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If you know me at all by now (Hey, hi, I’m Rachel), you’ll know that I will forever be at the front of the pack waving my pom-poms for using fertility awareness and charting as an effective and natural method of birth control.

 

While I absolutely believe that you don’t need artificial hormones to prevent pregnancy, I also believe that every woman is entitled to know *all* of her options so that she can make an informed decision about what’s best for her birth control needs in her current season of life.

 

So, we’re mixing it up in this episode and I’m talking you through the most common hormonal birth control options (that aren’t the Pill).

EPISODE TRANSCRIPT

Hello, and welcome to episode 42 of The Fertility Co Podcast. I’m your host, Rachel and today we’re talking about your hormonal options for birth control.

Now, you might be thinking that all this time I’ve talked about how natural birth control is the best option. And yes, I am inclined that way because I truly believe that this little thing called fertility awareness is effective, cheap, has zero side effects but I am also all about education and informed consent. So, I’ve shared an episode in the past all about your non-hormonal options for birth control, so in this episode I’m talking about the lesser known hormonal options. And I won’t be talking about the Pill because I think that is by far the most common option for hormonal birth control. So, if you’re someone who doesn’t have a great experience with the Pill but you want to know what else is out there apart from non-hormonal methods, I’m going to fill in your knowledge gaps with what else is actually out there.

There is no one-size fits all solution when it comes to birth control, and I know there are heaps of listeners of this podcast who use hormonal birth control and there is absolutely nothing wrong with that! I do think that the Pill is over-prescribed and I hate that it is often prescribed to treat underlying conditions and not just for birth control, because ultimately it’s all about informed consent and if you know exactly the advantages, disadvantages, potential side effects, then you are in the best possible position to choose what is right for you.

I know when I went on the Pill I wasn’t educated on any other option, so that’s what this episode is all about.

We’re skipping right past the Pill because it’s had its time in the sun. If you want to know more about the pill, how it works and its effect on the menstrual cycle, you can listen to Episodes 19 and 20, Coming Off The Pill – the most downloaded episode of the show by a mile!

Instead today, we’re talking about IUDs, contraceptive implants and Depo Provera. IUDs are certainly on the rise in Australia so I really want to spend some time there, but the others I doubt you were taught much about in sex ed.

So, let’s dive in.

IUD

The IUD is a small contraceptive device that is placed inside  the uterus. There are two kinds of IUD. The copper IUD is a small plastic device with copper wrapped around its stem and we talked about this type in Episode 30 – Non Hormonal Options for Birth Control.

The progestogen IUD, more commonly known as its brand name Mirena, is a small T-shape device with a cylinder containing progestogen around its stem. It releases the hormone levonorgestrel into the uterus, the same hormone that the Pill contains, and even though the IUD has been used for more than 30 years to prevent pregnancy, how it works is still not fully understood. The IUD impacts the movement of sperm and kills it before it reaches the uterus so they can’t reach or fertilise the egg. Just like the Pill, the IUD also changes the lining of the uterus so that it doesn’t thicken and isn’t suitable for implantation and pregnancy. So it works very similarly to the Pill, and is actually more effective than the pill, 99.8% effective. Likely because it’s a set and forget type situation, it’s inserted by a doctor and then it stays in place for at least 5 years and you don’t have to think anymore about it.

Advantages

Both the copper IUD and the progestogen IUD have the following benefits:

• effective long term contraception (at least five years)
• easy to maintain, you can’t forget to use it like you might with the Pill
• it is cheaper than other contraception (it’s more expensive at first to get it inserted, but then it’s cheaper over the long term because you’re not constantly filling a prescription)
• if you want to, you can try for pregnancy as soon as it is removed. Your menstrual cycle and fertility often returns quickly once it’s removed.

All of these benefits are the same for both the copper IUD and the progestogen IUD. The progestogen IUD also has the added benefit of reducing menstrual bleeding. This is great for women who would normally have heavy or long-lasting periods, or have experienced this fun side effect with the copper IUD.

Disadvantages

Both the copper and the progestogen IUD have the following disadvantages:

• The IUD may expel itself from the uterus, usually during a period. You may not be aware that this has happened and so you do need to check that the string is in place.
• Most side effects are related to insertion. There is a small risk of infection in the three weeks after insertion. Because pelvic infections can lead to long term problems and infertility, you need to be really careful about protecting yourself from sexually transmitted infections.
• The IUD may perforate the wall of the uterus during insertion. This is very rare.
• If an IUD fails and you get pregnant, your IUD needs to be removed as soon as possible, because an IUD in place increases the risk of miscarriage.
• There is the risk of an ectopic pregnancy (where the fertilised egg implants in the fallopian tubes) when the IUD fails. This is very rare with the copper IUD and even rarer with the progestogen IUD.

• Irregular bleeding or periods are likely in the first three to five months. Eventually you are likely to have very few periods at all. This is a contrast to the copper IUD, where periods often become heavier.
• There may be a slight increase in vaginal dryness, flushing, headaches, nausea and acne.

Who can use an IUD?

• Women at low risk of contracting sexually transmitted infections.
• Women who can’t or don’t want to take the Pill.

Who should not use an IUD?

• Women who are at long term risk of contracting sexually transmitted infections (STIs)
• Women who have undiagnosed vaginal bleeding.
• Women with pelvic inflammatory disease (PID), again due to that high risk of recurrent infection and potential impact on your fertility.

Having an IUD fitted

Before you have an IUD fitted you should have a cervical screening test and swabs to rule out any pelvic infections and make sure you are not pregnant. So, you can either have the IUD inserted immediately after your period or make sure you are using reliable contraception until it can be fitted.

How the IUD is fitted is similar to have a cervical screening test. A speculum will be placed in your vagina and your cervix cleaned with an antiseptic and the IUD is placed inside through the cervix. The string is cut so that it is well up into the vagina. You or your sexual partner won’t notice the string but you should be able to feel it if you reach right up into your vagina to your cervix. You can’t have sex or use tampons for 48 hours after insertion to prevent infection.

You should go back to your doctor if:

• the string feels like it is shorter or longer than normal or you cannot feel it at all, because this means that the IUD may have shifted. The recommendation is to check the length of string after each period
• if you experience persistent low back of abdominal pain, especially if you have a fever too.
• If you have any unusual discharge or bleeding or you experience pain with intercourse
• either you or your partner have had potential exposure to a sexually transmitted infection
• And finally, you should book in to see your doctor for a check six weeks after insertion and then when your regular cervical screening test is due.

Contraceptive Implant

You would be most familiar with the Implanon. Contraceptive implants work in a similar way to the Pill. The implant is a small thin flexible rod, containing progestogen that helps to prevent pregnancy. The implant is 4cm long and made of plastic. It is inserted just under the skin on the inside of the arm by a trained doctor or nurse. The implant steadily releases a small amount of progestogen and it can remain in place for 3 years. It must be removed at the end of three years but it can be taken out earlier at any time if needed. You can’t see the implant because it’s under your skin but you can feel if you touch the spot where it is inserted. 

The implant is inserted under a local anaesthetic and takes about a minute. Removal is also done under local anaesthetic, and with a small incision that might leave a tiny scar.

The implant is 99.8% effective and works to prevent pregnancy by preventing ovulation and thickening cervical mucus, so you won’t see thin, slippery fertile quality mucus, but rather the thick, sticky mucus that blocks the cervix and makes it hard for sperm to get through and fertilise an egg.

Advantages

• Effective contraception for three years.
• You don’t have to remember to use contraception every day.
• Doesn’t interfere with sexual intercourse.
• Low cost.
• Periods should return quite quickly after removal.

Disadvantages

• Women using implants have changes to their periods. Most women have less bleeding than before the implant, but some have more frequent or longer periods.
• Some women have side effects that may include headaches and acne.
• One less commonly reported side effect is that the implant can travel. I’ve heard some stories about them being found down towards the wrist among other places, so something to be mindful of with the implant.

Women who might want to consider using the contraceptive implant might be those who wants effective, long lasting and reversible contraception but they need to be aware that their cycle will change. It’s beneficial if you can’t remember to take birth control daily or if you can’t take the hormone oestrogen.

It may not be suitable if you:

• have liver disease
• have unusual vaginal bleeding
• take medication that may interfere with the implant to make it less effective
• have blood clots
• can’t take the hormone progesterone.

Depo Provera

Depo Provera is a hormone used for contraception. It is given by injection and its effects will last for three months at a time. It is similar to progesterone, which we know plays its part in the second half of the cycle after ovulation. When a woman has the Depo Provera injection, her body senses the presence of the hormone so that her own hormone production is effectively switched off. Because of this, her ovaries will not release an egg and so if you don’t ovulate, you can’t get pregnant. This is obviously very similar to the Pill. Depo Provera is also sometimes used in the treatment of endometriosis because it prevents inflammation and scar tissue because your body isn’t going through a menstrual cycle.

So, just like the other methods I’ve talked about today, Depo Provera is 99.8% effective. This is because, like I said, you don’t have a menstrual cycle while you are exposed to these hormones. Instead of the hormonal fluctuations that happen before and after ovulation, your hormone levels stay the same throughout. Just like the Pill, because hormones don’t trigger thickening of the endometrium for implantation, there isn’t a build up of lining to be flushed away as your period. So you don’t bleed much for the first couple of phases. After a couple of injections, which last for about 3 months each, you’ll likely stop getting periods altogether because there isn’t a lining build up to even have a withdrawal bleed. Some women will have really light and irregular bleeding, while others might have heavier bleeding which would then need to be controlled with other hormonal treatments.

Other side effects:

• A small amount of weight gain sometimes occurs, although many women have no change and some lose weight.
• Some women may be troubled by headaches, abdominal discomfort and mood changes.
• Some women have a reduced interest in sex, particularly women who are prone to depression.
• A small minority of women experience other side effects, which may be a nuisance but are unlikely to be serious. These include allergic reactions, fluid retention and breast soreness.

Hormone levels are really low while using Depo Provera, so there is some concern that long-term use may lead to osteoporosis. While it’s said that the changes stop when you stop the injections, as a physio I do wonder about how much of this bone density we can actually restore afterwards.

Advantages

• Depo Provera is really effective with a very low failure rate.
• For many women the loss of periods is an advantage and they do experience relief of symptoms like period pain. But remember what I’ve said before, it’s masking the actual cause of these underlying problems so this should not be your reason for selecting this as an option, because you will need to deal with the cause at some future stage.
• Depo Provera is also likely to reduce the risk of ovarian cancer, endometrial  or uterine cancer, endometriosis and possibly pelvic infection.
• An injection is given every 12 weeks and apart from remembering to make an appointment, you’re good to go.

Disadvantages

• Some women do not want to see their doctor every three months for an injection.
• Some women do experience side effects that I’ve already mentioned.
• Once the injection has been given, obviously the hormone can’t then be removed. If you want to stop the Depo Provera you need to wait for it to wear off. For some women, periods can be slow to return after the injections are stopped, anywhere from 6 to 12 months. So it’s something to be mindful of if you’re planning a pregnancy in the next couple of years.

Depo Provera is not recommended for the following women:

• bleeding disorders or taking anti-clotting medication

• undiagnosed abnormal bleeding
• history of some forms of cancer
• already pregnant
• wanting to become pregnant within 12 months. So that’s in there as a recommendation, so I would definitely steer clear of this option if you’re planning to conceive in the next couple of years.

So they are the three most common hormonal options for birth control that aren’t the Pill. But just like the pill, your body is exposed to artificial hormones which impacts your menstrual cycle because you would have seen the theme that ovulation is blocked, our cervical mucus is affected and our endometrial lining is affected. The time it takes for the effects of these options to disappear and for our regular cycles to return when we stop using them will vary considerably between women and if you are looking to change up your birth control then I would suggest listening to Episode 30 for Your Non-Hormonal Options for Birth Control.

I actually learnt a hell of a lot researching this episode because these are options I was never really taught about and have never really investigated for myself because I have never used them for myself. But like I said, even though I will shout from the rooftops that there are natural and effective ways to prevent pregnancy that are 99.4% effective – not too bad compared to 99.8% effective and without the side effects – but of course I also want you to be aware of all of your available options so that you can make an informed decision about what’s best for you.

There is a lot of Pill-bashing in my line of work and I see it every day. But the reality is that for some women, it’s the best option. So, not that you need it, but think of this episode as your permission to choose the option that is best for you. Not your doctor, not your family and friends, not even your sexual partner – how you choose to manage your fertile window and the method of birth control you choose to use it totally 100% up to you, and quite frankly nobody else’s business. Discuss your options with a trusted healthcare professional but make sure you have all the information you need to make the right decision for you at this moment in time.

If you learnt something new or found value in today’s episode, I’d love to hear from you! As always, if you have a question you want me to answer or an episode suggestion, please send me an Instagram DM, and let me know what you want me to talk about.

You can get today’s shownotes with everything I talked about in this episode, as well as links to freebies and other related episodes at fertilityco.com.au/42

Don’t forget you can also save your spot for my free fertility masterclass by clicking on the link in the shownotes or on the blog too. It’s on-demand, instant access and I’m talking you through how to know exactly when you’re fertile so that you can of course achieve pregnancy, but also how to avoid pregnancy without relying on these types of hormonal methods of birth control. And I promise it is way less complicated than you think!

I will see you in next week’s episode, thanks for listening. Bye for now and don’t forget that knowledge is power!

When you truly understand your body, you are empowered to make informed decisions and take control of your health!

Until next time.

LINKS & RESOURCES

Want to say goodbye to hormonal contraceptives and their weird and unpleasant side effects?

Want to improve your chances of conceiving quickly and naturally?

You need my Fertility Roadmap– My simple 3-step system to understanding your body’s natural fertile signs and pinpointing ovulation day so that you can use this knowledge to achieve (or avoid) pregnancy.

Related Episodes:

Episode 1 – Menstrual Cycle 101

Episode 2 – Am I Ovulating? The One Check You Can Do Every Day to Know For Sure When You’re Fertile

Episode 12 – The Menstrual Phase – Menstrual Cycle Masterclass Part 1

Episode 13 – The Follicular Phase – Menstrual Cycle Masterclass Part 2

Episode 14 – The Ovulatory Phase – Menstrual Cycle Masterclass Part 3

Episode 15 – The Luteal Phase – Menstrual Cycle Masterclass Part 4

Episode 18 – Is My Cervical Mucus Normal?

Episode 19 – Coming Off The Pill (Part I)

Episode 20 – Coming Off The Pill (Part II)

Episode 30 – Your Hormone-Free Options for Birth Control

OTHER FREE RESOURCES

Does your pelvic floor need a little extra TLC? Take the Pelvic Floor Quiz and find out how to start strengthening your pelvic floor today!

Want to make sure you’re exercising safely during your pregnancy? Get your Free Guide: 10 Exercises to Avoid During Pregnancy.

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