occur there is a slightly increased risk of it occurring in the fallopian tube.
  • Infection: There is a small risk of infection at the time of insertion(about 1 in 500).
  • Expulsion: In about 5% of cases the uterus will expel the device. Women need to check that the IUD is still in place by feeling for the IUD string after each period. If the string is not present this may indicate that the IUD has moved or been expelled.
  • Perforation: This is a rare event (approximately 2 in 1000 insertions)which occurs when the IUD passes through the wall of the uterus into the pelvic area. This will require surgery under a general anaesthetic to remove the IUD.

HOW IS AN IUD REMOVED?

Removal of an IUD is done by a doctor. It is a relatively quick and straightforward procedure.

WHO DO I GO TO FOR IUD INSERTION?

IUDs are only inserted by doctors who have done IUD training. The clinic at SHFPACT provides IUD insertion services. Some GPs and most gynaecologists also provide this service.

WHAT HAPPENS IN THE IUD INSERTION PROCESS AT SHFPACT?

INITIAL CONSULTATION APPOINTMENT

  • There will be an initial consultation with a doctor to determine if a hormone-releasing IUD is a suitable option for you. The method and insertion procedure will be explained, a Cervical Screening Test will be offered if it is due, and swabs may also be collected if required. It is best to ask any questions or raise concerns at this point.
  • A prescription for the IUD will then be given to you. You will need to go the chemist and have this filled then you need to bring the IUD with you to the clinic on the day of insertion. 
  • The hormone-releasing IUD needs to be inserted on day 1 to 7 of your menstrual cycle (day one being the first day of your period) or at any time if you are currently using the oral contraceptive pill or another reliable method of contraception.
  • Following your initial consultation, you will need to make an appointment for the insertion.

INSERTION APPOINTMENT

  • You will be encouraged to arrange to be driven home and to rest up after the procedure and for the remainder of the day (you may need to organise care for young children, time off work etc.). You will probably be fine to return to normal activities the following day.
  • Most women will be at the clinic for an hour to an hour and a half. If parking please ensure you have left enough time.
  • The doctor will run through the procedure and make sure the process is clear.
  • An uncomplicated insertion procedure takes about 15 mins. You will be asked to stay at the clinic for a minimum of 20 minutes following the procedure. If you are not feeling well you will be asked to remain until the staff caring for you feel that you are well enough to leave. 

AFTER INSERTION

  • There may be cramping and/or bleeding in the first few days afterwards.
  • Spotting may occur for up to 3 to 6 months after insertion.
  • We advise that nothing should enter the vagina for 3 days afterwards in order to reduce the risk of infection: no tampons, no sex, no baths, no swimming or douches (showering is ok).
  • You will need to return for a check-up in 4- 6 weeks. At this appointment, the doctor or nurse will do a speculum examination to check the strings are visible, and an internal exam to check for pain or infection.
  • You should contact the doctor if:
    • You suspect you might be pregnant.
    • You experience excessive pelvic pain or tenderness, fever or chills, offensive vaginal discharge, or deep pain with intercourse.
    • You can’t feel the string or can feel the plastic of the device.

HORMONE RELEASING IUD BROCHURE PDF

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References: Contraception: An Australian clinical practice handbook 4th Edition. Contraception: Intrauterine Devices/ Family Planning QLD. Hormone Releasing IUD (Mirena) Fact sheet, Family Planning NSW. Guillebaud, J & MacGregor, A. 2013. Contraception: Your questions answered. 6th Edition. Churchill Livingstone. Last updated Jan 2019.

Male pill on the horizon

Male PillThe female contraceptive pill has helped millions of women take control of their fertility and reproductive health since it became available in 1961. Yet a male equivalent has yet to be fully developed. This effectively leaves men with only two viable contraceptive options: condoms or a vasectomy.The idea of creating a male contraceptive has been around almost as long as the female contraceptive. In theory, targeting the production of sperm should be a simple process. The biology of sperm production and how they swim towards the egg are well understood.

New birth control pill for men

Birth Control PillA new birth control pill for men appears to be safe when used daily for a month, with hormone responses consistent with effective contraception, study researchers say.

 A new birth control pill for men appears to be safe when used daily for a month, with hormone responses consistent with effective contraception, study researchers say. Their study results, in 83 men, will be presented Sunday at ENDO 2018, the Endocrine Society's 100th annual meeting in Chicago, Ill.

Post Natal Contraception

Contraception is essential for planning the size of your family and spacing children optimally for your individual family unit. A pregnancy that occurs within twelve months of giving birth can be problematic for both the mother and baby, with a higher risk of pre-term birth and other complications, so having effective contraception during this time is very important.

Progestogen Only Pill (POP)

The POP (sometimes also called the mini-pill) is an oral hormonal contraceptive pill which contains a low dose of progestogen. The POP is taken continuously and at the same time every day in order to prevent pregnancy. It is different to the combined pill (‘the pill’) which contains two hormones, oestrogen and progestogen.

HOW DOES IT WORK?

The POP works by making the mucous produced by the cervix thicker, so that sperm cannot get into the uterus (womb) and fertilise an egg.

HOW EFFECTIVE IS IT?

It is thought to be between 91% - 99% effective in preventing pregnancy. This means that if 100 women were using the POP for a year, between 1 and 9 women would get pregnant. Effectiveness is very dependent on how well the pill is taken. The POP is more effective in women over 40 years.

WHAT ARE THE ADVANTAGES OF THE POP?

  • It is a low dose oral contraceptive.
  • It has minimal side effects.
  • It is easily reversible on stopping.
  • It can be used while breastfeeding.
  • It can be used by women who cannot take oestrogen.
  • It will not mask menopause symptoms.

WHAT ARE THE DISADVANTAGES OF THE POP?

  • It needs to be taken strictly at the same time every day.
  • It doesn’t protect against sexually transmissible infections.
  • Taking the POP can change your periods, some women may experience regular periods, while others experience irregular bleeding. 

WHEN DO I START TAKING IT?

You will need to discuss starting the POP with your prescribing doctor. The POP needs to be taken strictly at the same time every day. Choose a time that it is easiest for you to remember. It can be helpful to use an alarm or reminder system to help you remember to do this.

WHAT DO I DO IF I MISS A PILL?

If you are more than three hours late taking the POP you could get pregnant. You should take the late pill as soon as you remember and then take the next pill at the correct time. Use additional contraceptive precautions (condoms) or avoid sex for the following 48 hours.

If you had sex when you were not protected you should consider using the emergency contraceptive pill, available at pharmacies without a prescription (see our information brochure on Emergency Contraception).

WHAT SHOULD I DO IF I AM VOMITING?

If you vomit within two hours of taking the POP you should take another pill straight away. If you vomit the second pill you will need to use condoms or avoid sex until you have taken the next three pills at the correct time. If you have severe diarrhoea you should follow the missed pill advice.

WHAT IF I’M TAKING OTHER MEDICATIONS?

Some medications and herbal preparations may stop the progestogen-only pill working, this should be discussed with your prescribing doctor.

WHAT SIDE EFFECTS MIGHT I EXPECT?

The POP has very few side effect. The main side effect which may occur is a changed bleeding pattern. This might be irregular bleeding, missed periods or sometimes no periods. Some women who take the POP report mood changes and weight gain but there is no current evidence that the POP causes these side effects.


PROGESTOGEN ONLY PILL (POP) BROCHURE PDF

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Want to know more? Contact Sexual Health and Family Planning ACT on 02 62473077 or at our city clinic located at Level 1, 28 University Avenue Canberra. Last updated Feb 2019

The Pill

WHAT IS THE COMBINED ORAL CONTRACEPTIVE PILL?

The combined oral contraceptive pill, usually simply called ‘the pill’, is a contraceptive pill taken by mouth which contains two hormones, oestrogen and a progestogen. 

HOW DOES IT WORK?

The pill works by preventing ovulation, which means it stops the ovaries from releasing an egg each month, which in turn means that fertilization cannot occur and a pregnancy cannot begin.

HOW EFFECTIVE IS IT?

The pill is approximately 93% effective. 

HOW IS IT TAKEN?

The pill is taken by mouth every day. Most pill types come in a box of three to four sachets with each sachet containing a month’s supply of pills. Each pill sachet contains hormone pills that you usually take for three weeks, and inactive or sugar pills (which help you to keep the habit of taking the pill every day) that you take for seven days before starting the hormone pills again. You can also take the hormone pills for longer than three weeks so that you skip periods. If you think you would like to do this discuss it with your doctor.

WHO CAN TAKE THE PILL?

The pill is suitable for most contraceptive users.

There are some medical conditions which make the pill unsuitable, these include the following: 

  • Deep venous thrombosis (blood clot), stroke or heart attack.
  • Severe liver problems.
  • Migraine with aura (visual or other disturbances starting just before the migraine).
  • Some autoimmune conditions that increase the risk of blood clots.

The pill may also be unsuitable: 

  • If you have high blood pressure, diabetes, gall bladder disease, active liver disease, kidney disease, some blood problems, or if you are on some other medications which may interact with the pill.
  • If you have a history of breast cancer or cervical cancer.
  • If you are over 35 and smoke.
  • If you have unexplained bleeding from the vagina.
  • If any of these conditions apply to you, let your doctor help you decide
  • if the pill is suitable for you. 

ADVANTAGES OF THE PILL?

  • It is very effective with correct use.
  • It is readily accessible.
  • It is easily reversible.
  • It gives you a predictable bleeding pattern and allows you to skip periods if you want.
  • It can be useful in controlling heavy or painful periods and managing Premenstrual Syndrome.
  • It can improve acne.

DISADVANTAGES OF THE PILL?

  • It must be taken every day.
  • It is less effective if not used perfectly (for example if pills are missed).
  • Some pill types can be expensive.
  • Effectiveness may be reduced by vomiting or diarrhoea.

THE PILL AND YOUR HEALTH 

Serious health problems caused by the pill are very rare — the most significant of these is blood clotting. Symptoms of this are severe sudden chest pain, severe pain or swelling in one leg, sudden blurred vision or loss of sight, slurring of speech or sudden severe headache.

If you have any of these symptoms contact your doctor immediately.

Your risk of developing a blood clot is increased when you are not mobile for an extended period of time e.g. sitting in a car or airplane on a long trip, or if you are planning to have surgery. Please talk to your doctor if you are planning any of these.

As well as being a contraceptive, the pill has other health benefits. When on the pill you are less likely to develop a serious pelvic infection, cancer of the ovary, cancer of the endometrium (lining of the womb), cancer of the bowel, anaemia, non-cancerous breast lumps, and cysts of the ovary.

When you are taking the pill, periods are generally less painful, the bleeding is usually lighter and more regular, and there is often less premenstrual tension. Acne may also improve.

Most people feel fine on the pill, but it is common to have some minor side effects initially. You might get some bleeding in between periods, sore breasts and mild nausea (feeling sick) for the first couple of months. These side effects usually settle by themselves.

Some people report weight changes, reduced desire for sex, and mood changes, however, there is no scientific evidence to show that the pill causes these effects, other aspects of life may be contributing factors.

Very rarely the oestrogen in the pill can cause patchy brown discolouration of the skin on the face called melasma. This is more noticeable if you spend a lot of time in the sun. If melasma does occur it usually does so in the first few months after starting the pill. If you notice this discolouration starting to appear on your face see your doctor. 

TYPES OF PILLS AVAILABLE 

There are quite a few different types of the pill available. There are some differences between them and it may take a few trials to find the one most suitable for you. Don’t be afraid to discuss the different options with your doctor.

STARTING THE PILL

As long as you are absolutely certain that you are not pregnant, you an start the pill at any time of your menstrual cycle. If you start with a hormone pill on Day 1 to Day 5 of your cycle (Day 1 is your first day of bleeding), you are immediately protected from pregnancy.

If you start on any other day of your menstrual cycle, you will need to use additional contraception, such as condoms, or abstain from intercourse, until you have taken 7 of the hormone pills. 

WHAT TO DO IF YOU MISS A PILL

Is it more than 24 hours since the pill should have been taken? (This means more than 48 hours since you last took a pill).

What to do if you miss a pill


THE PILL BROCHURE PDF DOWNLOAD

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Last updated Feb 2020