The ideal contraception - You decide!

The pill as a contraceptive: The pill (also known as “combined oral contraceptive pill”) provides permanent protection from an unwanted pregnancy and thereby enables spontaneous intercourse without the risk of getting pregnant. The combination of oestrogen and gestagen (the composition varies with the different products) avoids ovulation (the detachment of a fertilizable ovum). It also alters the endometrium at the cervix, thereby preventing the man’s sperm cells from entering the uterus.

Most products are administered 21 days in a row (one pill a day), followed by a 7-days break. During this break a bleeding occurs. Other products contain 28 pills in one package of which 24 pills contain hormones and 4 don’t (placebo). These products are taken daily – one pill each day. The bleeding occurs within the 4 placebo days. If the intake of the pill doesn’t take place right on time, an additional contraceptive method (barrier method) has to be used to prevent an unwanted pregnancy. This also applies in case of diarrhoea and/or vomiting and/or the intake of antibiotics.

The pill can soothe menstrual cramps, PMS (premenstrual syndrome) and acne. Usage of the pill is not recommended for women suffering from certain health problems (e.g. high blood pressure, diabetes, tendency towards thrombosis). In such a case the pill should only be used after medical examination and consultation. Possible side effects of the pill include headaches, tenderness of the breasts, weight gain and loss of libido and vary from one woman to another. The pill should not be taken during lactation.

The mini pill (progestin-only pill) as a contraceptive: the mini pill only contains the hormone gestagen. Thus it doesn’t avoid ovulation but thickens the cervical mucus and reduces the build-up of the endometrium inside the uterus, thereby avoiding fertilization and the nidation of the ovum. The correct intake of the mini pill is essential for its reliability in preventing an unwanted pregnancy. It has to be taken every day at the exact same time without a gap. The mini pill’s contraceptive effect is in jeopardy if the intake is delayed by more than 3 hours. If the punctual intake is missed, an additional contraceptive method (barrier method) has to be used. This also applies in case of diarrhoea and/or vomiting and/or the intake of antibiotics. The mini pill can soothe menstrual cramps.

During the intake of the mini pill irregular spotting may occur. It is also possible that the menstruation stops altogether. This may vary from one woman to another. The mini pill may be used by smokers, women over the age of 35 and during lactation.

The oestrogen-free pill as a contraceptive: this pill doesn’t contain any oestrogen and avoids ovulation through an adequate dose of gestagen. Additionally a thickening of the cervical mucus is achieved, thereby preventing sperm cells from entering the uterus. 28 pills containing hormones have to be taken without a break – one each day.

The correct intake is essential to avoid an unwanted pregnancy. The time frame to take a forgotten pill is 12 hours. Outside this time frame the effect is in jeopardy and an additional contraceptive method (barrier method) has to be used. This also applies in case of diarrhoea and/or vomiting and/or the intake of antibiotics.

During the intake of the oestrogen-free pill irregular spotting may occur. It is also possible that the menstruation stops altogether. This may vary from one woman to another. The oestrogen-free pill may be used by smokers, women over the age of 35 and during lactation.

The NuvaRing® as a contraceptive: The NuvaRing® is an approximately 3 mm thin and bendy synthetic ring which is inserted into the vagina like a tampon. It stays there for 3 weeks. A new NuvaRing® is inserted after a 7-days break in which the menstruation occurs.

The NuvaRing® has almost the same effect as the pill, containing the hormones oestrogen and gestagen. These hormones are continually absorbed in small dosages by the vaginal mucosa and prevent ovulation. Because it is constantly carried inside the vagina, the locally administered hormones may intensify the vaginal secretion. This may vary from one woman to another. The contraceptive effect is not endangered by diarrhoea and/or vomiting. Usually the ring is undetectable during intercourse. However, it can be removed for up to 3 hours.

The vaginal ring can soothe menstrual cramps, PMS (premenstrual syndrome) and acne. Usage of the vaginal ring is not recommended for women suffering from certain health problems (e.g. high blood pressure, diabetes, tendency towards thrombosis). In such a case the ring should only be used after medical examination and consultation. Possible side effects of the ring include headaches, tenderness of the breasts, weight gain and loss of libido and vary from one woman to another. The vaginal ring should not be taken during lactation.

The EVRA® contraceptive patch as a contraceptive: the contraceptive patch too is based on the effective principles of the pill. The hormones oestrogen and gestagen are absorbed through the skin in small dosages and enter the bloodstream, thereby avoiding ovulation. 3 patches are used within a menstrual cycle. The first patch is put on the first day of the menstruation and is replaced by the next patch on the same weekday one week later. 3 weeks and patches later a one week break has to be taken in which the menstruation occurs.

The contraceptive patch is thin, skin-coloured and not much bigger than a postal stamp. It can be applied on different parts of the body. Ideally it is placed on the outer side of the upper arm, the belly or the buttocks. The skin has to be clean, dry and free of fat. Detached or forgotten patches have to be replaced within 24 hours. Outside this time frame the contraceptive effect is in jeopardy and an additional contraceptive method (barrier method) has to be used. The contraceptive effect is not endangered by diarrhoea and/or vomiting. The contraceptive patch can soothe menstrual cramps, PMS (premenstrual syndrome) and acne. Usage of the patch is not recommended for women suffering from certain health problems (e.g. high blood pressure, diabetes, tendency towards thrombosis). In such a case the patch should only be used after medical examination and consultation. Possible side effects of the patch include headaches, tenderness of the breasts, weight gain and loss of libido and may vary from one woman to another. Doing sports and having a shower or a bath don’t affect the contraceptive effect. Heavily obese women should not use the EVRA®-contraceptive patch because the effect could be impaired. Also the contraceptive patch should not be used during lactation.

The contraceptive implant as a contraceptive: the contraceptive implant is a match-sized, flexible plastic stick which is inserted into the upper arm by a doctor. The insertion of the implant takes only a few minutes and occurs under local anaesthesia during menstruation. The contraceptive protection is effective immediately. The implant continually releases the hormone gestagen (prevents ovulation, fertilization and the nidation of the ovum) and provides protection from an unwanted pregnancy for approximately 3 years.

The implant is not recommended for women suffering from certain health problems (e.g. tendency towards thrombosis, severe liver disease).
It can soothe menstrual cramps. During the use of the contraceptive implant irregular spotting may occur. It is also possible that the menstruation stops altogether. This may vary from one woman to another. To test the tolerance of the implant, the oestrogen-free pill (see oestrogen-free pill) can be used for a few months because the possible side-effects are the same. The implant may be used by smokers, women over the age of 35 and during lactation.

The contraceptive injection as a contraceptive: this hormonal injection causes the gradual distribution of gestagen into the body and thereby avoids ovulation for 3 months. The first hormonal injection occurs within the first 5 days after the onset of the menstruation either into the muscle of the hip or the upper arm. The contraceptive protection is effective immediately.

To continually provide a reliable protection from an unwanted pregnancy the injection has to be administered regularly every 3 months. It can soothe menstrual cramps. During the use of the contraceptive injection irregular spotting may occur. It is also possible that the menstruation stops altogether. This may vary from one woman to another. The injection is not recommended for women suffering from certain health problems (e.g. tendency towards thrombosis, severe liver disease and diabetes). It can however be used during lactation.

The copper coil (IUD) as a contraceptive: The IUD is a small T-shaped plastic stick which is spirally wrapped in copper wire (hence the name). Copper reduces the mobility of the sperm cells and thereby impede fertilization. Furthermore the IUD avoids the nidation of a fertilized ovum inside the uterus. The IUD doesn’t affect a woman’s hormonal balance.

The copper coil is placed inside the woman’s uterus (hence the term „intrauterine“) by a gynaecologist, ideally during the first few days of her menstruation. The procedure takes only a few minutes and may be carried out under local anaesthesia. The gynaecologist also demonstrates how to check on the removal cord. The contraceptive protection is effective immediately.

The copper coil can stay inside the body for up to 5 years. It is unnoticeable by the woman herself and doesn’t interfere with the sexual intercourse. During the use of the IUD irregular spotting may occur. It is also possible that the intensity of menstrual cramps is increased. This may vary from one woman to another.

Because there are different sizes available, the copper coil can be used by women of every age regardless of whether they have given birth before. However, it should not be used by women who suffer from frequent lower abdominal infections. The copper coil can be used by smokers, women above the age of 35 and during lactation.

The hormonal coil (Mirena®) as a contraceptive: the hormonal coil is a small T-shaped plastic stick containing the hormone gestagen. Gestagen is continually absorbed in small dosages by the endometrium. Thus ovulation is not avoided but the cervical mucus is thickened which reduces the mobility of the sperm cells and prevents them from entering the uterus. Hence the fertilization of the ovum and consequently a pregnancy are avoided.

The hormonal coil is placed inside the woman’s uterus (hence the term „intrauterine“) by a gynaecologist ideally during the first few days of menstruation. The procedure takes only a few minutes and may be carried out under local anaesthesia. The contraceptive protection is effective immediately.

The hormonal coil is effective for up to 5 years. Because of the local administration of hormones, Mirena® is especially beneficial for women suffering from very heavy menstrual bleeding and cramps, making them lighter, shorter and less painful. Irregular spotting may occur after the insertion of the hormonal coil. The menstruation can also gradually stop altogether.

Because there are different sizes available, the hormonal coil can be used by women of every age regardless of whether they have given birth before. Women suffering from certain health problems (e.g. liver disease, certain heart diseases and frequent lower abdominal infections) should not use the hormonal coil. However it can be used during lactation.

The copper Gynefix® coil as a contraceptive: Gynefix® is an approximately 2 centimeters long plastic thread on the end of which 4 small copper pearls are fixed. The released copper ions deactivate the sperm cells thus avoiding fertilization of a mature ovum.

Because the plastic thread is very flexible it fits itself neatly to the uterus. Gynefix® is a very reliable contraceptive which is effective for more than 5 years. It can even be used by very young women whose uterus isn’t fully grown yet. Gynefix® is inserted through the cervix and fixed to the upper end of the uterus cavity by the gynaecologist using a small insertion tube. For that, the cervix of women who haven’t given birth yet might have to be stretched a little.

The insertion of Gynefix® is carried out under local anesthesia. After insertion ultrasound imaging is used to check whether Gynefix® is properly placed and fastened.

The diaphragm as a contraceptive: Oves, Femcap, Lea or the so called cervical cap work in a similar fashion.

The diaphragm (also known as vaginal pessary) is a circular rubber cap measuring 6 to 8 centimetres in diameter. It is reusable and is placed by the woman herself over the cervix no longer than 2 hours prior to intercourse. It thereby builds a barrier which prevents sperm cells from entering the uterus.

The diaphragm is used in combination with a spermicide (sperm killing cream). The diaphragm is removed at the earliest 6 hours after intercourse to ensure ideal protection from an unwanted pregnancy. In case of further intercourse during that time another dose of spermicide has to be applied. The diaphragm has to be fitted to the size of the vagina by a gynaecologist to make sure that it is neither too small nor disruptive during intercourse. Correct usage is essential for maximum protection.

Caution: The spermicide my cause allergic reactions or skin irritations.

The condom as a contraceptive: the condom is a wafer-thin sheath (usually made of latex) which has to be rolled over the erect penis before it ever touches the vagina during intercourse. The seminal fluid is caught in the reservoir at the tip of the condom and therefore can’t reach the vagina.

It is important to take hold of the condom at the root of the penis after orgasm and to pull the penis out of the vagina before erection ceases. Even a very small amount of sperm reaching the vagina can lead to an unwanted pregnancy or transmit diseases. Condoms can be bought in every drugstore or pharmacy and are available in different sizes and designs (also latex-free). Condoms are meant for one-time use only and should never be used in combination with oil-containing substances like Vaseline®, foam suppositories or spermicide (sperm killing) gels because they can damage the material.

Only condoms bearing a seal of quality and a “CE”-mark on the package provide reliable protection. Correct storage and observation of the expiration date are equally as important. Condoms coming from a vending machine may be expired or damaged because of variation in temperature and may therefore not provide adequate protection from an unwanted pregnancy or sexually transmitted diseases.

By the way: Get your free condom at pro:woman!

Female sterilisation – like the male vasectomy – is a permanent method of contraception. Generally a reversal of the surgery is possible; the success of such a procedure however lies at only 30%.

The decision for a female or male sterilisation should therefore only be made after careful consideration.

Detailed consultation can help to make the individually right decision. Gynaecologists and experts of the pro:woman Ambulatorium / Centre for Vasectomy are happy to provide their long-time experience concerning all questions related to contraception.

Female sterilisation is achieved through tubal ligation. Thus the fallopian tubes are no longer passable. Still, even after female sterilisation an ovum continues to mature every month in one of the two ovaries. After ovulation the ovum is received by the corresponding fallopian tube. Any sperm cells passing from the vagina into the uterus and further on into the fallopian tubes are caught at the point of the ligations thus preventing them from meeting and penetrating the ovum. Fertilization and a possibly resulting pregnancy are prevented. Subsequently the sperm cells and ovum are dissolved inside the fallopian tube and absorbed by its mucous membrane.

Hormonal balance and menstruation:
Female sterilisation has no effect on the hormonal balance or a woman’s monthly cycle. She still has her usual menstruation. If hormonal contraceptives have been used for a long period prior to the sterilisation, the menstruation may occur irregularly and be accompanied by cramps and/or a heavier bleeding than usual. This isn’t due to the sterilisation but to discontinuing hormonal contraception and to the body returning to its natural cycle.

After the treatment no hormonally induced weight gain occurs and the menopause won’t come earlier than expected. The sterilization also has no effect on the ability to love or to experience pleasure. On the contrary: because you no longer have to fear an unwanted pregnancy, you as well as your partner are free to enjoy an unburdened and more spontaneous sexuality.

The so called laparoscopic sterilisation is performed under general anaesthesia and merely takes approximately 15 to 20 minutes. The surgery requires only a very small incision (approximately 1 centimetre) which is set at the navel. At first the abdominal wall has to be lifted by gas insufflation. A tube-like optical instrument – the laparoscope – is then inserted through which the surgeon is able to see inside the abdomen. By doing so the fallopian tubes are easily identified and closed up using so-called Filshie-clips (tiny clips made of titanium and silicone which are not perceptible, extremely durable, reliable and hypoallergenic). After the gas has been drained off and the abdominal wall has lowered again, the small incision is closed and sutured. The surgical scar is practically invisible once the healing process is finished.

Usually you can leave our clinic after a small rest of about five hours and are fit again after a short recovery period.
By the way: male sterilisation (vasectomy) is much easier than female sterilisation (see pro:man)

Infertility is in effect right after the surgery. Together with male sterilisation (vasectomy), female sterilisation is the safest method of contraception. Only in very rare cases – approximately 3 in 1,000 – a spontaneous reopening of the fallopian tubes can occur even though the surgery has been performed flawlessly. A pregnancy can’t be completely ruled out in such a case. If required, an x-ray of the fallopian tubes can ascertain whether they are permeable again.

At pro:woman, experts with long-time experience and a couple of thousand successfully performed tubal ligations are at your service.

Reasons for exclusion from a surgery in our clinic are:
Tissue adhesions as a result of an earlier abdominal surgery (e.g. longitudinal caesarean, tubal pregnancy, umbilical hernia, intestinal surgery, tummy tuck, …) and chronic ovaritis or peritonitis.

In those cases unfortunately a laparoscopic sterilisation is out of the question.