Contraception: Personalised Family Planning Advice and Fitting

Contraception is one of the most personal medical decisions a woman makes, and yet it is far too often handled in a rushed, transactional way — a prescription renewed on autopilot, a coil fitted without proper discussion of alternatives, a question about side effects left unanswered. In my practice, I believe a contraceptive consultation should be a genuine conversation: one that considers your age, your cycle, your fertility intentions, your relationship with hormones, your lifestyle, and your preferences. The right contraceptive method is the one that works for your whole life, not just your calendar.

I am trained by the Faculty of Sexual & Reproductive Healthcare (FSRH) in the fitting of all long-acting reversible contraceptive devices, and I keep fully up to date with FSRH guidelines to ensure every recommendation I make reflects the best available evidence.

Long-acting reversible contraception (LARC)

Long-acting reversible methods are consistently the most effective forms of contraception, with failure rates well below 1% in typical use. They require no daily action, and their effects are fully reversible once removed. For many women, a LARC is transformative — not just for contraception, but for their overall quality of life.

The hormonal IUS (Mirena, Kyleena, Jaydess, Levosert)

The intrauterine system (IUS) is a small T-shaped device inserted into the uterus that releases a low dose of levonorgestrel, a progestogen, directly into the uterine cavity. Because the hormone acts locally, the systemic absorption is minimal compared to oral hormonal methods. The IUS dramatically reduces menstrual bleeding — many women find their periods become very light or stop altogether — and is therefore used not only for contraception but also for heavy menstrual bleeding, endometriosis, and as the progestogen component of HRT. Depending on the brand, the IUS lasts between three and eight years. The fitting procedure takes around ten minutes in clinic.

The copper IUD (non-hormonal)

The copper intrauterine device (IUD) is entirely hormone-free, making it an excellent choice for women who prefer to avoid hormones altogether, or for whom hormonal methods are contraindicated. It works by releasing copper ions, which are toxic to sperm, and by preventing implantation. A copper IUD lasts between five and ten years depending on the device, and fertility returns immediately upon removal. The main consideration is that periods can initially become heavier and more painful, though this often improves over time. The copper IUD is also the most effective emergency contraceptive available when fitted within five days of unprotected sex.

The implant (Nexplanon)

The contraceptive implant is a small flexible rod, about the size of a matchstick, inserted just beneath the skin of the upper arm under local anaesthetic. It releases etonogestrel, a progestogen, over three years. The implant is one of the most effective methods of contraception available, with a failure rate of less than 0.1%. The most common side effect is irregular bleeding, which is unpredictable and can be bothersome for some women, though many experience lighter periods or none at all. I can fit and remove implants in clinic.

The injectable (Depo-Provera)

The contraceptive injection contains medroxyprogesterone acetate and is administered every thirteen weeks. It is highly effective and convenient for those who prefer not to think about daily contraception without committing to a device. The main considerations are that periods may become irregular or stop entirely, and there can be a delay of several months to over a year in the return of fertility after stopping. Bone density should be considered with long-term use. It is best suited to women who are confident they do not wish to conceive in the near term.

Short-acting hormonal methods

Short-acting hormonal contraceptives offer excellent efficacy when used consistently, along with a range of benefits beyond contraception.

The combined oral contraceptive pill (COC) contains both oestrogen and progestogen. Beyond contraception, it is widely used for cycle regulation, reduction of period pain and heavy bleeding, management of premenstrual syndrome, improvement of acne, and as part of endometriosis treatment. There are many formulations available, and finding the right pill for your body can make a considerable difference. The COC is not suitable for women with certain contraindications, including migraine with aura (see below), a personal history of thrombosis, or certain cardiovascular risk factors.

The progestogen-only pill (POP), sometimes called the mini-pill, contains no oestrogen and is safe for most women including those who cannot take the COC. Modern progestogen-only pills such as desogestrel suppress ovulation in most cycles. Periods may become irregular, lighter, or stop.

The contraceptive patch (Evra) delivers oestrogen and progestogen transdermally and is changed weekly. The vaginal ring (NuvaRing or Kyleena ring) is inserted for three weeks and removed for one. Both are combined hormonal methods with a similar profile of benefits and considerations to the COC.

Contraception at different life stages

Contraceptive needs change throughout a woman’s life, and I find it important to regularly revisit the discussion rather than assuming that what was right at 22 remains right at 38.

In adolescence, contraception often needs to address other concerns simultaneously — acne, painful periods, cycle irregularity — and the consultation should be led by the young woman’s own goals and preferences. Post-partum, the choice of method must consider breastfeeding (oestrogen-containing methods are generally avoided until at least six weeks post-partum and while breastfeeding), return of fertility, and the demands of new parenthood. In the perimenopause, women are often surprised to learn that contraception is needed until menopause is confirmed — typically two years after the last period under 50, or one year over 50. I can advise on when it is safe to stop, and how contraception and HRT can be used together.

IUD/IUS fitting: what to expect

Before any fitting, I carry out a thorough pre-procedure assessment: reviewing your medical history, any current infections (an untreated STI would need to be treated first), and discussing the procedure in detail so you are fully prepared. I will ask about your preferred method of pain management; options include ibuprofen or mefenamic acid taken beforehand, and in some cases local anaesthetic application to the cervix, which can significantly reduce discomfort.

The fitting itself takes approximately ten minutes. It involves a speculum examination to visualise the cervix, a measurement of the uterine cavity, and insertion of the device. Most women experience cramping during and shortly after the procedure, comparable to period pain. This usually settles within a day or two, though some spotting and cramping can continue for a few weeks.

I will teach you how to check the threads of your device, and I recommend a check appointment four to six weeks after fitting to confirm it is correctly positioned.

Contraception and medical history

Some medical conditions influence which contraceptive methods are suitable. This is an important part of any consultation I conduct.

Migraine with aura is a significant contraindication to all combined hormonal methods — the COC, the patch, and the ring — because of an elevated risk of ischaemic stroke. This is not a risk to be weighed and accepted; it is a firm safety boundary, as set out in FSRH guidance. Women with migrainous aura should use progestogen-only or non-hormonal methods. A history of venous thrombosis similarly excludes combined oestrogen-containing methods. Women with PCOS may particularly benefit from the COC for cycle regulation and anti-androgen effects. Women with fibroids can use most methods, but the IUS requires individual assessment. Breastfeeding women should use progestogen-only or non-hormonal methods until breastfeeding is established and settled.

Emergency contraception

If unprotected sex has occurred, or a contraceptive method has failed, there are several emergency options depending on timing.

• Levonorgestrel (e.g. Levonelle): Effective up to 72 hours after unprotected sex; most effective when taken as soon as possible
• Ulipristal acetate (ellaOne): Effective up to 120 hours (five days); may be more effective than levonorgestrel in the later window or in women with higher body weight
• Copper IUD: The most effective emergency contraceptive available, with a failure rate of less than 0.1% when fitted within five days of unprotected sex. It can then continue to provide long-term contraception

I can provide emergency contraception as part of a consultation and use the opportunity to discuss ongoing contraceptive needs.

When to review your contraception

1. You are experiencing troublesome side effects with your current method
2. Your circumstances have changed — a new relationship, a change in health, approaching perimenopause
3. You are planning to conceive and want to discuss the best timing for stopping contraception
4. You have developed a new medical condition such as migraines, hypertension, or a clotting disorder
5. You are due for a LARC replacement or removal
6. You have questions about using contraception alongside HRT
7. You have simply never had a thorough conversation about your options and would like one

Contraceptive care should evolve with you. I see women at every stage of their reproductive lives, and I am here to help you find an approach that genuinely serves your health and your plans.