Cap

A woman can get pregnant if a man's sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the cap.  

At a glance: facts about the contraceptive cap

How it works

Who can use it

Advantages and disadvantages

Risks

Where you can get it

The contraceptive cap is a circular dome made of thin, soft silicone (they used to be made of latex, but if you get a cap on the NHS today it will be made of silicone). It's inserted into the vagina before sex, and covers the cervix so that sperm cannot get into the womb. You need to use spermicide with it (spermicide kills sperm).

The cap must be left in place for six hours after sex. After that time, you take out the cap and wash it. Caps are reusable. They come in different sizes, and you must be fitted for the correct size by a trained doctor or nurse.

At a glance: facts about the cap

  • When used correctly with spermicide, the cap is 92-96% effective at preventing pregnancy. This means that between four and eight women out of every 100 who use a cap as contraception will become pregnant in a year.
  • There are no serious health risks.
  • You only have to think about it when you have sex.
  • You can put a cap in several hours before you have sex.
  • It can take time to learn how to use a cap.
  • If you lose or gain more than 3kg (7lbs) in weight, or have a baby, miscarriage or abortion, you may need to be fitted with a new cap.
  • By using condoms as well as a cap, you will help to protect yourself against sexually transmitted infections (STIs).

How the cap works

 

A cap, like a diaphragm, is a barrier method of contraception. It fits inside your vagina and prevents sperm from passing through the entrance of your womb (the cervix). Caps are soft, thin domes made of silicone, and come in different shapes and sizes.

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

To be effective in preventing pregnancy, a cap needs to be used in combination with spermicide, which is a chemical that kills sperm.

You only have to use a cap when you have sex, but you must leave it in for at least six hours after the last time you had sex. You can leave it in for longer than this, but do not take it out before.

When you first start using a cap, a doctor or nurse will examine you and advise on the correct size or shape. They will show you how to put in and take out the cap, and also how to use the spermicide, which must be applied every time you use a cap.

A cap provides only limited protection against STIs. If you're at a high risk of getting an STI – for example, you or your partner has more than one sexual partner – you may be advised to use another form of contraception.

Inserting a contraceptive cap

Your doctor or nurse will show you how to put in a cap. Caps come with instructions and are all inserted in a similar way:

  • With clean hands, fill one-third of the cap with spermicide, but do not put any spermicide around the rim, as this will stop the cap staying in place.
  • The silicone cap has a groove between the dome and the rim – some spermicide should also be placed there.
  • Squeeze the sides of the cap together and hold it between your thumb and first two fingers.
  • Slide the cap into your vagina, upwards.
  • The cap must fit neatly over your cervix – it stays in place by suction.
  • Depending on the type of cap, you may need to add extra spermicide after it has been put in.
  • Some women squat while they put their cap in, while others lie down or stand with one foot up on a chair – use the position that's easiest for you.
  • You can insert a cap up to three hours before you have sex – after this time, you will need to take it out and put some more spermicide on it.

You may be fitted with a temporary cap by your doctor or nurse. This is for you to practise with at home. It gives you the chance to learn how to use it properly, see how it feels and find out if the method is suitable for you. During this time, you are not protected against pregnancy and need to use additional contraception, such as condoms, when you have sex.

When you go back for a follow-up appointment with your doctor or nurse, wear the cap so they can check that it is the right size and you have put it in properly. When they are happy that you can use a cap properly, they will give you one to use as contraception.

Removing a cap

A cap can be easily removed by gently hooking your finger under its rim, loop or strap and pulling it downwards and out. You must leave all types of cap in place for at least 6 hours after the last time you had sex.

You can leave them in for longer than this, but do not leave them in for longer than the recommended maximum time of 48 hours (including the minimum six). A latex cap should not be left in for more than 30 hours.

Looking after your cap

After use, you can wash your cap with warm water and mild, unperfumed soap. Rinse it thoroughly, then leave to dry. You will be given a small container for it, which you should keep in a cool, dry place.

  • Never boil a cap.
  • Do not use disinfectant, detergent, oil-based products or talcum powder to keep it clean, as these products can damage it. 
  • Your cap may become discoloured over time, but this does not make it less effective.
  • Always check your cap for any signs of damage before using it. 

You can visit your GP or nurse when you want to replace your cap. Most women can use the same cap for a year before they need to replace it. You may need to get a different sized cap if you gain or lose more than 3kg (7lb) in weight, or if you have a baby, miscarriage or abortion.

Who can use the cap

Most women are able to use contraceptive caps. However, they may not be suitable for you if you:

  • have an unusually shaped or positioned cervix (entrance to the womb), or if you cannot reach your cervix
  • have weakened vaginal muscles (possibly as a result of giving birth) that cannot hold a cap in place 
  • have a sensitivity or an allergy to the chemicals in spermicide (or latex, if you have a latex cap)
  • have ever had toxic shock syndrome (a rare, but life-threatening bacterial infection) 
  • have repeated urinary tract infections (an infection of the urinary system, such as the urethra, bladder or kidneys) 
  • currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap)
  • are not comfortable touching your vagina 
  • have a high risk of getting an STI – for example, if you have multiple sexual partners

Research shows that spermicides which contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an STI.

A cap may be less effective if:

  • it is damaged – for example, it is torn or has holes
  • it is not the right size for you
  • you use it without spermicide
  • you do not use extra spermicide with your cap every time you have more sex
  • you remove it too soon (less than six hours after the last time you had sex)
  • you use oil-based products, such as baby lotion, bath oils, moisturiser or some vaginal medicines (for example, pessaries) with a latex cap – these can damage the latex

If any of these things happen, or you have had sex without contraception, you may need emergency contraception.

You can use a cap after having a baby, but you may need a different size. It is recommended that you wait at least six weeks after giving birth before using a contraceptive cap. You can use a cap after a miscarriage or abortion, but you may need a different size.

Advantages and disadvantages of the cap

A cap has the following advantages:

  • you only need to use it when you want to have sex
  • you can put it in at a convenient time before having sex (do not forget to use extra spermicide if you have it in for more than three hours)
  • there are no serious associated health risks or side effects

A cap has the following disadvantages:

  • it is not as effective as other types of contraception
  • it only provides limited protection against STIs
  • it can take time to learn how to use a cap
  • putting a cap in can interrupt sex
  • cystitis (bladder infection) can be a problem for some women who use a cap
  • latex and spermicide can cause irritation in some women and their sexual partners

Risks

There are no serious health risks associated with using a contraceptive cap.

Where you can get it

Most types of contraception are free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include: 

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics 
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people's services (call our Sexual Health Line on 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Combined pill

The combined oral contraceptive pill is usually just called "the pill". It contains artificial versions of the female hormones oestrogen and progesterone, which women produce naturally in their ovaries.

At a glance: the combined pill

How the combined pill works

What to do if you miss a pill

Who can use the combined pill

Advantages and disadvantages

Risks of the combined pill

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the combined pill.

The hormones in the pill prevent your ovaries from releasing an egg (ovulating). They also make it difficult for sperm to reach an egg, or for an egg to implant itself in the lining of the womb. The pill is usually taken to prevent pregnancy, but can also be used to treat painful periods, heavy periods, premenstrual syndrome (PMS) and endometriosis.

At a glance: the combined pill

  • When taken correctly, the pill is over 99% effective at preventing pregnancy. This means that fewer than one woman in 100 who use the combined pill as contraception will get pregnant in one year.
  • You need to take the pill every day for 21 days, then stop for seven days, and during this week you have a period-type bleed. You start taking the pill again after seven days.
  • You need to take the pill at the same time every day. You could get pregnant if you don't do this, or if you miss a pill, or vomit or have severe diarrhoea.
  • If you have heavy periods or painful periods, the combined pill can help.
  • Minor side effects include mood swings, breast tenderness and headaches.
  • There is no evidence that the pill makes women gain weight.
  • There's a very low risk of serious side effects, such as blood clots and cervical cancer.
  • The combined pill is not suitable for women over 35 who smoke, or women with certain medical conditions.
  • The pill does not protect against sexually transmitted infections (STIs), so using a condom as well will help to protect you against STIs.

How the combined pill works

The pill prevents the ovaries from releasing an egg each month (ovulation). It also:

  • thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
  • thins the lining of the womb, so there is less chance of a fertilised egg implanting into the womb and being able to grow

Although there are many different brands of pill, there are three main types:

Monophasic 21-day pills

This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then no pills are taken for the next seven days. Microgynon, Brevinor and Cilest are examples of this type of pill.

Phasic 21-day pills

Phasic pills contain two or three sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then no pills are taken for the next seven days. Phasic pills need to be taken in the right order. Binovum and Logynon are examples of this type of pill.

Every day (ED) pills

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

There are 21 active pills and seven inactive (dummy) pills in a pack. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED and Logynon ED are examples of this type of pill.

Follow the instructions that come with your packet. If you have any questions about how to take the pill, ask your GP, practice nurse or pharmacist. It's important to take the pills as instructed, because missing pills or taking them at the same time as certain medicines may make them less effective.

How to take 21-day pills

  • Take your first pill from the packet marked with the correct day of the week, or the first pill of the first colour (phasic pills).
  • Continue to take a pill at the same time each day until the pack is finished. 
  • Stop taking pills for seven days (during these seven days you will get a bleed). 
  • Start your next pack of pills on the eighth day, whether you are still bleeding or not. This should be the same day of the week as when you took your first pill.

How to take every day pills

  • Take the first pill from the section of the packet marked "start". This will be an active pill.
  • Continue to take a pill every day, in the correct order and preferably at the same time each day, until the pack is finished (28 days). 
  • During the seven days of taking the inactive pills, you will get a bleed.
  • Start your next pack of pills after you have finished the first, whether you are still bleeding or not.

Starting the combined pill

Most women can start the pill at any time in their menstrual cycle. There is special guidance if you have just had a baby, abotion or miscarriage. You may need to use additional contraception during your first days on the pill – this depends on when in your menstrual cycle you start taking it.

If you start the combined pill on the first day of your period (day one of your menstrual cycle) you will be protected from pregnancy straight away. You will not need additional contraception.

If you start the pill on the fifth day of your period or before, you will still be protected from pregnancy straight away, unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you will need additional contraception, such as condoms, until you have taken the pill for seven days.

If you start the pill on any other day of your cycle, you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for seven days.

Taking pill packs back-to-back

For monophasic combined pills (pills all the same colour and with the same level of hormones), it is normally fine to start a new pack of pills straight after your last one – for example, if you want to delay your period for a holiday.

However, avoid taking more than two packs together unless advised to by a doctor or nurse. This is because you may have breakthrough bleeding as the womb lining sheds slightly. Some women find they feel bloated if they run several packs of the pill together.

What to do if you miss a pill

If you miss a pill or pills, or you start a pack late, this can make the pill less effective at preventing pregnancy. The chance of getting pregnant after missing a pill or pills depends on:

  • when the pills are missed
  • how many pills are missed

A pill is late when you have forgotten to take it at your usual time. You have missed a pill when it is more than 24 hours since the time you should have taken it. Missing one pill anywhere in your pack or starting the new pack one day late isn’t a problem, as you will still be protected against pregnancy (known as having contraceptive cover).

However, missing two or more pills, or starting the pack two or more days late (more than 48 hours late) may affect your contraceptive cover. In particular, if you make the 7-day pill-free break longer by forgetting two or more pills, your ovaries might release an egg and there is a risk of getting pregnant. This is because your ovaries are not getting any effect from the pill during the seven-day break.

If you miss a pill, follow the advice below. If you are not sure what to do, continue to take your pill and use another method of contraception, such as condoms, and seek advice as soon as possible.

If you have missed one pill, anywhere in the pack:

  • take the last pill you missed now, even if it means taking two pills in one day
  • continue taking the rest of the pack as usual
  • you don’t need to use additional contraception, such as condoms
  • take your seven-day pill-free break as normal

If you have missed 2 or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:

  • take the last pill you missed now, even if it means taking two pills in one day
  • leave any earlier missed pills
  • continue taking the rest of the pack as usual and use an extra method of contraception for the next seven days
  • you may need emergency contraception
  • you may need to start the next pack of pills without a break (see starting the next pack after missing two or more pills)

You may need emergency contraception if you have had unprotected sex in the previous 7 days and have missed 2 or more pills (you are taking your pill more than 48 hours late) in the first week of a pack.

Get advice from your contraception clinic, doctor or pharmacist about this. You can also call the NHS 24 111 service or our Sexual Health Line on 0800 22 44 88.

Starting the next pack after missing 2 or more pills

If there are seven or more pills left in the pack after the last missed pill:

  • finish the pack
  • have the usual seven-day break

If there are fewer than seven pills left in the pack after the last missed pill: 

  • finish the pack and start the new one the next day, without having a break

Vomiting and diarrhoea

If you vomit within two hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception while you're ill and for two days after recovering.

Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for two days after recovering.

Speak to your GP or contraception nurse or call NHS 111 for more information, or if your sickness or diarrhoea continues.

Who can use the combined pill

If there are no medical reasons why you cannot take the pill and you do not smoke, you can take the pill until your menopause. However, the pill is not suitable for all women. To find out whether the pill is right for you, talk to your GP, practice nurse or pharmacist.

You should not take the pill if you:

  • are pregnant
  • smoke and are 35 or older
  • stopped smoking less than a year ago and are 35 or older
  • are very overweight
  • take certain medicines (ask your GP about this)

You should also not take the pill if you have (or have had):

  • thrombosis (a blood clot)
  • a heart abnormality or heart disease, including high blood pressure
  • severe migraines, especially with aura (warning symptoms)
  • breast cancer
  • disease of the gallbladder or liver
  • diabetes with complications or diabetes for the past 20 years

After having a baby

If you have just had a baby and are not breastfeeding, you can start the pill on day 21 after the birth. You will be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next seven days.

If you are breastfeeding a baby less than six months old, taking the pill can reduce your flow of milk. It is recommended that you use a different method of contraception until you stop breastfeeding.

After a miscarriage or abortion

If you have had a miscarriage or abortion, you can start the pill up to 5 days after this and you will be protected from pregnancy straight away. If you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for 7 days.

Advantages and disadvantages

Some advantages of the pill include:

  • it does not interrupt sex
  • it usually makes your bleeds regular, lighter and less painful
  • it reduces your risk of cancer of the ovaries, womb and colon
  • it can reduce symptoms of PMS
  • it can sometimes reduce acne
  • it may protect against pelvic inflammatory disease
  • it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some disadvantages of the pill include:

  • it can cause temporary side effects at first, such as headaches, nausea, breast tenderness and mood swings – if these do not go after a few months, it may help to change to a different pill
  • it can increase your blood pressure
  • it does not protect you against sexually transmitted infections
  • breakthrough bleeding and spotting is common in the first few months of using the pill
  • it has been linked to an increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer

The combined pill with other medicines

Some medicines interact with the combined pill and it doesn't work properly. Some interactions are listed on this page, but it is not a complete list. If you want to check your medicines are safe to take with the combined pill, you can:

  • ask your GP, practice nurse or pharmacist
  • read the patient information leaflet that comes with your medicine

Antibiotics

The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the combined pill. Other antibiotics do not have this effect.

If you are prescribed rifampicin or rifabutin, you may need additional contraception (such as condoms) while taking the antibiotic. Speak to your doctor or nurse for advice.

Epilepsy and HIV medicines, and St John's wort

The combined pill can interact with medicines called enzyme inducers. These speed up the breakdown of progestogen by your liver, reducing the effectiveness of the pill.

Examples of enzyme inducers are:

  • the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
  • St John's wort (a herbal remedy)
  • antiretroviral medicines used to treat HIV (research suggests that interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both)

Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

Risks of taking the combined pill

There are some risks associated with using the combined contraceptive pill. However, these risks are small and, for most women, the benefits of the pill outweigh the risks.

Blood clots

The oestrogen in the pill may cause your blood to clot more readily. If a blood clot develops, it could cause deep vein thrombosis (clot in your leg), pulmonary embolus (clot in your lung), stroke or heart attack. The risk of getting a blood clot is very small, but your doctor will check if you have certain risk factors that make you more vulnerable before prescribing the pill.

The pill can be taken with caution if you have one of the risk factors below, but you should not take it if you have two or more risk factors. These include:

  • being 35 years old or over
  • being a smoker or having quit smoking in the past year
  • being very overweight (in women with a BMI of 35 or over, the risks of using the pill usually outweigh the benefits)
  • having migraines (you should not take the pill if you have severe or regular migraine attacks, especially if you get aura or a warning sign before an attack)
  • having high blood pressure
  • having had a blood clot or stroke in the past
  • having a close relative who had a blood clot when they were younger than 45
  • being immobile for a long time – for example, in a wheelchair or with a leg in plaster

Cancer

Research is ongoing into the link between breast cancer and the pill. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing endometrium (lining of the womb) cancerovarian cancer and colon cancer.

Where you can get the combined pill

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people's services (call our Sexual Health Line on 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions.

Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.  

Condoms

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the condom.

At a glance: condoms

How a condom works

Who can use condoms

Advantages and disadvantages

Risks of condoms 

Where to get condoms

There are two types of condoms: male condoms, which are worn on the penis, and female condoms, which are worn inside the vagina. This page is about male condoms, where you can get them and how they work.

Male condoms are made from very thin latex (rubber), polyisoprene or polyurethane, and are designed to stop a man's semen from coming into contact with his sexual partner.

When condoms are used correctly during vaginal sex, they help to protect against pregnancy and sexually transmitted infections (STIs).

When used correctly during anal and oral sex, they help to protect against STIs. Condoms are the only contraception that protect against pregnancy and STIs.

At a glance: condoms

  • If used correctly every time you have sex, male condoms are 98% effective. This means that two out of 100 women using male condoms as contraception will become pregnant in one year.
  • You can get free condoms from contraception clinics, sexual health clinics and some GP surgeries.
  • Oil-based products, such as moisturiser, lotion and Vaseline, can make latex and polyisoprene condoms less effective, but they are safe to use with condoms made from polyurethane.
  • Water-based lubricant, available in pharmacies and sexual health clinics, is safe to use with all condoms.
  • It's possible for a condom to slip off during sex. If this happens, you may need emergency contraception, and to get checked for STIs.
  • Condoms need to be stored in places that aren't too hot or cold, and away from sharp or rough surfaces that could tear them or wear them away.
  • Putting on a condom can be an enjoyable part of sex, and doesn't have to feel like an interruption.
  • If you're sensitive to latex, you can use polyurethane or polyisoprene condoms instead. 
  • A condom must not be used more than once. Use a new one each time you have sex.
  • Condoms have a use-by date on the packaging. Don't use out-of-date condoms.
  • Always buy condoms that have the BSI kite mark and the CE mark on the packet. This means that they've been tested to high safety standards. Condoms that don't have the BSI kite mark and CE mark won't meet these standards, so don't use them.

How a condom works

Condoms are a barrier method of contraception. They stop sperm from reaching an egg by creating a physical barrier between them. Condoms can also protect against STIs if used correctly during vaginal, anal and oral sex.

It's important that the man's penis does not make contact with the woman's vagina before a condom has been put on. This is because semen can come out of the penis before a man has fully ejaculated (come). If this happens, or if semen leaks into the vagina while using a condom, seek advice about emergency contraception from your GP or contraception clinic. You should also consider having an STI test.

How to use a condom 

  • Take the condom out of the packet, taking care not to tear it with jewellery or fingernails – do not open the packet with your teeth.
  • Place the condom over the tip of the erect penis.
  • If there's a teat on the end of the condom, use your thumb and forefinger to squeeze the air out of it.
  • Gently roll the condom down to the base of the penis.
  • If the condom won't roll down, you're probably holding it the wrong way round – if this happens, throw the condom away because it may have sperm on it, and try again with a new one.
  • After sex, withdraw the penis while it's still erect – hold the condom onto the base of the penis while you do this. 
  • Remove the condom from the penis, being careful not to spill any semen.
  • Throw the condom away in a bin, not down the toilet.
  • Make sure the man's penis does not touch his partner's genital area again.
  • If you have sex again, use a new condom.

Condoms with spermicide

Some male condoms come with spermicide on them. Spermicide is a chemical that kills sperm. These condoms are slowly being phased out, as research has found that a spermicide called nonoxynol 9 does not protect against STIs such as chlamydia and HIV, and may even increase the risk of infection. It is best to avoid using spermicide-lubricated condoms, or spermicide as an additional lubricant.

Who can use condoms

Most people can safely use condoms. There are many different varieties and brands of male condom, and it's up to you and your partner which type of condom you use. However, condoms may not be the most suitable method of contraception for everyone.

  • Some men and women are sensitive to the chemicals in latex condoms. If this is a problem, polyurethane or polyisoprene condoms have a lower risk of causing an allergic reaction.
  • Men who have difficulty keeping an erection may not be able to use male condoms, as the penis must be erect to prevent semen leaking from the condom, or the condom slipping off. 

Advantages and disadvantages of condoms

It is important to consider which form of contraception is right for you and your partner. Take care to use condoms correctly, and consider using other forms of contraception for extra protection.

Advantages

  • When used correctly and consistently, condoms are a reliable method of preventing pregnancy. 
  • They help to protect both partners from STIs, including chlamydia, gonorrhoea and HIV.
  • You only need to use them when you have sex – they do not need advance preparation and are suitable for unplanned sex.
  • In most cases, there are no medical side effects from using condoms.
  • Male condoms are easy to get hold of and come in a variety of shapes, sizes and flavours.

Disadvantages

  • Some couples find that using condoms interrupts sex – to get around this, try to make using a condom part of foreplay. 
  • Condoms are very strong, but may split or tear if not used properly.
  • Some people may be allergic to latex, plastic or spermicides – you can get condoms that are less likely to cause an allergic reaction.
  • When using a male condom, the man has to pull out after he has ejaculated and before the penis goes soft, holding the condom firmly in place.

If male condoms aren't used properly, they can slip off or split. If this happens, practise putting them on so that you get used to using them properly.  

Can anything make condoms less effective?

Sperm can sometimes get into the vagina during sex, even when using a condom. This may happen if:

  • the penis touches the area around the vagina before a condom is put on
  • the condom splits or comes off
  • the condom gets damaged by sharp fingernails or jewellery
  • you use oil-based lubricants, such as lotion, baby oil or petroleum jelly, with latex or polyisoprene condoms – this damages the condom 
  • you are using medication for conditions like thrush, such as creams, pessaries or suppositories – this can damage latex and polyisoprene condoms and stop them working properly

If you think that sperm has entered the vagina, talk to your GP or staff at a contraception clinic about emergency contraception and the risk of STIs.

As well as condoms, you can use other forms of contraception, such as the contraceptive pill, for extra protection against pregnancy. However, other forms of contraception will not protect you against STIs. You will still be at risk of STIs if the condom breaks.

Using lubricant

Condoms come ready lubricated to make them easier to use, but you may also like to use additional lubricant, or lube. This is particularly advised for anal sex, to reduce the chance of the condom splitting.

Any kind of lubricant can be used with condoms that are not made of latex. However, if you are using latex or polyisoprene condoms, do not use oil-based lubricants, such as:

  • body oil or lotion
  • petroleum jelly or creams (such as Vaseline)

This is because they can damage the condom and make it more likely to split.

If a condom splits or comes off

If the condom splits or comes off, you can use emergency contraception to help prevent pregnancy. This is for emergencies only and shouldn't be used as a regular form of contraception.

Depending on the type of pill, you need to take the emergency contraceptive pill up to 72 hours or up to 120 hours (five days) after unprotected sex. The intrauterine device (IUD) can be used as emergency contraception up to five days after sex.

If you have been at risk of pregnancy, you have also been at risk of STIs. You should have a check-up at:

  • a GP surgery
  • a contraception clinic
  • a sexual health clinic or genitourinary medicine (GUM) clinic
  • a young person's clinic

Risks

For most people, there are no serious risks associated with using condoms, although some people are allergic to latex condoms. You can get condoms that are less likely to cause an allergic reaction.

Where to get condoms

Everyone can get condoms for free, even if they are under 16. They are available from:

  • contraception clinics
  • sexual health or GUM (genitourinary medicine) clinics
  • some GP surgeries 
  • some young people's services

You can also buy condoms from:

  • pharmacies
  • supermarkets
  • websites
  • mail-order catalogues
  • vending machines in some public toilets
  • some petrol stations

If you buy condoms online, make sure that you buy them from a pharmacist or other legitimate retailer. Always choose condoms that carry the BSI kite mark and the European CE mark as a sign of quality assurance. This means they have been tested to the required safety standards.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions.

Doctors and nurses work under strict guidelines when dealing with young people under 16. They'll encourage you to consider telling your parents but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Contraceptive implant

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method is the implant.

At a glance: facts about the contraceptive implant

How it works

Who can use it

Advantages and disadvantages

Risks

Where you can get it

The contraceptive implant is a small flexible tube about 40mm long that's inserted under the skin of your upper arm. It's inserted by a trained professional, such as a doctor, and lasts for three years. 

The implant stops the release of an egg from the ovary by slowly releasing progestogen into your body. Progestogen also thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through your cervix, and less likely for your womb to accept a fertilised egg.

At a glance: the implant

  • If implanted correctly, it's more than 99% effective. Fewer than one woman in 1,000 who have the implant as contraception for three years will get pregnant.
  • It's very useful for women who know they don't want to get pregnant for a while. Once the implant is in place, you don't have to think about contraception for three years. 
  • It can be useful for women who can't use contraception that contains oestrogen. 
  • It's very useful for women who find it difficult to take a pill at the same time every day. 
  • If you have side effects, the implant can be taken out. You can have the implant removed at any time, and your natural fertility will return very quickly.
  • When it's first put in, you may feel some bruising, tenderness or swelling around the implant. 
  • In the first year after the implant is fitted, your periods may become irregular, lighter, heavier or longer. This usually settles down after the first year. 
  • A common side effect of the implant is that your periods stop (amenorrhoea). It's not harmful, but you may want to consider this before deciding to have an implant. 
  • Some medications can make the implant less effective, and additional contraceptive precautions need to be followed when you are taking these medications (see Will other medicines affect the implant?).
  • The implant does not protect against sexually transmitted infections (STIs). By using condoms as well as the implant, you'll help to protect yourself against STIs.

How the implant works

The implant steadily releases the hormone progestogen into your bloodstream. Progestogen is similar to the natural hormone progesterone, which is released by a woman's ovaries during her period.

The continuous release of progestogen:

  • stops a woman releasing an egg every month (ovulation) 
  • thickens the mucus from the cervix (entrance to the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg
  • makes the lining of the womb thinner so that it is unable to support a fertilised egg

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

The implant can be put in at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant. In the UK, Nexplanon is the main contraceptive implant currently in use. Implants inserted before October 2010 were called Implanon. Since October 2010, insertion of Implanon has decreased as stocks are used up, and Nexplanon has become the most commonly used implant.

Both types of implant work in the same way, but Nexplanon is designed to reduce the risk of insertion errors and is visible on an X-ray or CT (computerised tomography) scan. There is no need for existing Implanon users to have their implant removed and replaced by Nexplanon ahead of its usual replacement time.

Nexplanon is a small, thin, flexible tube about 4cm long. It is implanted under the skin of your upper arm by a doctor or nurse. A local anaesthetic is used to numb the area. The small wound made in your arm is closed with a dressing and does not need stitches.

Nexplanon works for up to three years before it needs to be replaced. You can continue to use it until you reach the menopause, when a woman’s monthly periods stop (at around 52 years of age). The implant can be removed at any time by a specially trained doctor or nurse. It only takes a few minutes to remove, using a local anaesthetic.

As soon as the implant has been removed, you will no longer be protected against pregnancy.

When it starts to work

If the implant is fitted during the first five days of your menstrual cycle, you will be immediately protected against becoming pregnant. If it is fitted on any other day of your menstrual cycle, you will not be protected against pregnancy for up to seven days, and should use another method, such as condoms.  

After giving birth

You can have the contraceptive implant fitted after you have given birth, usually after three weeks.

  • If it is fitted on or before day 21 after the birth, you will be immediately protected against becoming pregnant. 
  • If it is fitted after day 21, you will need to use additional contraception, such as condoms, for the following seven days.

It is safe to use the implant while you are breastfeeding.

After a miscarriage or abortion

The implant can be fitted immediately after a miscarriage or an abortion, and you will be protected against pregnancy straight away.

Who can use the implant

Most women can be fitted with the contraceptive implant. It may not be suitable if you:

  • think you might be pregnant
  • want to keep having regular periods 
  • have bleeding in between periods or after sex
  • have arterial disease or a history of heart disease or stroke
  • have a blood clot in a blood vessel (thrombosis)
  • have liver disease 
  • have migraines
  • have breast cancer or have had it in the past
  • have diabetes with complications
  • have cirrhosis or liver tumours
  • are at risk of osteoporosis  

Advantages and disadvantages of the implant

The main advantages of the contraceptive implant are:

  • it works for three years
  • the implant does not interrupt sex
  • it is an option if you cannot use oestrogen-based contraception, such as the combined contraceptive pill, contraceptive patch or vaginal ring
  • you do not have to remember to take a pill every day
  • the implant is safe to use while you are breastfeeding
  • your fertility should return to normal as soon as the implant is removed
  • implants offer some protection against pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb
  • the implant may reduce heavy periods or painful periods after the first year of use
  • after the contraceptive implant has been inserted, you should be able to carry out normal activities

Using a contraceptive implant may have some disadvantages, which you should consider carefully before deciding on the right method of contraception for you. These include:

Disrupted periods

Your periods may change significantly while using a contraceptive implant. Around 20% of women using the implant will have no bleeding, and almost 50% will have infrequent or prolonged bleeding. Bleeding patterns are likely to remain irregular, although they may settle down after the first year.

Although these changes are not harmful, they may not be acceptable for some women. Your GP may be able to help by providing additional medication if you have prolonged bleeding.

Other side effects that some women report are:

  • headaches
  • acne
  • nausea
  • breast tenderness
  • changes in mood
  • loss of sex drive

These side effects usually stop after the first few months. If you have prolonged or severe headaches or other side effects, tell your doctor.

Some women put on weight while using the implant, but there is no evidence to show that the implant causes weight gain.

Will other medicines affect the implant?

Some medicines can reduce the implant's effectiveness. These include:

  • medication for HIV
  • medication for epilepsy
  • complementary remedies, such as St John's Wort
  • an antibiotic called rifabutin (which can be used to treat tuberculosis)
  • an antibiotic called rifampicin (which can be used to treat several conditions, including tuberculosis and meningitis)

These are called enzyme-inducing drugs. If you are using these medicines for a short while (for example, rifampicin to protect against meningitis), it is recommended that you use additional contraception during the course of treatment and for 28 days afterwards. The additional contraception could be condoms, or a single dose of the contraceptive injection. The implant can remain in place if you have the injection.

Women taking enzyme-inducing drugs in the long term may wish to consider using a method of contraception that isn't affected by their medication.

Always tell your doctor that you are using an implant if you are prescribed any medicines. Ask your doctor or nurse for more details about the implant and other medication.

Risks of the implant

In rare cases, the area of skin where the implant has been fitted can become infected. If this happens, the area will be cleaned and may be treated with antibiotics.

Where you can get the contraceptive implant

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Contraceptive injection

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the injection.

At a glance: the contraceptive injection

How it works

Who can use it

Advantages and disadvantages

Risks

Where you can get it

There are three types of contraceptive injections in the UK: Depo-Provera, which lasts for 12 weeks, Sayana Press, which lasts for 13 weeks, and Noristerat, which lasts for eight weeks. The most popular is Depo-Provera. Noristerat is usually used for only short periods of time – for example, if your partner is waiting for a vasectomy.

The injection contains progestogen. This thickens the mucus in the cervix, stopping sperm reaching an egg. It also thins the womb lining and, in some, prevents the release of an egg.

At a glance: the contraceptive injection

  • If used correctly, the contraceptive injection is more than 99% effective. This means that less than one woman in 100 who use the injection will become pregnant in a year.
  • The injection lasts for eight, 12 or 13 weeks (depending on the type), so you don't have to think about contraception every day or every time you have sex.
  • It can be useful for women who might forget to take the contraceptive pill every day.
  • It can be useful for women who can't use contraception that contains oestrogen.
  • It's not affected by medication.
  • The contraceptive injection may provide some protection against cancer of the womb and pelvic inflammatory disease.
  • Side effects can include weight gain, headaches, mood swings, breast tenderness and irregular bleeding. The injection can't be removed from your body, so if you have side effects they'll last as long as the injection and for some time afterwards.
  • Your periods may become more irregular or longer, or stop altogether (amenorrhoea). Treatment is available if your bleeding is heavy or longer than normal – talk to your doctor or nurse about this.
  • It can take up to one year for your fertility to return to normal after the injection wears off, so it may not be suitable if you want to have a baby in the near future.
  • Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones. 
  • The injection does not protect against sexually transmitted infections (STIs). By using condoms as well as the injection, you'll help to protect yourself against STIs.

How the injection works

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

The contraceptive injections Depo-Provera and Noristerat are usually given into a muscle in your bottom, although sometimes may be given in a muscle in your upper arm. Sayana Press is given under the skin (subcutaneously) rather than into a muscle, in the abdomen or thigh.

The contraceptive injection works in the same way as the implant. It steadily releases the hormone progestogen into your bloodstream. Progestogen is similar to the natural hormone progesterone, which is released by a woman's ovaries during her period.

The continuous release of progestogen:

  • stops a woman releasing an egg every month (ovulation) 
  • thickens the mucus from the cervix (neck of the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg 
  • makes the lining of the womb thinner, so that it is unable to support a fertilised egg

The injection can be given at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant.

When it starts to work

If you have the injection during the first five days of your cycle, you will be immediately protected against becoming pregnant. 

If you have the injection on any other day of your cycle, you will not be protected against pregnancy for up to seven days. Use condoms or another method of contraception during this time.

After giving birth

You can have the contraceptive injection at any time after you have given birth, if you are not breastfeeding. If you are breastfeeding, the injection will usually be given after six weeks, although it may be given earlier if necessary.

  • If you start injections on or before day 21 after giving birth, you will be immediately protected against becoming pregnant.
  • If you start injections after day 21, you will need to use additional contraception for the following seven days.

Heavy and irregular bleeding is more likely to occur if you have the contraceptive injection during the first few weeks after giving birth.

It is safe to use contraceptive injections while you are breastfeeding.

After a miscarriage or abortion

You can have the injection immediately after a miscarriage or abortion, and you will be protected against pregnancy straight away. If you have the injection more than five days after a miscarriage or abortion, you'll need to use additional contraception for seven days.

Who can use the injection?

Most women can be given the contraceptive injection. It may not be suitable if you:

Advantages and disadvantages of the injection

The main advantages of the contraceptive injection are:

  • each injection lasts for either eight, 12 or 13 weeks 
  • the injection does not interrupt sex 
  • the injection is an option if you cannot use oestrogen-based contraception, such as the combined pill, contraceptive patch or vaginal ring
  • you do not have to remember to take a pill every day
  • the injection is safe to use while you are breastfeeding 
  • the injection is not affected by other medicines
  • the injection may reduce heavy, painful periods and help with premenstrual symptoms for some women
  • the injection offers some protection from pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb

Using the contraceptive injection may have some disadvantages, which you should consider carefully before deciding on the right method of contraception for you. These are as follows:

Disrupted periods

Your periods may change significantly during the first year of using the injection. They will usually become irregular and may be very heavy, or shorter and lighter, or stop altogether. This may settle down after the first year, but may continue as long as the injected progestogen remains in your body.

It can take a while for your periods and natural fertility to return after you stop using the injection. It takes around eight to 12 weeks for injected progestogen to leave the body, but you may have to wait longer for your periods to return to normal if you are trying to get pregnant.

Until you are ovulating regularly each month, it can be difficult to work out when you are at your most fertile. In some cases, it can take three months to a year for your periods to return to normal.

Weight gain

You may put on weight when you use the contraceptive injection, particulaly if you are under 18 years old and are overweight with a BMI (body mass index) of 30 or over.   

Other side effects that some women report are:

  • headaches
  • acne
  • tender breasts
  • changes in mood
  • loss of sex drive

Depo-Provera, oestrogen and bone risk

Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones, but it does not increase your risk of breaking a bone. This isn't a problem for most women, because the bone replaces itself when you stop the injection, and it doesn't appear to cause any long-term problems.

Thinning of the bones may be a problem for women who already have an increased risk of developing osteoporosis (for example, because they have low oestrogen, or a family history of osteoporosis). It may also be a concern for women under 18, because the body is still making bone at this age. Women under 18 may use Depo-Provera, but only after careful evaluation by a doctor.

Will other medicines affect the injection?

No – the contraceptive injection is not affected by other medication.

Risks

There is a small risk of infection at the site of the injection. In very rare cases, some people may have an allergic reaction to the injection.

Where you can get it

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. You can get contraception at:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics 
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Contraceptive patch

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production. One method of contraception is the patch.

At a glance: the patch

How it works

Who can use it

Advantages and disadvantages

Risks

Where you can get it 

The contraceptive patch is a sticky patch, a bit like a nicotine patch, measuring 5x5cm. It delivers hormones into your body through your skin. In the UK, the patch's brand name is Evra.

It contains the same hormones as the combined pill, and it works in the same way. This means that it prevents ovulation (the release of an egg); it thickens cervical mucus, which makes it more difficult for sperm to travel through the cervix; and it thins the womb lining, making it less likely that a fertilised egg will implant there.

At a glance: facts about the patch

  • When used correctly, the patch is more than 99% effective at preventing pregnancy.
  • Each patch lasts for one week. You change the patch every week for three weeks, then have a week off without a patch.
  • You don't need to think about it every day, and it's still effective if you vomit or have diarrhoea.
  • You can wear the patch in the bath, in the swimming pool and while playing sports.  
  • If you have heavy or painful periods, the patch can help.
  • The patch can increase blood pressure, and some women get temporary side effects, such as headaches.  
  • Some women develop a blood clot when using the patch, but this is rare.
  • The patch may protect against ovarian cancer, womb cancer and colon cancer.
  • The patch may not be suitable for women who smoke and who are 35 or over, or who weigh 90kg (14 stone) or more.
  • The patch does not protect against sexually transmitted infections (STIs), so using a condom as well will help to protect you against STIs.

How it works

You can use the contraceptive patch on most areas of your body, as long as the skin is clean, dry and not very hairy. 

You apply a new patch once a week (every seven days) for three weeks, and then stop using the patch for seven days. This is known as your patch-free week. During your patch-free week you will get a withdrawal bleed, like a period, although this may not always happen.

After seven patch-free days, you apply a new patch and start the four-week cycle again. Start your new cycle even if you are still bleeding.

You should not stick the patch on:

  • sore or irritated skin 
  • anywhere it may get rubbed off by tight clothing 
  • your breasts

When you first start using the patch, you can vary the position every time you use a new patch to reduce your risk of irritation.

When the patch starts to work

The licence for the patch states that if you start using the patch on the first day of your period, it starts working straight away. This means you can have sex without getting pregnant.

The Faculty of Sexual and Reproductive Healthcare guidance states that if you start using the patch in the first five days of your menstrual cycle, you will be protected and won't need to use additional contraception.

If you start using it on any other day, you need to use an additional form of contraception, such as condoms, for the first seven days.

You can talk to your doctor or nurse for more information about when the patch will start to work, and whether you need to use additional contraception.

What to do if the patch falls off

The contraceptive patch is very sticky and should stay on. It should not come off after a shower, bath, hot tub, sauna or swim, or after exercise.

If the patch does fall off, what you need to do depends on how long it has been off, and how many days you had a patch on before it came off.

If the patch has been off for less than 48 hours:

  • stick your patch back on as soon as possible (if it is still sticky)
  • if it is not sticky, replace it with a new patch (do not try to hold the old patch in place with a plaster or bandage)
  • continue to use your patch as normal and change your patch on your normal change day

If the patch has been off for less than 48 hours before you replace it, you will still be protected against pregnancy as long as the patch was on properly for seven days before the patch came off. If this is the case, you do not need to use additional contraception.

If you have had a patch on for six days or less before it falls off, you may not be protected against pregnancy and should use additional contraception, such as condoms, for seven days.

If the patch has been off for 48 hours or more, or you're not sure how long it has been off:

  • apply a new patch as soon as possible and start a new patch cycle (this will now be day one of your new cycle) 
  • use another form of contraception, such as condoms, for the next seven days

If you had unprotected sex in the previous few days, you may need emergency contraception. See your GP, nurse, local sexual health (GUM) clinic or pharmacist if you are concerned.

What to do if you forget to take the patch off

If you forget to take the patch off after week one or two, what you need to do depends on how long you have forgotten it.

If it has been on for:

  • Less than 48 hours longer than it should have been (eight or nine days in total) – take off the old patch and put on a new one. Continue to use your patch as normal, changing it on your normal change day. You don’t need to use any additional contraception and you are protected against pregnancy. 
  • 48 hours or more longer than it should have been (10 days or more in total) – start a whole new patch cycle by applying a new patch as soon as possible. This is now week one of the patch cycle and you will have a new day of the week as your start day and change day. Use another method of contraception, such as condoms, for the next seven days. Ask your doctor or nurse for advice if you have had sex in the previous few days and were not using a condom, as you may need emergency contraception.

If you forget to take the patch off after week three, take the patch off as soon as possible and start your patch-free break. Start a new patch on your usual start day, even if you are bleeding. This means that you will not have a full week of patch-free days. You will be protected against pregnancy and do not need to use any additional contraception. You may or may not bleed on the patch-free days.

What to do if you forget to put a patch on after the patch-free week

There is no specific research on what happens if the patch-free week is longer than seven days. The patch works in a similar way to the vaginal ring and the combined pill, and advice for extending the patch-free week is based on what is known about the vaginal ring and combined pill.

If you forget to put on a patch at the end of the patch-free week, put a new one on as soon as you remember.

If you put the patch on 48 hours late or less (so the patch-free interval has been nine days or less), you will still be protected against pregnancy, as long as you wore the patch correctly before the patch-free interval.

If you put the patch on more than 48 hours late, so the interval has been 10 days or more, you may not be protected against pregnancy and need to use additional contraception, such as condoms, for seven days. Ask your doctor or nurse for advice if you have had sex in the patch-free interval, as you may need emergency contraception.  

Bleeding in the patch-free week

Some women do not always have a bleed in their patch-free week. This is nothing to worry about if you have used the patch properly and have not taken any medication that could affect it.

See your GP or nurse for advice if you are worried, or do a pregnancy test to check if you are pregnant. If you miss more than two bleeds, get medical advice.

Who can use the patch

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

The contraceptive patch is not suitable for everyone. If you are thinking of using it, your doctor or nurse will need to ask you about your health and your family’s medical history, to make sure the patch is suitable for you. It is very important to tell them about any illnesses or operations you have had, or medications you are currently taking.

Conditions and circumstances that may mean you should not use the patch include: 

  • you are pregnant or think you may be pregnant 
  • you are breastfeeding 
  • you smoke and are 35 or over
  • you are 35 or over and stopped smoking less than a year ago 
  • you are very overweight
  • you take certain medicines, such as some antibiotics, St John’s Wort or medicines used to treat epilepsytuberculosis (TB) or HIV

You will also not be able to use the patch if you have (or have had) any of the following conditions: 

  • thrombosis (blood clots) in a vein or artery
  • a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
  • migraine with aura (warning signs)
  • breast cancer
  • disease of the liver or gallbladder 
  • diabetes with complications, or diabetes for more than 20 years

Advantages and disadvantages of the patch

If it is used properly, the contraceptive patch is more than 99% effective in stopping you from getting pregnant. This means that if 100 women use the patch according to the instructions, fewer than one will get pregnant in a year. Other advantages of the patch are:

  • it is very easy to use and does not interrupt sex
  • unlike the combined oral contraceptive pill, you do not have to think about it every day – you only have to remember to change the patch once a week
  • the hormones from the contraceptive patch do not need to be absorbed by the stomach, so it is just as effective even if you vomit or have diarrhoea
  • like the pill, it tends to make your periods more regular, lighter and less painful
  • it can help with premenstrual symptoms
  • it may reduce the risk of ovarian, womb and bowel cancer
  • it may reduce the risk of fibroidsovarian cysts and non-cancerous breast disease

Some women may find that the contraceptive patch has some disadvantages and may wish to use a different form of contraception.

Some potential disadvantages of the patch are that:

  • it may be visible
  • it can cause skin irritation, itching and soreness
  • it does not protect you against STIs, so you may need to use condoms as well
  • some women get mild temporary side effects when they first start using the patch, such as headaches, nausea (sickness), breast tenderness and mood changes; these side effects usually settle down after a few months
  • bleeding between periods (breakthrough bleeding) and spotting (very light, irregular bleeding) is common in the first few cycles of using the patch; this is nothing to worry about if you are using the patch properly, and you will still be protected against pregnancy

Some medicines can make the patch less effective. If you are prescribed new medicine or are buying an over-the-counter medicine, ask the doctor or pharmacist for advice. You may need to use an extra form of contraception while you are taking the medicine, and for 28 days afterwards.

Risks of using the patch

There is a very small risk of some serious side effects when you use a hormonal contraceptive, such as the contraceptive patch or combined pill.

Blood clots

The patch slightly increases your chance of developing a blood clot, which can block a vein (venous thrombosis) or an artery (arterial thrombosis, which may lead to a heart attack or stroke). If you have had a blood clot before, do not use the patch.

Your risk of blood clots is higher during the first year of using the patch. Your risk is also higher if:

  • you smoke
  • you are very overweight 
  • you are immobile (unable to move) or use a wheelchair
  • you have severe varicose veins 
  • a close family member had a venous thrombosis before they were 45 years old

The risk of arterial thrombosis is greatest if:

  • you smoke
  • you are diabetic
  • you have high blood pressure (hypertension)
  • you are very overweight 
  • you regularly have migraines with aura (warning signs)
  • a close family member had a heart attack or stroke before they were 45

Cancer

Current research suggests that people who use hormonal contraception, such as the contraceptive patch, are at a slightly increased risk of being diagnosed with breast cancer compared with people who do not use hormonal contraception. However, further research is needed to provide more definitive evidence.

Research also suggests there is a small increase in your risk of developing cervical cancer with the long-term use of oestrogen and progestogen hormonal contraception.

For most women, the benefits of the patch outweigh the risks. However, discuss all risks and benefits with your GP or nurse before starting to use the patch. You will not be allowed to use the patch if you are considered to be at a higher risk of serious side effects.

Where you can get it

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. When you first get the contraceptive patch you will be given a three-month supply, to see how you get on with it. If there are no problems, you can be prescribed the patch for six months to a year.

Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics 
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call our Sexual Health Line on 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer), as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Diaphragm

A woman can get pregnant if a man's sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production. One method of contraception is the diaphragm. 

At a glance: facts about the diaphragm

How it works

Who can use it

Advantages and disadvantages

Risks

Where you can get it  

A contraceptive diaphragm is inserted into the vagina before sex, and it covers the cervix so that sperm can't get into the womb (uterus). You need to use spermicide with it (spermicides kill sperm).

The diaphragm must be left in place for at least six hours after sex. After that time, you take out the diaphragm and wash it (they're reusable). Diaphragms come in different sizes – you must be fitted for the correct size by a trained doctor or nurse.

At a glance: contraceptive diaphragm

  • When used correctly with spermicide, a diaphragm is 92-96% effective at preventing pregnancy – this means that between four and eight women out of every 100 who use a diaphragm as contraception will become pregnant within a year.
  • There are no serious health risks.
  • You only have to think about it when you have sex.
  • You can put a diaphragm in several hours before you have sex.
  • It can take time to learn how to use it.
  • Some women develop cystitis (a bladder infection) when they use a diaphragm. Your doctor or nurse can check the size – switching to a smaller size may help.
  • If you lose or gain more than 3kg (7lbs) in weight, or have a baby, miscarriage or abortion, you may need to be fitted with a new diaphragm.
  • By using condoms as well as a diaphragm, you'll help to protect yourself against sexually transmitted infections (STIs).  

How the contraceptive diaphragm works

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

A diaphragm (like a cap) is a barrier method of contraception. It fits inside your vagina and prevents sperm from passing through the cervix (the entrance of your womb). Diaphragms are soft, thin domes made of latex (rubber) or silicone, and come in different shapes and sizes.

To be effective in preventing pregnancy, diaphragms need to be used in combination with spermicide, which is a chemical that kills sperm.

You only have to use a diaphragm when you have sex, but you must leave it in for at least six hours after the last time you had sex. You can leave it in for longer than this, but do not take it out before.

When you first start using a diaphragm, a doctor or nurse will examine you and advise on the correct size or shape to suit you. They will show you how to put in and take out a diaphragm, and also how to use the spermicide, which must be applied every time you use the diaphragm.

A diaphragm provides only limited protection against sexually transmitted infections (STIs). If you're at a high risk of getting an STI – for example, you or your partner has more than one sexual partner – you may be advised to use another form of contraception. 

Inserting a diaphragm

Your doctor or nurse will show you how to put in a diaphragm. Diaphragms come with instructions and are all inserted in a similar way:

  • With clean hands, put a small amount of spermicide on each side of the diaphragm (also putting a little spermicide on the rim may make the diaphragm easier to put in).
  • Put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers.
  • Slide the diaphragm into your vagina, upwards. This should ensure that the diaphragm covers your cervix.
  • Always check that your cervix is covered – it feels like a lump, a bit like the end of your nose.
  • If your cervix is not covered, take the diaphragm out by hooking your finger under the rim or loop (if there is one) and pulling downwards, then try again.
  • Some women squat while they put their diaphragm in; others lie down or stand with one foot up on a chair – use the position that's easiest for you.
  • You can insert a diaphragm up to three hours before you have sex – after this time, you will need to take it out and put some more spermicide on it.

You may be fitted with a temporary diaphragm by your doctor or nurse. This is for you to practise with at home. It allows you to learn how to use it properly, see how it feels and find out if the method is suitable for you. During this time, you are not protected against pregnancy and need to use additional contraception, such as condoms, when you have sex.

When you go back for a follow-up appointment with your doctor or nurse, wear the diaphragm so they can check that it is the right size and you have put it in properly. When they are happy that you can use a diaphragm properly, they will give you one to use as contraception.

Removing a diaphragm

A diaphragm can be easily removed by gently hooking your finger under its rim, loop or strap and pulling it downwards and out. You must leave all types of diaphragm in place for at least six hours after the last time you had sex.

You can leave them in for longer than this, but do not leave them in for longer than the recommended time of 30 hours (including the minimum six). 

Looking after your diaphragm 

After using, you can wash your diaphragm with warm water and mild unperfumed soap. Rinse it thoroughly, then leave it to dry. You will be given a small container for it, which you should keep in a cool, dry place.

  • Never boil a diaphragm.
  • Do not use disinfectant, detergent, oil-based products or talcum powder to keep it clean, as these products can damage it. 
  • Your diaphragm may become discoloured over time, but this does not make it less effective.
  • Always check your diaphragm or cap for any signs of damage before using it. 

You can visit your GP or nurse when you want to replace your diaphragm. Most women can use the same diaphragm for a year before they need to replace it. You may need to get a different size diaphragm if you gain or lose more than 3kg (7lb) in weight, or if you have a baby, miscarriage or abortion.

Who can use a diaphragm?

Most women are able to use a diaphragm. However, they may not be suitable for you if you: 

  • have an unusually shaped or positioned cervix (entrance to the womb), or if you cannot reach your cervix 
  • have weakened vaginal muscles (possibly as a result of giving birth) that cannot hold a diaphragm in place
  • have a sensitivity or an allergy to latex or the chemicals in spermicide 
  • have ever had toxic shock syndrome (a rare but life-threatening bacterial infection) 
  • have repeated urinary tract infections (infection of the urinary system, such as the urethra, bladder or kidneys) 
  • currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap) 
  • are not comfortable touching your vagina 
  • have a high risk of getting an STI – for example, if you have multiple sexual partners

Research shows that spermicides which contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an infection.

A diaphragm may be less effective if:

  • it is damaged – for example, it is torn or has holes 
  • it is not the right size for you
  • you use it without spermicide 
  • you do not use extra spermicide with your diaphragm every time you have more sex 
  • you remove it too soon (less than six hours after the last time you had sex)
  • you use oil-based products, such as baby lotion, bath oils, moisturiser or some vaginal medicines (for example, pessaries) with latex diaphragms – these can damage the latex

If any of these things happen, or you have had sex without contraception, you may need to use emergency contraception.

You can use a diaphragm after having a baby, but you may need a different size. It is recommended that you wait at least six weeks after giving birth before using a diaphragm. You can use a diaphragm after a miscarriage or abortion, but you may need a different size.

Advantages and disadvantages

A diaphragm has the following advantages:

  • You only need to use a diaphragm when you want to have sex.
  • You can put it in at a convenient time before having sex (but do not forget to use extra spermicide if you have it in for more than three hours).
  • There are no serious associated health risks or side effects.
  • You are in control of your contraception.

A diaphragm has the following disadvantages:

  • It is not as effective as other types of contraception.
  • It only provides limited protection against STIs.
  • It can take time to learn how to use it.
  • Putting it in can interrupt sex.
  • Cystitis (bladder infection) can be a problem for some women who use a diaphragm.
  • Latex and spermicide can cause irritation in some women and their sexual partners.

Risks 

There are no health risks associated with using a contraceptive diaphragm.

Where you can get a diaphragm

Most types of contraception are free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics 
  • some genitourinary (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people's services (call our Sexual Health Line on 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Female condoms

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the female condom.

At a glance: female condoms

How female condoms work

Who can use them

Advantages and disadvantages

Risks of the female condom

Where to get female condoms

Female condoms are made from thin, soft plastic called polyurethane (some male condoms are made from this too). Female condoms are worn inside the vagina to prevent semen getting to the womb.

When used correctly during vaginal sex, they help to protect against pregnancy and sexually transmitted infections (STIs). Condoms are the only contraception that protect against pregnancy and STIs. Currently, there is only one brand of female condom available in the UK, called Femidom.

At a glance: facts about the female condom

  • If used correctly and consistently, female condoms are 95% effective. This means that five out of 100 women using female condoms as contraception will become pregnant in a year.
  • Using female condoms protects against both pregnancy and STIs.
  • A female condom needs to be placed inside the vagina before there is any contact between the vagina and the penis.
  • Female condoms need to be stored in places that aren't too hot or too cold, and away from sharp or rough surfaces that could tear them or wear them away.
  • Always buy condoms that have the CE mark on the packet. This means they've been tested to European safety standards. Condoms that don't have the CE mark won't meet these standards, so don't use them.
  • A female condom can get pushed too far into the vagina, but it's easy to remove it yourself.
  • Female condoms may not be suitable for women who are not comfortable touching their genital area.
  • Do not use a female condom more than once. If you have sex again, use a new female condom.

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

How female condoms work

The female condom is worn inside the vagina to stop sperm getting to the womb.

It is important to use condoms correctly, and to make sure the penis doesn't make contact with the vagina before a condom has been put in. This is because semen can come out of the penis before a man has fully ejaculated (come). A female condom can be put in up to eight hours before sex.

How to use a female condom

  • Take the female condom out of the packet, taking care not to tear the condom – do not open the packet with your teeth.
  • Squeeze the smaller ring at the closed end of the condom and insert it into the vagina.
  • Make sure that the large ring at the open end of the female condom covers the area around the vaginal opening.
  • Make sure the penis enters into the female condom, not between the condom and the side of the vagina.
  • Remove the female condom immediately after sex by gently pulling it out – you can twist the large ring to prevent semen leaking out.
  • Throw the condom away in a bin, not down the toilet.

Who can use female condoms

Most people can safely use condoms. However, they may not be the most suitable method of contraception for women who do not feel comfortable touching their genital area.

Advantages and disadvantages of female condoms

It is important to consider which form of contraception is right for you and your partner. Take care to use condoms correctly, and consider using other forms of contraception for extra protection.

Advantages

  • By preventing the exchange of bodily fluids (semen and vaginal fluid), female condoms help to protect against many STIs, including HIV.
  • When used correctly and consistently, condoms are a reliable method of preventing pregnancy.
  • You only need to use them when you have sex – they do not need advance preparation and are suitable for unplanned sex.
  • In most cases, there are no medical side effects from using condoms. 
  • Female condoms can be inserted up to eight hours before sex, and mean that women share the responsibility for using condoms with their partner.

Disadvantages

  • Some couples find that putting a condom in can interrupt sex – to get around this, try making using a condom part of Foreplay or insert the female condom in advance.
  • condoms are very strong, but may split or tear if not used properly.
  • Female condoms are not as widely available as male condoms and are more expensive to buy.

Can anything make condoms less effective?

Sperm can sometimes get into the vagina during sex, even when using a condom. This may happen if:

  • the penis touches the area around the vagina before a condom is put in 
  • the female condom gets pushed too far into the vagina
  • the man’s penis enters the vagina outside the female condom by mistake
  • the condom gets damaged by sharp fingernails or jewellery

Although female condoms (when used correctly) offer reliable protection against pregnancy, using an additional method of contraception will protect you against pregnancy if the female condom fails. If a female condom slips or fails, you can use emergency contraception to help to prevent pregnancy. This is for emergencies only, and shouldn't be used as a regular form of contraception.

If you've been at risk of unintended pregnancy, you're also at risk of catching an STI, so have a check-up at: 

  • a GP surgery 
  • a local sexual health clinic or genitourinary medicine (GUM) clinic 
  • a young persons' service (call the sexual health line on 0800 22 44 88 for details)

Using lubricant

Condoms come ready lubricated, to make them easier to use, but you may also like to use additional lubricant. This is particularly advised when using male condoms for anal sex to reduce the chance of the condom splitting.

Any kind of lubricant can be used with female polyurethane condoms. If you are using male latex condoms, do not use oil-based lubricants, such as body oil, petroleum jelly or creams (like Vaseline), as they can damage the latex and make the condom more likely to split.

Risks

There are no serious risks associated with using female condoms.

Where to get female condoms

Everyone can get condoms for free, even if they are under 16. They are available from the following places in your local area:

  • contraception (or family planning) clinics  
  • sexual health or GUM (genitourinary medicine) clinics
  • some GP surgeries 

Some places might only offer male condoms – you can ask the staff whether they provide free female condoms.

You can also buy male and female condoms from: 

  • pharmacies 
  • supermarkets
  • websites
  • mail-order catalogues
  • vending machines in some public toilets
  • some petrol stations

If you buy condoms online, make sure you buy them from a pharmacist or other legitimate retailer. Always choose condoms that carry the European CE mark or British BSI Kitemark as a sign of quality assurance.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions.

Doctors and nurses work under strict guidelines when dealing with young people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Female sterilisation

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is female sterilisation.

At a glance: female sterilisation

How it works

Who can have it done

Advantages and disadvantages

Risks of female sterilisation

Where you can get it

Female sterilisation is usually carried out under general anaesthetic, but can be carried out under local anaesthetic, depending on the method used. The surgery involves blocking or sealing the fallopian tubes, which link the ovaries to the womb (uterus). 

This prevents the woman’s eggs from reaching sperm and becoming fertilised. Eggs will still be released from the ovaries as normal, but they will be absorbed naturally into the woman's body.  

At a glance: facts about female sterilisation

  • In most cases, female sterilisation is more than 99% effective, and only one woman in 200 will become pregnant in her lifetime after having it done. 
  • You don't have to think about it every day, or every time you have sex, so it doesn't interrupt or affect your sex life. 
  • Sterilisation can be carried out at any stage of the menstrual cycle. It won't affect hormone levels.
  • You'll still have periods after being sterilised.
  • You will need to use contraception until the operation is done and until your next period or for three months afterwards (depending on the type of sterilisation).
  • As with any surgery, there's a small risk of complications. These include internal bleeding, infection or damage to other organs. 
  • There's a small risk that the operation won't work. Blocked tubes can rejoin immediately or years later. 
  • If the operation fails, this may increase the risk of ectopic pregnancy (when a fertilised egg implants outside the womb, usually in a fallopian tube). 
  • The sterilisation operation is difficult to reverse.
  • Female sterilisation doesn't protect against sexually transmitted infections (STIs), so always use a condom to protect yourself and your partner against them.

How female sterilisation works

Female sterilisation works by preventing eggs from travelling down the fallopian tubes. This means a woman's eggs cannot meet sperm, and fertilisation cannot happen.

How female sterilisation is carried out

There are two main types of female sterilisation:

  • when your fallopian tubes are blocked – for example, with clips or rings (tubal occlusion)  
  • when implants are used to block your fallopian tubes (hysteroscopic sterilisation, or HS) 

It can be a fairly minor operation, with many women returning home the same day. Sterilisation is usually carried out using tubal occlusion.

Tubal occlusion

First, your surgeon will need to access and examine your fallopian tubes, using either laparoscopy or mini-laparotomy.

A laparoscopy is the most common method of accessing the fallopian tubes. The surgeon makes a small cut in your abdominal wall near your belly button and inserts a laparoscope. A laparoscope is a small flexible tube that contains a tiny light and camera. The camera relays images of the inside of your body to a television monitor. This allows the surgeon to see your fallopian tubes clearly.

A mini-laparotomy involves a small incision, usually less than 5cm (2 inches), just above the pubic hairline. Your surgeon can then access your fallopian tubes through this incision.

A laparoscopy is usually the preferred option because it is faster. However, a mini-laparotomy may be recommended for women who:

  • have had recent abdominal or pelvic surgery
  • are obese (have a body mass index of 30 or over) 
  • have a history of pelvic inflammatory disease (a bacterial infection that can affect the womb and fallopian tubes)

Blocking the tubes

The fallopian tubes can be blocked using one of the following methods:

  • applying clips – plastic or titanium clamps are closed over the fallopian tubes 
  • applying rings – a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut 
  • tying and cutting the tube – this destroys 3-4cm (1-1.5 inches) of the tube

Hysteroscopic sterilisation (fallopian implants)

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

The National Institute for Health and Care Excellence (NICE) has published guidance about hysteroscopic sterilisation. In the UK, the brand name of the hysteroscopic sterilisation technique is Essure.

The procedure doesn't require cuts to be made in your abdomen so general anaesthetic is not required. Though you may be given a painkiller and /or a local anaesthetic.

A narrow tube with a telescope at the end, called a hysteroscope, is passed through your vagina and cervix. A guidewire is used to insert a tiny piece of titanium metal (called a microinsert) into the hysteroscope, then into each of your fallopian tubes. This means that the surgeon does not need to cut into your body.

The implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tube.

You should carry on using contraception until an imaging test has confirmed that your fallopian tubes are blocked. This can be done with one or more of the following: 

  • a hysterosalpingogram (HSG) – a type of X-ray that is taken after a special dye has been injected to show up any blockages in your fallopian tubes 
  • a hysterosalpingo-contrast-sonography (HyCoSy) – a type of ultrasound scan involving injecting dye into your fallopian tubes

The manufacturer of Essure now advises that ultrasound scan is an additional option for checking placement of the implants 3 months after the sterilisation procedure. If the coils of the implant are seen to be in the correct position tubal occlusion can be assumed

Removing the tubes (salpingectomy)

If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

Before the operation

Your GP will strongly recommend counselling before referring you for sterilisation. Ideally, this should be with you and your partner if appropriate and acceptable. If possible, you should both agree to the procedure, but it is not a legal requirement to get your partner’s permission.

Counselling will give you a chance to talk about the operation in detail, and talk about any doubts, worries or questions that you might have.

Your GP does have the right to refuse to carry out the procedure or refuse to refer you for the procedure if they do not believe that it is in your best interests. If this is the case, you may have to pay to have a sterilisation privately.

If you decide to be sterilised, your GP will usually refer you to a specialist for treatment. This will usually be a gynaecologist at your nearest NHS hospital. A gynaecologist is a specialist in the female reproductive system.

If you choose to have a sterilisation, you will be asked to use contraception until the day of the operation, and to continue using it: 

  • until your next period if you are having your fallopian tubes blocked (tubal occlusion)  
  • for around three months if you are having fallopian implants (hysteroscopic sterilisation)

Sterilisation can be performed at any stage in your menstrual cycle.

Before you have the operation, you will be given a pregnancy test to make sure that you are not pregnant. It is vital to know this because once the surgeon blocks your fallopian tubes, there is a high risk that any pregnancy will become ectopic (when the fertilised egg grows outside the womb, usually in the fallopian tubes). An ectopic pregnancy can be life-threatening because it can cause severe internal bleeding.

Recovering after the operation

Once you have recovered from the anaesthetic, passed urine and had something to eat, you will be allowed home. If you leave hospital within hours of the operation, ask a relative or friend to pick you up, or take a taxi.

The healthcare professionals treating you in hospital will tell you what to expect and how to care for yourself after surgery. They may give you a contact number to call if you have any problems or any questions.

If you have had a general anaesthetic, do not drive a car for 48 hours afterwards. This is because even if you feel fine, your reaction times and judgement may not be back to normal.

How you will feel

It is normal to feel unwell and a little uncomfortable for a few days if you have had a general anaesthetic, and you may have to rest for a couple of days. Depending on your general health and your job, you can normally return to work five days after tubal occlusion. However, you should avoid heavy lifting for about a week.

You may have some slight vaginal bleeding. Use a sanitary towel rather than a tampon until this has gone. You may also feel some pain, similar to period pain. You may be prescribed painkillers for this. If the pain or bleeding gets worse, seek medical attention.

Caring for your wound

If you had tubal occlusion to block your fallopian tubes, you will have a wound with stitches where the surgeon made an incision (cut) into your stomach. Some stitches are dissolvable and disappear on their own, and some will need to be removed. If your stitches need removing, you will be given a follow-up appointment for this.

If there is a dressing over your wound, you can normally remove this the day after your operation. After this, you will be able to have a bath or shower as normal.

Having sex

Your sex drive and enjoyment of sex will not be affected. You can have sex as soon as it is comfortable to do so after the operation.

If you had tubal occlusion, you will need to use contraception until your first period to protect yourself from pregnancy.

If you had hysteroscopic sterilisation, you will need to use another form of contraception for around three months after surgery. After scans have confirmed that the implants are in the correct position, you will no longer need contraception.

Sterilisation will not protect you from STIs, so continue to use barrier contraception such as condoms if you are unsure of your partner's sexual health.

Who can have it done?

Almost any woman can be sterilised. However, sterilisation should only be considered by women who do not want any more children, or do not want children at all. Once you are sterilised it is very difficult to reverse the process, so it's important to consider the other options available before making your decision. Sterilisation reversal is not usually available on the NHS.

Surgeons are more willing to perform sterilisation when women are over 30 years old and have had children, although some younger women who have never had a baby choose it.

Advantages and disadvantages of female sterilisation

Advantages

  • female sterilisation can be more than 99% effective at preventing pregnancy
  • tubal occlusion (blocking the fallopian tubes) and removal of the tubes (salpingectomy) should be effective immediately – however, doctors strongly recommend that you continue to use contraception until your next period
  • hysteroscopic sterilisation is usually effective after around three months – research collected by NICE found that the fallopian tubes were blocked after three months in 96% of sterilised women

Other advantages of female sterilisation are that:

  • there are rarely any long-term effects on your sexual health
  • it will not affect your sex drive
  • it will not affect the spontaneity of sexual intercourse or interfere with sex (as other forms of contraception can)
  • it will not affect your hormone levels

Disadvantages

  • female sterilisation does not protect you against STIs, so you should still use a condom if you are unsure about your partner's sexual health 
  • it is very difficult to reverse a tubal occlusion – this involves removing the blocked part of the fallopian tube and rejoining the ends, and reversal operations are rarely funded by the NHS
  • a 2015 US study found that around 1 in 50 women who had a hysteroscopic sterilisation required further surgery due to complications such as persistent pain 

Risks

  • with tubal occlusion, there is a very small risk of complications, including internal bleeding and infection or damage to other organs
  • it is possible for sterilisation to fail – the fallopian tubes can rejoin and make you fertile again, although this is rare (about one in 200 women become pregnant in their lifetime after being sterilised)
  • if you do get pregnant after the operation, there is an increased risk that it will be an ectopic pregnancy (when the fertilised egg grows outside the womb, usually in the fallopian tubes)

If you miss a period, take a pregnancy test immediately. If the pregnancy test is positive, you must see your GP so that you can be referred for a scan to check if the pregnancy is inside or outside your womb.

With hysteroscopic sterilisation, there is a small risk of pregnancy even after your tubes have been blocked. Research collected by NICE has shown that possible complications after fallopian implants can include:

  • pain after the operation – in one study, nearly eight out of 10 women reported pain afterwards
  • the implants being inserted incorrectly – this affected two out of 100 women  
  • bleeding after the operation – many women had light bleeding after the operation, and nearly a third had bleeding for three days

Where to get contraception

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. You can get contraception, and information and advice about contraception, at:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraceptive clinics
  • some genitourinary medicine (GUM) clinics 
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.  

IUD (intrauterine device, coil)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this by keeping the egg and sperm apart or by stopping eggs being produced. One method of contraception is the intrauterine device, or IUD (sometimes called a coil).

At a glance: facts about the IUD

How the IUD works

Who can use the IUD

Advantages and disadvantages of the IUD

Risks of the IUD

Where you can get an IUD

An IUD is a small T-shaped plastic and copper device that’s inserted into your womb (uterus) by a specially trained doctor or nurse. 

The IUD works by stopping the sperm and egg from surviving in the womb or fallopian tubes. It may also prevent a fertilised egg from implanting in the womb.

The IUD is a long-acting reversible contraceptive (LARC) method. This means that once it's in place, you don't have to think about it each day or each time you have sex. There are several types and sizes of IUD.

You can use an IUD whether or not you've had children.  

At a glance: facts about the IUD

  • There are different types of IUD, some with more copper than others. IUDs with more copper are more than 99% effective. This means that fewer than one in 100 women who use an IUD will get pregnant in one year. IUDs with less copper will be less effective. 
  • An IUD works as soon as it's put in, and lasts for five to 10 years, depending on the type.
  • It can be put in at any time during your menstrual cycle, as long as you're not pregnant.
  • It can be removed at any time by a specially trained doctor or nurse and you'll quickly return to normal levels of fertility.
  • Changes to your periods (for example, being heavier, longer or more painful) are common in the first three to six months after an IUD is put in, but they're likely to settle down after this. You might get spotting or bleeding between periods. 
  • There's a very small chance of infection within 20 days of the IUD being fitted. 
  • There's a risk that your body may expel the IUD.
  • If you get pregnant, there's an increased risk of ectopic pregnancy (when the egg implants outside the womb). But because you're unlikely to get pregnant, the overall risk of ectopic pregnancy is lower than in women who don't use contraception. 
  • Having the IUD put in can be uncomfortable. Ask the doctor or nurse about pain relief.
  • An IUD may not be suitable for you if you've had previous pelvic infections.
  • The IUD does not protect against sexually transmitted infections (STIs). By using condoms as well as the IUD, you'll help to protect yourself against STIs.

How the IUD works

The IUD is similar to the IUS (intrauterine system) but works in a different way. Instead of releasing the hormone progestogen like the IUS, the IUD releases copper. Copper changes the make-up of the fluids in the womb and fallopian tubes, stopping sperm surviving there. IUDs may also stop fertilised eggs from implanting in the womb.

There are types and sizes of IUD to suit different women. IUDs need to be fitted by a trained doctor or nurse at your GP surgery, local contraception clinic or sexual health clinic.

An IUD can stay in the womb for five to 10 years, depending on the type. If you're 40 or over when you have an IUD fitted, it can be left in until you reach the menopause or until you no longer need contraception.

Having an IUD fitted

An IUD can be fitted at any time during your menstrual cycle, as long as you are not pregnant. You'll be protected against pregnancy straight away.

Before you have an IUD fitted, you will have an internal examination to find out the size and position of your womb. This is to make sure that the IUD can be put in the correct place.

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

You may also be tested for infections, such as STIs. It's best to do this before an IUD is fitted so that you can have treatment (if you need it) before the IUD is put in. Sometimes, you may be given antibiotics at the same time as the IUD is fitted.

It takes about 15 to 20 minutes to insert an IUD. The vagina is held open, like it is during a cervical screening (smear) test, and the IUD is inserted through the cervix and into the womb.

The fitting process can be uncomfortable and sometimes painful. You may get cramps afterwards. You can ask for a local anaesthetic or painkillers before having the IUD fitted. An anaesthetic injection itself can be painful, so many women have the procedure without.

You may get pain and bleeding for a few days after having an IUD fitted. Discuss this with your GP or nurse beforehand.  

The IUD needs to be checked by a doctor after three to six weeks. Speak to your doctor or nurse if you have any problems before or after this first check or if you want the IUD removed.

Speak to your doctor or nurse if you or your partner are at risk of getting an STI. This is because STIs can lead to an infection in the pelvis.

See your GP or go back to the clinic where your IUD was fitted as soon as you can if you:

  • have pain in your lower abdomen
  • have a high temperature
  • have a smelly discharge

These may mean you have an infection.

How to tell whether an IUD is still in place

An IUD has two thin threads that hang down a little way from your womb into the top of your vagina. The doctor or nurse who fits your IUD will teach you how to feel for these threads and check that it is still in place.

Check your IUD is in place a few times in the first month, and then after each period or at regular intervals. 

It's very unlikely that your IUD will come out, but if you can't feel the threads, or if you think the IUD has moved, you may not be fully protected against getting pregnant. See your doctor or nurse straight away and use an extra method of contraception, such as condoms, until your IUD has been checked. If you've had sex recently, you may need to use emergency contraception.

Your partner shouldn't be able to feel your IUD during sex. If he can feel the threads, get your doctor or nurse to check that your IUD is in place. They may be able to cut the threads to a shorter length. If you feel any pain during sex, go for a check-up.

Removing an IUD

An IUD can be removed at any time by a trained doctor or nurse.

If you're not going to have another IUD put in and you don't want to get pregnant, use another method (such as condoms) for seven days before you have the IUD removed. This is to stop sperm getting into your body. Sperm can live for up to seven days in the body and could make you pregnant once the IUD is removed.

As soon as an IUD is taken out, your normal fertility should return. 

Who can use an IUD

Most women can use an IUD. This includes women who have never been pregnant and those who are HIV positive. Your doctor or nurse will ask about your medical history to check if an IUD is the most suitable form of contraception for you.

You should not use an IUD if you have:

  • an untreated STI or a pelvic infection 
  • problems with your womb or cervix 
  • any unexplained bleeding from your vagina – for example, between periods or after sex

Women who have had an ectopic pregnancy or recent abortion, or who have an artificial heart valve, must consult their GP or clinician before having an IUD fitted.

You should not be fitted with an IUD if there's a chance that you are already pregnant or if you or your partner are at risk of catching STIs. If you or your partner are unsure, go to your GP or a sexual health clinic to be tested.

Using an IUD after giving birth

An IUD can usually be fitted four to six weeks after giving birth (vaginal or caesarean). You'll need to use alternative contraception from three weeks (21 days) after the birth until the IUD is fitted. In some cases, an IUD can be fitted within 48 hours of giving birth. An IUD is safe to use when you're breastfeeding and it won't affect your milk supply.

Using an IUD after a miscarriage or abortion

An IUD can be fitted straight away or within 48 hours after an abortion or miscarriage by an experienced doctor or nurse, as long as you were pregnant for less than 24 weeks. If you were pregnant for more than 24 weeks, you may have to wait a few weeks before having an IUD fitted. 

Advantages and disadvantages of the IUD

Although an IUD is an effective method of contraception, there are some things to consider before having one fitted.

Advantages of the IUD

  • Most women can use an IUD, including women who have never been pregnant.
  • Once an IUD is fitted, it works straight away and lasts for up to 10 years or until it's removed.
  • It doesn't interrupt sex.
  • It can be used if you're breastfeeding.
  • Your normal fertility returns as soon as the IUD is taken out
  • It's not affected by other medicines.

There's no evidence that having an IUD fitted will increase the risk of cancer of the cervixendometrial cancer (cancer of the lining of the womb) or ovarian cancer. Some women experience changes in mood and libido, but these changes are very small. There is no evidence that the IUD affects weight.

Disadvantages of the IUD

  • Your periods may become heavier, longer or more painful, though this may improve after a few months. 
  • An IUD doesn't protect against STIs, so you may have to use condoms as well. If you get an STI while you have an IUD, it could lead to a pelvic infection if not treated.
  • The most common reasons that women stop using an IUD are vaginal bleeding and pain.

Risks of the IUD

Complications after having an IUD fitted are rare. Most will appear within the first year after fitting.

Damage to the womb

In fewer than one in 1,000 cases, an IUD can perforate (make a hole in) the womb or neck of the womb (cervix) when it's put in. This can cause pain in the lower abdomen, but doesn't usually cause any other symptoms. If the doctor or nurse fitting your IUD is experienced, the risk of this is very low.

If perforation occurs, you may need surgery to remove the IUD. Contact your GP straight away if you feel a lot of pain after having an IUD fitted as perforations should be treated immediately.

Pelvic infections

Pelvic infections can occur in the first 20 days after the IUD is fitted. The risk of infection is very small. Fewer than one in 100 women who are at low risk of STIs will get a pelvic infection.

Rejection

Occasionally, the IUD is rejected (expelled) by the womb or can move (this is called displacement). This is more likely to happen soon after it has been fitted, although this is uncommon. Your doctor or nurse will teach you how to check that your IUD is in place.

Ectopic pregnancy

If the IUD fails and you become pregnant, your IUD should be removed as soon as possible if you're going to continue with the pregnancy. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUD.

Where to get an IUD

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – these offer contraceptive and STI testing services
  • some young people’s services (call the sexual health line on 0800 22 44 88 for details)

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents or carer, as long as they believe you fully understand the information you're given, and your decisions.

Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.  

IUS (intrauterine system)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the IUS, or intrauterine system (sometimes called the hormonal coil).

At a glance: facts about the IUS

How the IUS works

Who can use the IUS

Advantages and disadvantages of the IUS

Risks of the IUS

Where to get the IUS

An IUS is a small, T-shaped plastic device that is inserted into your womb (uterus) by a specially trained doctor or nurse.

The IUS releases a progestogen hormone into the womb. This thickens the mucus from your cervix, making it difficult for sperm to move through and reach an egg. It also thins the womb lining so that it's less likely to accept a fertilised egg. It may also stop ovulation (the release of an egg) in some women.

The IUS is a long-acting reversible contraceptive (LARC) method. It works for five years or three years, depending on the type, so you don't have to think about contraception every day or each time you have sex. Two brands of IUS are used in the UK – Mirena and Jaydess. 

You can use an IUS whether or not you've had children.

At a glance: facts about the IUS

  • It's more than 99% effective. Less than one in every 100 women who use Mirena will get pregnant in five years, and less than one in 100 who use Jaydess will get pregnant in three years.
  • It can be taken out at any time by a specially trained doctor or nurse and your fertility quickly returns to normal.
  • The IUS can make your periods lighter, shorter or stop altogether, so it may help women who have heavy periods or painful periods. Jaydess is less likely than Mirena to make your periods stop altogether.
  • It can be used by women who can't use combined contraception (such as the combined pill) – for example, those who have migraines.
  • Once the IUS is in place, you don't have to think about contraception every day or each time you have sex.
  • Some women may experience mood swings, skin problems or breast tenderness.  
  • There's a small risk of getting an infection after it's inserted.
  • It can be uncomfortable when the IUS is put in, although painkillers can help with this.
  • The IUS can be fitted at any time during your monthly menstrual cycle, as long as you're definitely not pregnant. Ideally, it should be fitted within seven days of the start of your period, because this will protect against pregnancy straight away. You should use condoms for seven days if the IUS is fitted at any other time.
  • The IUS does not protect against sexually transmitted infections (STIs). By using condoms as well as the IUS, you'll help to protect yourself against STIs.

How the IUS works

The IUS is similar to the IUD (intrauterine device), but works in a slightly different way. Rather than releasing copper like the IUD, the IUS releases a progestogen hormone, which is similar to the natural hormone progesterone that's produced in a woman's ovaries.

Progestogen thickens the mucus from the cervix (opening of the womb), making it harder for sperm to move through it and reach an egg. It also causes the womb lining to become thinner and less likely to accept a fertilised egg. In some women, the IUS also stops the ovaries from releasing an egg (ovulation), but most women will continue to ovulate.

If you're 45 or older when you have the IUS fitted, it can be left until you reach menopause or you no longer need contraception.

Having an IUS fitted

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

An IUS can be fitted at any stage of your menstrual cycle, as long as you are not pregnant. If it's fitted in the first seven days of your cycle, you will be protected against pregnancy straight away. If it's fitted at any other time, you need to use another method of contraception (such as condoms) for seven days after it's fitted.

Before you have an IUS fitted, you will have an internal examination to determine the size and position of your womb. This is to make sure that the IUS can be positioned in the correct place.

You may also be tested for any existing infections, such as STIs. It is best to do this before an IUS is fitted so that any infections can be treated. You may be given antibiotics at the same time as an IUS is fitted.

It takes about 15 to 20 minutes to insert an IUS:

  • the vagina is held open, like it is during a cervical screening (smear) test
  • the IUS is inserted through the cervix and into the womb

The fitting process can be uncomfortable or painful for some women, and you may also experience cramps afterwards.

You can ask for a local anaesthetic or painkillers before having the IUS fitted. Discuss this with your GP or nurse beforehand. An anaesthetic injection itself can be painful, so many women have the procedure without one.

Once an IUS is fitted, it will need to be checked by a doctor after three to six weeks to make sure everything is fine. Speak to your GP or clinician if you have any problems after this initial check or if you want the IUS removed.

Also speak to your GP if you or your partner are at risk of getting an STI, as this can lead to infection in the pelvis.

See your GP or go back to the clinic if you:

  • have pain in your lower abdomen
  • have a high temperature
  • have smelly discharge

This may mean you have an infection.

How to tell if an IUS is still in place

An IUS has two thin threads that hang down a little way from your womb into the top of your vagina. The GP or clinician that fits your IUS will teach you how to feel for these threads and check that the IUS is still in place.

Check your IUS is in place a few times in the first month and then after each period at regular intervals.

It is highly unlikely that your IUS will come out, but if you can't feel the threads or if you think the IUS has moved, you may not be fully protected against pregnancy. See your doctor or nurse straight away and use extra contraception, such as condoms, until your IUS has been checked. If you've had sex recently, you may need to use emergency contraception.

Your partner shouldn't be able to feel your IUS during sex. If he can feel the threads, get your GP or clinician to check that your IUS is in place. They may be able to cut the threads a little. If you feel any pain during sex, go for a check-up with your GP or clinician.

Removing an IUS

Your IUS can be removed at any time by a trained doctor or nurse.

If you're not going to have another IUS put in and you don't want to become pregnant, use another contraceptive method (such as condoms) for seven days before you have the IUS removed. Sperm can live for seven days in the body and could fertilise an egg once the IUS is removed. As soon as an IUS is taken out, your normal fertility should return.

Who can use an IUS

Most women can use an IUS, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUS is the most suitable form of contraception for you.

Your family and medical history will determine whether or not you can use an IUS. For example, this method of contraception may not be suitable for you if you have:

  • breast cancer, or have had it in the past five years
  • cervical cancer 
  • liver disease
  • unexplained vaginal bleeding between periods or after sex
  • arterial disease or history of serious heart disease or stroke
  • an untreated STI or pelvic infection
  • problems with your womb or cervix

An IUS may not be suitable for women who have untreated STIs. A doctor will usually give you a check-up to make sure you don't have any existing infections.

Using an IUS after giving birth

An IUS can usually be fitted four to six weeks after giving birth (vaginal or caesarean). You'll need to use alternative contraception from three weeks (21 days) after the birth until the IUS is put in. In some cases, an IUS can be fitted within 48 hours of giving birth. It is safe to use an IUS when you're breastfeeding, and it won't affect your milk supply.

Using an IUS after a miscarriage or abortion

An IUS can be fitted by an experienced doctor or nurse straight after an abortion or miscarriage, as long as you were pregnant for less than 24 weeks. If you were pregnant for more than 24 weeks, you may have to wait a few weeks before an IUS can be fitted.

Advantages and disadvantages of the IUS

Although an IUS is an effective method of contraception, there are several things to consider before having an IUS fitted.

Advantages of the IUS

  • It works for five years (Mirena) or three years (Jaydess). 
  • It's one of the most effective forms of contraception available in the UK.
  • It doesn't interrupt sex.
  • An IUS may be useful if you have heavy or painful periods because your periods usually become much lighter and shorter, and sometimes less painful – they may stop completely after the first year of use.
  • It can be used safely if you're breastfeeding. 
  • It's not affected by other medicines.
  • It may be a good option if you can't take the hormone oestrogen, which is used in the combined contraceptive pill. 
  • Your fertility will return to normal when the IUS is removed.

There's no evidence that an IUS will affect your weight or that having an IUS fitted will increase the risk of cervical cancercancer of the uterus or ovarian cancer. Some women experience changes in mood and libido, but these changes are very small.

Disadvantages of the IUS

  • Some women won't be happy with the way that their periods may change. For example, periods may become lighter and more irregular or, in some cases, stop completely. Your periods are more likely to stop completely with Mirena than with Jaydess.
  • Irregular bleeding and spotting are common in the first six months after having an IUS fitted. This is not harmful and usually decreases with time.
  • Some women experience headaches, acne and breast tenderness after having the IUS fitted.
  • An uncommon side effect of the IUS is the appearance of small fluid-filled cysts on the ovaries – these usually disappear without treatment.
  • An IUS doesn't protect you against STIs, so you may also have to use condoms when having sex. If you get an STI while you have an IUS fitted, it could lead to pelvic infection if it's not treated.
  • Most women who stop using an IUS do so because of vaginal bleeding and pain, although this is uncommon. Hormonal problems can also occur, but these are even less common.

Risks of the IUS

Complications caused by an IUS are rare and usually happen in the first six months after it has been fitted. These include:

Damage to the womb

In rare cases (fewer than one in 1,000 insertions) an IUS can perforate (make a hole in) the womb or neck of the womb (cervix) when it is put in. This can cause pain in the lower abdomen, but doesn't usually cause any other symptoms. If the doctor or nurse fitting your IUS is experienced, the risk of perforation is extremely low.

If perforation occurs, you may need surgery to remove the IUS. Contact your GP straight away if you feel a lot of pain after having an IUS fitted. Perforations should be treated immediately.

Pelvic infections

Pelvic infections may occur in the first 20 days after the IUS has been inserted.

The risk of infection from an IUS is extremely small (fewer than one in 100 women who are at low risk of STIs will get an infection). A GP or clinician will usually recommend an internal examination before fitting an IUS to be sure that there are no existing infections.

Rejection

Occasionally, the IUS is rejected (expelled) by the womb or it can move (this is called displacement). This is not common and is more likely to happen soon after it has been fitted. Your doctor or nurse will teach you how to check that your IUS is in place.

Ectopic pregnancy

If the IUS fails and you become pregnant, your IUS should be removed as soon as possible if you are continuing with the pregnancy. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUS.

Where to get the IUS

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents or carer as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Progestogen-only pill (POP, mini pill)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the progestogen-only pill (POP).

It contains the hormone progestogen but doesn't contain oestrogen.

You need to take the progestogen-only pill at or around the same time every day.

The progestogen-only pill thickens the mucus in the cervix, which stops sperm reaching an egg. In can also stop ovulation, depending on the type of progestogen-only pill you take. Newer progestogen-only pills contain desogestrel.

This page covers:

At a glance: facts about the progestogen-only pill

  • If taken correctly, it can be more than 99% effective. This means that fewer than one woman in 100 who use the progestogen-only pill as contraception will get pregnant in one year.
  • You take a pill every day, with no break between packs of pills.
  • The progestogen-only pill can be used by women who can't use contraception that contains oestrogen – for example, because they have high blood pressure, previous blood clots or are overweight.
  • You can take the progestogen-only pill if you're over 35 and you smoke.
  • You must take the progestogen-only pill at the same time each day – if you take it more than three hours late (or 12 hours late if you take a desogestrel pill, such as Cerazette) it may not be effective.
  • If you’re sick (vomit) or have severe diarrhoea, the progestogen-only pill may not work.
  • Some medicines may affect the progestogen-only pill's effectiveness – ask your doctor for details.
  • Your periods may stop or become lighter, irregular or more frequent.
  • Side effects may include spotty skin and breast tenderness – these should clear up within a few months.
  • The progestogen-only pill doesn’t protect against sexually transmitted infections (STIs). By using condoms as well as the progestogen-only pill, you'll help to protect yourself against STIs.

How the progestogen-only pill works

The progestogen-only pill works by thickening the mucus in the neck of the womb, so it is harder for sperm to penetrate into the womb and reach an egg.

Sometimes, depending on the type of progestogen-only pill, it may also prevent ovulation (the release of an egg from your ovaries each month). The desogestrel pill (12-hour pill, such as Cerazette) stops ovulation in 97% of menstrual cycles. This means that if you're using a 12-hour progestogen-only pill, you won't release an egg in 97 cycles out of 100.

Using the progestogen-only pill

There are two different types of progestogen-only pill:

  • The three-hour progestogen-only pill must be taken within three hours of the same time each day. Examples are Femulen, Micronor, Norgeston and Noriday.
  • The 12-hour progestogen-only pill (desogestrel pill, such as Cerazette) must be taken within 12 hours of the same time each day.

It is important to follow the instructions that come with your pill packet, because missing pills or taking the pill alongside other medicines can reduce its effectiveness.

There are 28 pills in a pack of progestogen-only pills. You need to take one pill every day, within either three or 12 hours of the same time each day, depending on which type you are taking. There’s no break between packs of pills – when you finish one pack, you start the next one the next day.

Starting the first pack of pills

  • Choose a convenient time in the day to take your first pill.
  • Continue to take a pill at the same time each day until the pack is finished.
  • Start your next pack of pills the following day. There is no break between packs of pills.

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

You can start the progestogen-only pill at any time in your menstrual cycle. If you start it on day one of your menstrual cycle (the first day of your period) it will work straight away and you will be protected against pregnancy. You won’t need additional contraception.

If you start the progestogen-only pill on day five of your menstrual cycle or earlier (the fifth day after the start of your period or before) you will be protected from pregnancy straight away unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you will need additional contraception, such as condoms, until you have taken the pill for two days.

If you start the progestogen-only pill on any other day of your cycle, you will not be protected from pregnancy straight away and will need additional contraception until you have taken the pill for two days.

After having a baby

If you have just had a baby, you can start the progestogen-only pill on day 21 after the birth. You will be protected against pregnancy straight away.

If you start the progestogen-only pill more than 21 days after giving birth, you will need additional contraception (such as condoms) until you have taken the pill for two days.

After a miscarriage or abortion

If you have had a miscarriage or abortion, you can start the progestogen-only pill up to five days afterwards and you will be protected from pregnancy straight away.

If you start the pill more than five days after a miscarriage or abortion, use additional contraception until you have taken the pill for two days.

What to do if you miss a pill

If you forget to take a progestogen-only pill, what you should do depends on:

  • the type of pill you are taking
  • how long ago you missed the pill and how many pills you have forgotten to take
  • whether you have had sex without using another form of contraception during the previous seven days

If you are less than three or less than 12 hours late taking the pill

If you are taking a three-hour progestogen-only pill and are less than three hours late taking it, or if you are taking the 12-hour progestogen-only pill and are less than 12 hours late:

  • take the late pill as soon as you remember, and
  • take the remaining pills as normal, even if that means taking two pills on the same day

The pill will still work, and you’ll be protected against pregnancy – you do not need to use additional contraception. Don’t worry if you have had sex without using another form of contraception. You do not need emergency contraception.

If you are more than three or more than 12 hours late taking the pill

If you are taking a three-hour progestogen-only pill and are more than three hours late taking it, or are taking the 12-hour progestogen-only pill and are more than 12 hours late you will not be protected against pregnancy.

You will need to use additional contraception, such as condoms for two or seven days (depending on what pill you are taking) after missing a pill. You should:

  • take the last pill you missed straight away (if you have missed more than one, take only one)
  • take your next pill at the normal time

Depending on when you remember, it may mean taking two pills on the same day (one at the time of remembering, and one at the regular time), or even at the same time.

How long you need to use additional contraception such as condoms depends on the type of pill you are taking:

  • If you are taking a three-hour pill (such as Femulen, Micronor, Norgeston or Noriday) you will need to use additional contraception for two days after missing the pill. It takes two days for the pill's contraceptive effect on cervical mucus to be re-established after missing a pill.
  • If you are taking a 12-hour pill that stops ovulation (a desogestrel pill, such as Cerazette), you will need additional contraception for seven days. This is because it takes seven days for the pill's effect on ovulation to be re-established after a missed pill.

Emergency contraception

If you have recently had unprotected sex, you may need emergency contraception. Seek advice straight away from your GP or local sexual health clinic. You can also call NHS 111 or our Sexual Health Line on 0800 22 44 88.

Vomiting and diarrhoea

If you vomit within two hours of taking a progestogen-only pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you don’t take the replacement within three hours (or 12 hours for the 12-hour pill) of your normal time, use additional contraception, such as condoms, for two days (seven days for the 12-hour pill).

If you continue to be sick, keep using another form of contraception while you’re ill and for two days after recovering.

Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn’t work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for two days after recovering (seven days if you are taking a 12-hour pill).

Speak to your GP or contraception nurse or call the NHS 24 111 service or our Sexual Health Line on 0800 22 44 88 if you are unsure whether you are protected against pregnancy, or if your sickness or diarrhoea continues.

Who can use the progestogen-only pill?

Most women can use the progestogen-only pill. You may not be able to use it if you have had:

  • heart disease
  • liver disease
  • breast cancer
  • cysts on your ovaries
  • unexplained vaginal bleeding

If you are healthy and there are no medical reasons why you should not take the progestogen-only pill, you can take it until your menopause or until you are 55.

Breastfeeding

The progestogen-only pill is safe to use if you are breastfeeding. Small amounts of progestogen may pass into your breast milk, but this is not harmful to your baby. The progestogen-only pill does not affect the way your breast milk is produced.

Pregnancy

Although it is very unlikely, there is a very small chance that you could become pregnant while taking the progestogen-only pill. If this happens, there is no evidence that the pill will harm your unborn baby. If you think you may be pregnant, speak to your GP or visit your local contraception clinic.

Get medical advice if you have a sudden or unusual pain in your abdomen (tummy), or if your period is much shorter or lighter than usual. It is possible that these are warning signs of an ectopic pregnancy, although this is rare.

Advantages and disadvantages

Some advantages of the progestogen-only pill include:

  • it does not interrupt sex
  • you can use it when breastfeeding
  • it is useful if you cannot take the hormone oestrogen, which is in the combined pill, contraceptive patch and vaginal ring
  • you can use it at any age – even if you smoke and are over 35
  • it can reduce the symptoms of premenstrual syndrome (PMS) and painful periods

Some disadvantages of the progestogen-only pill include:

  • you may not have regular periods while taking it – your periods may be lighter, more frequent or may stop altogether, and you may get spotting between periods
  • it does not protect you against STIs
  • you need to remember to take it at or around the same time every day
  • some medications, including certain types of antibiotic, can make it less effective

The progestogen-only pill is generally well tolerated and side effects are rare. Some side effects can include:

  • acne
  • breast tenderness and breast enlargement
  • an increased or decreased sex drive
  • mood changes
  • headache and migraine
  • nausea or vomiting
  • cysts (small fluid-filled sacs) on your ovaries (these are usually harmless and disappear without treatment)
  • stomach upset
  • weight gain

These side effects are most likely to occur during the first few months of taking the progestogen-only pill, but they generally improve over time and should stop within a few months.

If you have any concerns about your contraceptive pill, see your GP or practice nurse. They may advise you to change to another pill or a different form of contraception.

The progestogen-only pill with other medicines

When you take two or more medicines at the same time, the effects of one medicine can be changed by the other. This is known as an interaction.

Some medicines interact with the progestogen-only pill and it doesn’t work properly. Some interactions are listed on this page but it is not a complete list – if you want to check your medicines are safe to take with the progestogen-only pill, you can:

  • ask your GP, practice nurse or pharmacist
  • read the patient information leaflet that comes with your medicine

Antibiotics

The antibiotics rifampicin and rifabutin (which can be used to treat illnesses including tuberculosis and meningitis) can reduce the effectiveness of the progestogen-only pill. Other antibiotics do not have this effect.

If you are prescribed rifampicin or rifabutin, you may need additional contraception (such as condoms) while taking the antibiotic and for 28 days after. Speak to your doctor or nurse for advice.

Epilepsy and HIV medicines, and St John’s wort

The progestogen-only pill can interact with medicines called enzyme inducers. These speed up the breakdown of progestogen by your liver, reducing the effectiveness of the progestogen-only pill.

Examples of enzyme inducers are:

  • the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
  • St John’s wort (a herbal remedy)
  • some antiretroviral medicines used to treat HIV (research suggests interactions between these medicines and the progestogen-only pill can affect the safety and effectiveness of both)

Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

Risks of taking the progestogen-only pill

The progestogen-only pill is very safe to take. However, as with the combined contraceptive pill, there are certain risks. These risks are small. For most women, benefits of the progestogen-only pill outweigh the risks.

Ovarian cysts

Some women can develop fluid-filled cysts on their ovaries. These are not dangerous and do not usually need to be removed. These cysts usually disappear without treatment. In many cases, the cysts do not cause symptoms, although some women experience pelvic pain.

Breast cancer

Research is continuing into the link between breast cancer and the progestogen-only pill. Research suggests that women who use any type of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with people who don’t use hormonal contraception. However, 10 years after you stop taking the pill, your risk of breast cancer goes back to normal.

If you have a family history of breast cancer, you may feel that this increase in risk (however small it is) is not worth taking. However, doctors do not think that using the contraceptive pill is likely to increase the risk in women who already have close relatives with breast cancer.

Where you can get the progestogen-only pill

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Vaginal ring

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the vaginal ring. 

At a glance: the vaginal ring

How the ring works

Who can use the ring

Advantages and disadvantages

Risks of the ring

The vaginal ring is a small, soft plastic ring that you place inside your vagina. It’s about 4mm thick and 5.5cm in diameter. You leave it in your vagina for 21 days, then remove it and throw it in the bin (not down the toilet) in a special disposal bag. Seven days after removing the ring, you insert a new one for the next 21 days. 

The ring releases oestrogen and progestogen. This prevents ovulation (release of an egg), makes it difficult for sperm to get to an egg and thins the womb lining, so it’s less likely that an egg will implant there.  

At a glance: facts about the vaginal ring

  • If used correctly, the vaginal ring is more than 99% effective. This means that fewer than one woman out of every 100 who use the vaginal ring as contraception will become pregnant in one year. 
  • One ring will provide contraception for a month, so you don’t have to think about it every day. 
  • It doesn’t interrupt sex, because you can have sex with the ring in place. 
  • Unlike the pill, the ring is still effective if you have vomiting or diarrhoea.
  • The ring may ease premenstrual symptoms, and bleeding will probably be lighter and less painful. 
  • Some women have temporary side effects, including more vaginal discharge, breast tenderness and headaches. 
  • A few women develop a blood clot (thrombosis) when using the ring, but this is rare. 
  • The ring can sometimes come out on its own, but you can rinse it in warm water and put it back in as soon as possible. You might need emergency contraception, depending on how long it has been out. 
  • The vaginal ring doesn’t protect against sexually transmitted infections (STIs). By using condoms as well as the ring, you’ll protect yourself against STIs.

How the ring works

The ring continually releases oestrogen and progestogen, which are synthetic versions of the hormones that are naturally released by the ovaries. This:

  • reduces ovulation (the release of an egg)
  • thickens vaginal mucus, which makes it more difficult for sperm to get through
  • thins the lining of the womb so that an egg is less likely to implant there

Using the vaginal ring

You can start using the vaginal ring at any time during your menstrual cycle. You leave it in for 21 days, then remove it and have a seven-day ring-free break. You’re protected against pregnancy during the ring-free break. You then put a new ring in for another 21 days.

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

The licence for the vaginal ring states that:

  • you will be protected against pregnancy straight away if you insert it on the first day of your period (the first day of your menstrual cycle)
  • you won't be protected from pregnancy if you start using it at any other time in your menstrual cycle, and you'll need to use additional contraception (such as condoms) for the first seven days

You can discuss this with your doctor or nurse to decide when might be the best time for you to start using the ring.

To insert the ring:

  • with clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina
  • gently push the ring up into your vagina until it feels comfortable

Unlike a diaphragm or cap, the ring does not need to cover your cervix (the entrance to your womb) to work.

If you can feel the ring and it is uncomfortable, push it a bit further into your vagina. There isn’t a right or wrong place for it to be, as long as it isn’t uncomfortable.

You should be able to check that the ring is still there using your fingers. If you can’t feel it, but you’re sure it’s there, see your doctor or nurse. The ring cannot get "lost" inside you.

After the ring has been in your vagina for 21 days (three weeks), you remove it. This should be on the same day of the week that you put it in.

To remove the ring:

  • with clean hands, put a finger into your vagina and hook it around the edge of the ring
  • gently pull the ring out
  • put it in the special bag provided and throw it in the bin – don’t flush it down the toilet

Removing the ring should be painless. If you have any bleeding or pain, or you can’t pull it out, tell your doctor or nurse immediately.

When you’ve taken the ring out, you don’t put a new one in for seven days (one week). This is the ring-free interval. You might have a period-type bleed during this time. 

After seven days without a ring in, you need to insert a new one. Put the new ring in even if you’re still bleeding. Leave this ring in for 21 days, then repeat the cycle.

You can have sex and use tampons while the ring is in your vagina. You and your partner may feel the ring during sex, but this isn’t harmful.

If you forget to take the ring out

If you forget to take the ring out after 21 days, what you should do depends on how much extra time the ring has been left in.

If the ring has been in for up to seven days after the end of week three

  • take the ring out as soon as you remember
  • don’t put a new ring in – start your seven-day interval as normal
  • begin your new ring after your seven-day interval as normal
  • you’re still protected against pregnancy, and you don’t need to use additional contraception

If the ring has been in for more than seven extra days (more than four weeks in total):

  • take the ring out as soon as you remember
  • put a new ring in straight away

The licence for the vaginal ring states that you should use additional contraception (such as condoms) until the new ring has been in for seven days.

Speak to your doctor or nurse about when you should use additional contraception.

You may need emergency contraception if you had sex in the days before changing the rings over. Talk to your doctor or nurse.

If you forget to put a new ring in

Put in a new ring as soon as you remember, and use additional contraception, such as condoms, for seven days.

You may need emergency contraception if you had sex before you remembered to put the new ring in, and the ring-free interval was 48 hours or more longer than it should have been (nine days or more in total). If this is the case, talk to your doctor or nurse.

If the ring comes out by itself

Sometimes the ring may come out on its own (this is called expulsion). This is most likely to happen after or during sex, or when you're constipated. What you should do depends on how long the ring is out for, and whether you’re in the first, second or third week of using it.

The licence for the vaginal ring states that if the ring is out for more than three hours, you will not be protected against pregnancy. Discuss this with your GP or nurse.

The information below is based on the licence information on what to do if the ring comes out.

If the ring is out for more than three hours in the first or second week of using it, rinse it and put it back in. You need to use additional contraception for seven days. You may need emergency contraception if you have had sex in the last few days – talk to your doctor or nurse.

If the ring is out for more than three hours in the third week of using it, don’t put it back in. Dispose of it in the normal way. You now have two options: 

  • You can put a new ring in straight away. You may not have a period-type bleed, but you may have spotting.

OR

  • Don’t put a ring in and have a seven-day interval. You’ll have a period-type bleed, and you should put a new ring in seven days after the old one came out (you can only choose this option if the ring was in continuously for the previous seven days).

Whichever option you choose, you need to use additional contraception until the ring has been in for seven days in a row. You should also talk to your doctor or nurse if you’ve had sex in the last few days, as you may need emergency contraception.

Who can use the vaginal ring?

Some women cannot use the vaginal ring. Your doctor or nurse will ask about your medical history and your family's medical history, to see whether the ring is suitable for you. The ring may not be suitable if you:

  • have had a blood clot in a vein or artery
  • have had heart or circulatory problems, including high blood pressure
  • are 35 or older and smoke, or stopped smoking in the past year
  • have severe migraine with aura (warning symptoms)
  • have had breast cancer in the past five years
  • have diabetes with complications
  • are overweight
  • take certain medicines
  • have vaginal muscles that can’t hold a vaginal ring

If you don’t smoke and there are no medical reasons why you can’t use the ring, you can use it until you are 50 years old.

After giving birth

You can start using the vaginal ring 21 days after giving birth, and you will be protected against pregnancy straight away.

If you start the ring more than 21 days after giving birth, you need to use additional contraception for seven days after you insert the ring.

The vaginal ring may reduce your flow of milk if you’re breastfeeding a baby under six months old. It’s usually recommended that you use a different method.

After miscarriage or abortion

You can start using the ring immediately after a miscarriage or abortion, and it will work straight away. You don’t need to use additional contraception.

Advantages and disadvantages

Some of the advantages of the vaginal ring include:

  • it doesn’t interrupt sex
  • it’s easy to put in and remove
  • you don’t have to think about it every day or each time you have sex
  • the ring is not affected if you vomit or have diarrhoea
  • it may help with premenstrual symptoms
  • period-type bleeding usually becomes lighter, more regular and less painful
  • it may reduce the risk of cancer of the ovary, uterus and colon
  • it may reduce the risk of fibroidsovarian cysts and non-cancerous breast disease

Some of the disadvantages of the vaginal ring include:

  • it may not be suitable if you don’t feel comfortable inserting or removing it from your vagina
  • spotting and bleeding while the ring is in your vagina can occur in the first few months
  • it may cause temporary side effects, such as increased vaginal discharge, headaches, nausea, breast tenderness and mood changes
  • the ring does not protect against STIs

The vaginal ring with other medicines

Some medicines may interact with the vaginal ring, meaning it doesn’t work properly. If you want to check that your medicines are safe to take with the vaginal ring, you can: 

  • ask your GP, practice nurse or pharmacist
  • read the patient information leaflet that comes with your medicine

The vaginal ring can interact with medicines called enzyme inducers. These speed up breakdown of progestogen by your liver, reducing the effectiveness of the ring.

Examples of enzyme inducers are:

  • the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate 
  • St John’s Wort (a herbal remedy) 
  • some antiretroviral medicines used to treat HIV
  • antibiotics called rifampicin and rifabutin, which can be used to treat illnesses including tuberculosis (TB) and meningitis

Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

Risks

There are some serious side effects, but these are not common. They include: 

  • developing a blood clot in a vein or artery
  • having a heart attack or stroke

Research into the risk of breast cancer and hormonal contraception is complex and contradictory. It suggests that all women who use hormonal contraception appear to have a small increased risk of being diagnosed with breast cancer, compared with women who don’t use hormonal contraception.

Research suggests there is a small increase in the risk of developing cervical cancer with longer use of oestrogen and progestogen hormonal contraception. Some research suggests a link between oestrogen and progestogen hormonal contraception and a very rare liver cancer.

Where you can get the vaginal ring

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse 
  • community contraception clinics 
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents or carer as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Vasectomy

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is vasectomy (male sterilisation).

At a glance: vasectomy

How vasectomy works

Who can have a vasectomy

Advantages and disadvantages

Risks

Common questions

During a minor operation, the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed.

This prevents sperm from reaching the seminal fluid (semen), which is ejaculated from the penis during sex. There will be no sperm in the semen, so a woman's egg can't be fertilised.

Vasectomy is usually carried out under local anaesthetic, and takes about 15 minutes.

At a glance: facts about vasectomy

  • In most cases, vasectomy is more than 99% effective. Out of 2,000 men who are sterilised, one will get a woman pregnant during the rest of his lifetime.
  • Male sterilisation is considered permanent – once it's done, you don't have to think about contraception again.
  • You need to use contraception for at least eight weeks after the operation, because sperm stay in the tubes leading to the penis.
  • Up to two semen tests are done after the operation, to ensure that all the sperm have gone. 
  • Your scrotum (ball sack) may become bruised, swollen or painful – some men have ongoing pain in their testicles.
  • As with any surgery, there's a slight risk of infection. 
  • Reversing the operation isn't easy, and is rarely available on the NHS.
  • Vasectomy doesn't protect against sexually transmitted infections (STIs). By using a condom, you’ll protect yourself and your partner against STIs. 

How vasectomy works

Vasectomy works by stopping sperm from getting into a man’s semen. This means that when a man ejaculates, the semen has no sperm and a woman’s egg cannot be fertilised.

How vasectomy is carried out

Vasectomy is a quick and relatively painless surgical procedure. The tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed with heat. In most cases, you will be able to return home the same day.

Most vasectomies are carried out under local anaesthetic. This means that only your scrotum and testicles will be numbed, and you will be awake for the procedure. You will not feel any pain, although it may feel slightly uncomfortable.

In rare cases, a general anaesthetic may be required. This means that you will be asleep during the procedure. A general anaesthetic may be used if you are allergic to local anaesthetic or have a history of fainting easily. However, most people will only need a local anaesthetic.

A vasectomy has no effect on sex drive or ability to enjoy sex. You will still have erections and ejaculate normally. The only difference is that your semen will not contain sperm. 

A vasectomy can be performed at:

  • your local GP surgery
  • a hospital as a day-patient appointment
  • a sexual health clinic
  • a private clinic  

There are two types of vasectomy. The traditional technique, called conventional vasectomy, involves making two small incisions in the scrotum (the pouch of skin that surrounds your testicles) using a scalpel (surgical knife).

The other type, called a no-scalpel vasectomy, is a newer technique now in common use. The doctor doing your vasectomy will discuss with you which is best.

Conventional vasectomy

During a conventional vasectomy, the skin of your scrotum is numbed with local anaesthetic. The doctor makes two small cuts, about 1cm long, on each side of your scrotum.

The incisions allow your surgeon to access the tubes that carry sperm out of your testicles. These tubes are known as "vas deferens". Each tube is cut and a small section removed. The ends of the tubes are then closed, either by tying them or sealing them using diathermy (an instrument that heats to a very high temperature).

The incisions are stitched, usually using dissolvable stitches, which will disappear naturally within about a week.

No-scalpel vasectomy

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

No-scalpel vasectomy is usually carried out under local anaesthetic. During a no-scalpel vasectomy, the doctor will feel the vas deferens underneath the skin of your scrotum and then hold them in place using a small clamp.

A special instrument is then used to make a tiny puncture hole in the skin of the scrotum. A small pair of forceps is used to open up the hole, allowing the surgeon to access the vas deferens without needing to cut the skin with a scalpel. The tubes are then closed in the same way as in a conventional vasectomy, either by being tied or sealed.

During a no-scalpel vasectomy, there will be little bleeding and no stitches. The procedure is also thought to be less painful and less likely to cause complications than a conventional vasectomy.

Before you decide to have a vasectomy

Your doctor will ask about your circumstances and provide information and counselling before agreeing to the procedure.

You should only have a vasectomy if you are certain that you do not want to have any, or any more, children. If you have any doubts, consider another method of contraception until you are completely sure.

You shouldn't make the decision about having a vasectomy after a crisis or a big change in your life – for example, if your partner has just had a baby, or has just terminated a pregnancy.

If you have a partner, discuss it with them before deciding to have a vasectomy. If possible, you should both agree to the procedure, but it is not a legal requirement to get your partner's permission.

You can have a vasectomy at any age. However, if you are under 30, particularly if you do not have children, your doctor may be reluctant to perform the procedure.

Your GP does have the right to refuse to carry out the procedure or refuse to refer you for the procedure if they do not believe that it is in your best interests. If this is the case, you may have to pay to have a vasectomy privately.

How long will I have to wait for the operation?

In most parts of the UK, a vasectomy is available free of charge from the NHS. However, waiting lists can be several months, depending on where you live.

Speak to your GP or ask at your local contraception clinic about vasectomies in your area. As waiting lists for vasectomies can be long, some men choose to pay to have the procedure carried out privately.

You can request a male doctor, but in some cases this may mean having to wait longer. Your GP may be able to offer you options of where the vasectomy can be carried out.

Recovering after the operation

It’s common to have some mild discomfort, swelling and bruising of your scrotum for a few days after the vasectomy. If you have pain or discomfort, you can take painkillers, such as paracetamol. Contact your GP for advice if you are still experiencing considerable pain after taking painkillers.

It’s common to have blood in your semen in the first few ejaculations after a vasectomy. This isn’t harmful.

Some other common questions about recovery are outlined below.

Underwear

Wearing close-fitting underwear, such as Y-fronts, during the day and at night will help to support your scrotum and will also help ease any discomfort or swelling. Make sure you change your underwear every day.

Hygiene

It is usually safe for you to have a bath or shower after your operation – check with your doctor what is suitable for you. Make sure you dry your genital area gently and thoroughly.

Returning to work

Most men will be fit to return to work one or two days after their vasectomy, but you should avoid sport and heavy lifting for at least one week after the operation. This is to minimise the risk of developing complications (see below). If any symptoms continue after a few days, consult your GP.

Having sex

You can have sex again as soon as it is comfortable to do so, although it is best to wait for a couple of days. However, you will still have sperm in your semen immediately after the operation, as it takes time to clear the remaining sperm in your tubes. It takes an average of 20-30 ejaculations to clear the tubes of sperm. You will need to use another method of contraception until you have had two clear semen tests.

Once the operation has been carried out successfully and semen tests have shown that there is no sperm present, long-term partners may not need to use other forms of contraception.

However, a vasectomy does not protect against HIV infection or any other STIs, so you should still use condoms with any new partner.

How will I know if my vasectomy has worked?

After the vasectomy, there will be some sperm left in the upper part of the vas deferens tubes. It can take more than 20 ejaculations to clear these sperm from the tubes so, during this time, there is still a risk of pregnancy.

Until it has been confirmed that your semen is free of sperm, you should continue to use another form of contraception.

At least eight weeks after the procedure, you will need to produce a sample of semen, which will be tested for sperm. This will also help to identify the rare cases in which the tubes naturally rejoin themselves. Once tests have confirmed that your semen is free of sperm, the vasectomy is considered successful and you can stop using additional contraception.

A few men continue to have small numbers of sperm in their system, but these sperm do not move (they are known as non-motile sperm). If you are one of these men, your doctor will discuss your options with you. The chances of making your partner pregnant may be low enough to consider the vasectomy successful, or you may be advised to have further tests or consider other options.

Is reversal possible?

It is possible to have a vasectomy reversed. However, the procedure is not always successful. You have a better chance if it is done soon after the vasectomy.

If a reversal is carried out within 10 years of your vasectomy, the success rate is about 55%. This falls to 25% if your reversal is carried out more than 10 years after your vasectomy.

Even if a surgeon manages to join up the vas deferens tubes again, pregnancy may still not be possible. This is why you should be certain before going ahead with the vasectomy. Your doctor can help you to make your decision.

Reversal is rarely available on the NHS and the operation can be expensive if done privately.

Who can have a vasectomy

Having a vasectomy should always be viewed as permanent sterilisation. This is because, although reversal is sometimes possible, it may not be successful. A reversal operation requires delicate microsurgery to join the tubes together again. Even with a successful operation, it still may not be possible to father a child.

Advantages and disadvantages of vasectomy

Advantages

  • The failure rate is only one in 2,000 – out of 2,000 men who have a vasectomy, only one will get a woman pregnant in the rest of his lifetime.
  • There are rarely long-term effects on your health.
  • Vasectomy does not affect your hormone levels or sex drive.
  • It will not affect the spontaneity of sex or interfere with sex.
  • Vasectomy may be chosen as a simpler, safer and more reliable alternative to female sterilisation.

Disadvantages

  • Vasectomy doesn’t protect against STIs
  • It’s difficult to reverse, and reversal may not be available on the NHS.
  • You need to use contraception after the operation until tests show your semen is free of sperm – if your semen contains sperm, you could make your partner pregnant.
  • Complications can occur – the risks are listed below.

Risks

Most men feel sore and tender for a few days after the operation, and will usually experience some bruising and swelling on or around their scrotum.

However, in some cases, a vasectomy can cause more serious problems, some of which are outlined below.

Haematoma

A haematoma is when blood collects and clots in the tissue surrounding a broken blood vessel. Following a vasectomy, you may develop a haematoma inside your scrotum.

Haematomas are mostly small (pea-sized), but can occasionally be large (filling the scrotum) and, rarely, they can be very large. This can cause your scrotum to become very swollen and painful. In severe cases, you may need further surgery to treat the blood clot.

Sperm granulomas

When the tubes that carry sperm from your testicles are cut, sperm can sometimes leak from them. In rare cases, sperm can collect in the surrounding tissue, forming hard lumps that are known as sperm granulomas.

Your groin or scrotum may become painful and swollen either immediately or a few months after the procedure. The lumps are not usually painful and can often be treated using anti-inflammatory medication, which your GP will prescribe. If the granulomas are particularly large or painful, they may have to be surgically removed.

Infection

After a vasectomy, you may be at risk of developing an infection as a result of bacteria entering through the cuts made in your scrotum. Therefore, after the operation, it is important to keep your genital area clean and dry to keep the risk of infection as low as you can.

Long-term testicle pain

Some men get pain in one or both of their testicles after a vasectomy. It can happen immediately, a few months or a few years after the operation. It may be occasional or quite frequent, and vary from a constant dull ache to episodes of sharp, intense pain. For most men, however, any pain is quite mild and they do not need further help for it.

Long-term testicular pain affects around one in 10 men after vasectomy. The pain is usually the result of a pinched nerve or scarring that occurred during the operation. You may be advised to undergo further surgery to repair the damage and to help minimise further pain.

Testicles feeling full

After a vasectomy, some men may develop the sensation that their testicles are "fuller" than normal. This is usually caused by the epididymis becoming filled with stored sperm. The epididymis is the long, coiled tube that rests on the back of each testicle. It helps to transport and store sperm.

Any such feelings should pass naturally within a few weeks. However, speak to your GP if you are still experiencing fullness after this time.

Fertility

In a very small number of vasectomy cases, the vas deferens reconnects over a period of time. This means that the vasectomy will no longer be an effective form of contraception. However, it is rare for this to happen.

Common questions about vasectomy

Can I have the operation if I am single?

Yes, but if you are under 30 you will find that many surgeons are reluctant to do it, in case your circumstances change and you regret it later.

Will it affect my sex drive?

No. After a successful vasectomy, your testicles will continue to produce the male hormone (testosterone) just as they did before the procedure. Your sex drive, sensation and ability to have an erection won’t be affected. The only difference is that there will be no sperm in your semen. Your body still produces sperm, but they are absorbed without harm.

Could being sterile affect me emotionally?

It is a big decision to end the part of your life where you could father a child. This is another reason to think it over carefully.

If you are sure about your decision to have a vasectomy, you may feel relieved that the worry of possible pregnancy is over and you do not need to think about contraception again.

If you feel anxious or uncomfortable about the procedure, or if you think you would suffer mentally from being infertile, then it is not the best type of contraception for you. You can discuss alternatives with your GP or with a professional at a contraception clinic (sometimes called a family planning clinic).

Is there any risk of vasectomy causing cancer?

Although prostate cancer and testicular cancer can occur in men who have had a vasectomy, research suggests that vasectomy does not increase your risk of cancer.

Can I use IVF to father a child?

If you have a vasectomy, and then decide later that you want a child, there may be the option of doing so by IVF (in vitro fertilisation). To do this, a surgeon would retrieve sperm from your testicles and use this to fertilise your partner’s egg. However:

  • IVF may not be available on the NHS
  • IVF done privately can be expensive 
  • IVF is not always successful

Can I store sperm in a sperm bank, just in case?

You could but, as with IVF, sperm stored in a sperm bank cannot be relied on to bring about a pregnancy. It can also be expensive.

Where to get contraception

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. You can get contraception, and information and advice about contraception, at:

  • most GP surgeries – talk to your GP or practice nurse 
  • community contraception clinics 
  • some genitourinary medicine (GUM) clinics 
  • sexual health clinics – they also offer contraception and STI testing services 
  • some young people’s services (call 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first. 

Natural family planning (fertility awareness)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is natural family planning.

At a glance: facts about natural family planning

How it works

Who can use it

Advantages and disadvantages

Lactational amenorrhoea method (LAM)

Natural family planning is a method that teaches you at what time during the month you can have sex without contraception and with a reduced risk of pregnancy. The method is sometimes called fertility awareness.

It works by plotting the times of the month when you’re fertile and when you’re not. You learn how to record fertility signals, such as your body temperature and cervical secretions (fluids or mucus), to identify when it’s safer to have sex. Natural family planning is more effective when more than one fertility signal is monitored.

You can't learn natural family planning from a book. It has to be learned from a specialist teacher.

At a glance: facts about natural family planning

  • If the instructions are properly followed, natural family planning methods can be up to 99% effective, depending on what methods are used. This means that one woman in 100 who use natural family planning will get pregnant in one year.
  • It will be less effective if it's not used according to the instructions – estimates suggest that it may only be around 75% effective because of mistakes.
  • There are no physical side effects, and you can use it to plan when you get pregnant. 
  • You have to keep a daily record of your fertility signals, such as your temperature and the fluids coming from your cervix – it takes three to six menstrual (monthly) cycles to learn the method.
  • Your fertility signals can be affected by factors such as illness, stress and travel.
  • If you want to have sex during the time when you might get pregnant, you need to use a condom, diaphragm or cap.
  • By using condoms as well as natural family planning, you'll help to protect yourself against sexually transmitted infections (STIs).

How natural family planning works

The aim of natural family planning is to prevent pregnancy by avoiding sex, or using barrier methods of contraception, during the woman's fertile time. Natural family planning involves using your body's signs and symptoms to assess if you're currently fertile and likely to get pregnant if you have sex.

It is important that you are taught natural family planning by a suitably qualified teacher. You can check the availability of instructors in your local area by visiting the Fertility UK website.

The information in this section is designed to serve as an overview only. It is not a substitute for proper instruction and training.

There are three different fertility indicators you can use in combination to increase the effectiveness of natural family planning. These are:

  • daily readings of your body temperature
  • changes to your cervix – specifically, the secretions of mucus from your cervix
  • the length of your menstrual cycle

These are discussed in more detail below.

Your menstrual cycle

Your menstrual cycle lasts from the first day of your period until the day before your next period starts. The length of a woman’s menstrual cycle can vary. Anything from 24 to 35 days is common, although it could be longer or shorter than this. The average length of the menstrual cycle is 28 days. 

Ovulation

During your menstrual cycle:

  • hormones are released to stimulate your ovaries
  • a tiny egg stored in one of your ovaries begins to grow and mature
  • when the egg is mature, it’s released from your ovary (a process called ovulation) and travels down the fallopian tube

Occasionally a second egg is released, within 24 hours of the first egg.

Ovulation occurs roughly halfway through your menstrual cycle, usually around 10 to 16 days before the start of your next period. Ovulation could happen earlier or later than this, depending on the length of your cycle.

When calculating your fertile time, you need to take into account the uncertainty over exactly when you ovulate.

For pregnancy to happen, a sperm needs to meet the egg to fertilise it. Sperm can live in a woman's body for up to seven days after sex.

As the length of a menstrual cycle can vary over time, to make sure your calculations are as precise as possible, you will need to measure your menstrual cycle over the course of 12 months.

Calculating the length of your cycle is not a reliable way of working out your fertile time and should not be used on its own as a fertility indicator.

The temperature method

The temperature method is based on the fact that there is a small rise in body temperature after ovulation takes place.

You will need to use either a digital thermometer or a thermometer specifically designed for natural family planning. These are available from pharmacies. Ear or forehead thermometers are not accurate enough to be used in this way.

The temperature method involves:

  • Taking your temperature every morning before you get out of bed. This should be done before eating or drinking anything, before smoking and ideally at the same time every morning. 
  • Look out for three days in a row when your temperature is higher than all of the previous six days. The increase in temperature is very small, usually around 0.2C (0.4F). It is likely that you are no longer fertile at this time.

Cervical secretion monitoring method

There is a change in the amount and consistency of the mucus secreted from your cervix during different times in your menstrual cycle.

You can check this by gently placing your middle finger into your vagina and pushing it up to around your middle knuckle. For the first few days after your period, you will probably find that your vagina is dry and you cannot feel any mucus.

As the levels of hormones rise to prepare your body for ovulation, you will probably find that your cervix is now producing mucus that is:

  • moist and sticky
  • white and creamy

This is the start of the fertile period of your menstrual cycle. Immediately before ovulation the mucus will get:

  • wetter
  • clearer
  • slippery, a bit like raw egg white

This is when you are at your most fertile.

The mucus should then soon return to being thicker and sticky, and after three days you should no longer be fertile.

Combining fertility awareness methods

It is best to combine all three methods to give you a more accurate picture of when you are likely to be most fertile.

You can use fertility charts to record information from all three methods, which you can then track over the course of each menstrual cycle. You can download fertility charts from the Fertility Education and Training site, with information on how to use them.

There are also apps you can download for smartphones or software for your computer that allow you to track this information.

How effective natural family planning is

If natural family planning methods are used according to instructions, they can be up to 99% effective. This means that one out of 100 women using natural family planning correctly will get pregnant. It takes commitment and practice to use natural family planning this effectively.

Taking into account the fact that people can make mistakes, forget instructions or that other problems can occur, some estimates suggest that, in reality, natural family planning can be around 75% effective. This means that 25 out of 100 women using natural family planning may get pregnant.

If you decide to use natural family planning, you can reduce your risk of accidental pregnancy by making sure you are taught natural family planning by a suitably qualified teacher, and then making sure you follow their instructions and advice.

Who can use natural family planning

Most women are able to use natural family planning. However, there are some circumstances where it is not recommended as a form of contraception, or as your only form of contraception. You might want to consider a different method if:  

  • you have a medical condition that makes becoming pregnant dangerous – such as poorly controlled high blood pressure or heart disease
  • there could potentially be a health risk to the baby if you got pregnant – for example, if you are dependent on drugs or alcohol, or taking medications known to cause birth defects  
  • you are having irregular periods, so predicting your fertile time may be hard or impossible; irregular periods can have a wide range of causes, such as age, stress, rapid weight gain or weight loss, excessive exercise and having an overactive thyroid gland
  • you have a temporary condition that is disrupting the normal signs of fertility, such as pelvic inflammatory disease (PID), a sexually transmitted infection (STI) or bacterial vaginosis; you would have to wait until the infection passed before using natural family planning
  • you have a long-term condition (or other underlying factors) that is disrupting the normal signs of fertility, such as liver disease, an over or underactive thyroid gland, cervical cancer or polycystic ovary syndrome (PCOS); find out more about things that affect your fertility signs
  • you are taking a medication known to disrupt the normal production of cervical mucus, making fertility awareness methods difficult to use – this can include lithium (used to treat a number of serious mental health conditions, such as bipolar disorder) and some older types of antidepressants 
  • you have an increased risk of catching an STI – for example, you have multiple sexual partners

Things that affect your fertility signs

Some factors can disrupt normal fertility signs, for example if you: 

  • have irregular periods 
  • have recently stopped taking hormonal contraception 
  • have recently had a miscarriage or an abortion 
  • have recently given birth and are breastfeeding 
  • regularly travel through different time zones 
  • have an infection in your vagina such as thrush or an STI

Other factors that affect your body's natural signs include:

  • altering how and when you take your temperature
  • drinking alcohol 
  • taking certain medication 
  • illness
  • some long-term conditions

Advantages and disadvantages of natural family planning

Advantages

  • It does not cause any side effects. 
  • Natural family planning is acceptable to all faiths and cultures.
  • Most women can use natural family planning, providing they are properly trained by a teacher in fertility awareness, and keep accurate records. 
  • Once you have learned the techniques, there should be no further need for input from health professionals. 
  • Natural family planning can be used to avoid pregnancy or to become pregnant, according to your wishes. 
  • It does not involve chemicals or physical products. 
  • It can help you recognise normal and abnormal vaginal secretions, so you can be aware of possible infection.
  • It involves your partner in the process, which can help increase feelings of closeness and trust. 

Disadvantages

  • Natural family planning does not protect against STIs such as chlamydia or HIV.
  • You will need to avoid sex, or use contraception such as condoms, during the time you might get pregnant, which some couples can find difficult. 
  • If you do decide to abstain, there can sometimes be up to 16 days during which you cannot have sex, depending on your cycle.
  • It can be much less effective than other methods of contraception. Depending on how accurately it is used, as many as one in four women using natural family planning may get pregnant.
  • It will not work without the continuing commitment and co-operation of both you and your partner.
  • It can take several menstrual cycles before you become confident in identifying your fertile time. During this time, you will have to use barrier contraception, such as condoms.
  • You will need to keep a daily record of your fertility signs.
  • It is not suitable if you have persistent irregular periods.
  • Factors such as stress, illness, travel, lifestyle and use of hormonal treatments can disrupt your fertility signs. This includes oral emergency contraception. If you use the emergency contraceptive pill, you will need to wait for two complete cycles before relying on natural family planning again.

Lactational amenorrhoea method (LAM)

Women don't have periods while they're breastfeeding (this is known as lactational amenorrhoea), so breastfeeding can be used as a form of contraception. This is known as the lactational amenorrhoea method (LAM).

The fertility signals used in natural family planning methods are not reliable in women who are breastfeeding.

Women who are fully (or nearly fully) breastfeeding can use the LAM for the first six months after their baby is born, as long as: 

  • the woman has complete amenorrhoea (no periods at all)
  • she's fully or very nearly fully breastfeeding (this means that the baby is having breastmilk only, and very little or no formula)
  • the baby is less than six months old

When used correctly and consistently, one in 200 women who use LAM will get pregnant in the first six months. However, take care to use the method correctly. Don't feed your baby other foods because this may reduce your lactation.

LAM becomes unreliable when: 

  • other foods or liquids are substituted for breastmilk 
  • your baby reaches six months old

After having a baby, it is possible to get pregnant before your periods start again. This is because you ovulate around two weeks before your period. For more information on breastfeeding, LAM and other reliable methods of contraception, talk to your health visitor, midwife or doctor. You can also read about breastfeeding in the pregnancy and baby guide

Where to get contraception

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people's services (call our Sexual Health Line on 0800 22 44 88 for more information)

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents or carer as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.