Many women get part way through a pregnancy and decide this will be their last one. This gets them thinking about what contraception would work for them next. They have many options and the option they choose will be very personal to them. Certain factors they may need to take into account are age, relationship status, views of a current partner, past health issues, past experience with contraception and any regular medication they take. There are many others such as health beliefs, concern over procedures and how sure they are this is their final child.
This blog will discuss long acting reversible contraception (LARC) as well as non-reversible permanent methods of contraception.
Long Acting Reversible Contraception
The three most common options are the implant, the copper coil (also known as intrauterine device (IUD)), and the intrauterine system (IUS) which is sometimes known by a brand name such as Mirena coil.
The implant is inserted in the upper arm and contains slow release progesterone. The implant can be inserted any time after giving birth. The procedure to have it put in is quick but does require some local anaesthetic. Having it removed can be slightly more complex but in most cases is also straightforward and you can have another one put in straight away. This suits women who don’t get on with oestrogen containing methods of contraception. It can make periods erratic for the first 6 months, if this occurs and is interrupting the woman’s quality of life she can take a contraceptive pill as well for a few months until it settles down. Many women have lighter periods once the periods have settled and some have them infrequently or not at all. To read more about the implant see here:
The IUD has no hormonal component so works well for women who are sensitive to hormonal methods. IUD’s are easier to fit if a woman has already had a vaginal delivery but they don’t have to have had. IUD’s can make periods heavier and more painful so work well if you have light periods but may not be so good for somebody who has heavy periods. IUD’s are put into the uterus in a procedure that is similar to having a smear i.e. you have a speculum inserted – a special device is then used to insert it through the neck of the womb. The procedure usually takes about 20 minutes and women can get some period cramps during this. Women can take a friend or family member in with them. It is probably better if they get somebody to look after their children so that they are more relaxed during it. It can be inserted 4 weeks after giving birth. Many women ask whether their partner will be able to feel the strings during sex – the answer is no, this shouldn’t be the case and if it is they may be too long and your healthcare provider can trim them for you. After the coil is inserted you will be followed-up a few weeks later to check how you are getting on with it. If all goes well you can have it in for 5-10 years depending on the type of coil chosen – do check which you are having with your healthcare provider and then record this date somewhere sensible (perhaps as an alert in your phone). If at any point you want the coil out this can be done very quickly and easily. You can read more about IUDs here:
The IUS is similar to the IUD in how it is inserted but it is different in that it contains progesterone hormone which acts locally to thin the lining of the womb. In this way it prevents pregnancies but also makes periods less heavy and can even stop them in some women (many women love this). There are different types of IUS and each last different lengths of time and this should be chatted over with your healthcare provider. The Mirena is perhaps the most common and lasts 5 years, the Jaydess lasts 3 years. The IUS can be inserted 4-6 weeks after giving birth. Although the hormones act locally, it is worth adding that a small amount of progesterone can get into the rest of the body and in some women this has implications i.e. it can worsen acne in somebody who is acne prone – this is worth considering. Again, it can be removed quickly if somebody is having side-effects or decides they want to have another child after all.
You can read more on the IUS here:
Permanent methods of contraception
The two permanent methods are the vasectomy (for a man) and female sterilisation or tubal occlusion (for women).
Vasectomy: Many couples feel that it is only fair that after a woman has been responsible for contraception for a long period of time in their relationship it is only fair that now the man takes a turn! However, it is worth saying that vasectomy should be thought of as permanent. Some go into it thinking it is reversible as there are procedures available to reverse them. These are not always successful and should not be relied upon. Having said that for many vasectomy is a great option as it is relatively straightforward and very effective with only one in 2,000 vasectomies failing. Furthermore, it rarely has any side-effects for either partner and does not involve hormones. It is clear that this option wouldn’t work for a woman who is not in a stable relationship. Here is more information on vasectomy:
And here is a video on vasectomy:
Female sterilisation: There are a few different ways this can be done but it involves blocking the ovarian tubes to prevent an egg reaching the womb (uterus) and being fertilised. It can be done during a caesarean section so can be worth mentioning to your obstetrician if you are having a planned C-section and know that this is something you want in advance. Alternatively, this can be done laparoscopically (keyhole surgery) or with a mini-laparotomy (open surgery – more invasive than keyhole). For the former you may not require a general anaesthetic but for the latter you will. Anaesthetics are not without risk and you may have to stay in hospital after the procedure.
The failure rate is higher than for vasectomy – about one in 200. It is also a more invasive procedure and may require an anaesthetic and some time in hospital. For these reasons, it is not that popular a procedure especially when there are other good options for women (IUS, IUD and implant). However, it might be right for some women and is worth at least considering.
Of note, none of the methods discussed prevent against sexually transmitted infections and so should be used with a barrier method of contraception such as condoms if this is a concern. This blog has not considered shorter acting methods of contraception such as barrier methods, pills, patches, injections and vaginal rings – you can read about these options here: https://www.fpa.org.uk/help-and-advice/contraception-help
I hope this blog helps women to make an empowered choice about their contraception when they feel their family may be finished. It may also be worth visiting a family planning clinic or a GP or nurse with a special interest in family planning for more information. And of course, they should discuss this with their partner and friends and family if this helps – take care though as people tend to share horror stories and this doesn’t give the real picture. The number of women I meet who have been put off by one off stories is huge and this severely restricts their own options. It is worth remembering each woman is different and you must pick the right mode of contraception for you.
If you have further queries or comments do post them in the comments below or get in touch @PregnaPouch or PregnaPouch@gmail.com.
The PregnaPouch team
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