Condoms |
Pros |
Cons (and considerations) |
Contraindications |
- If used correctly, provides protection from STIs
- Can be used for vaginal, anal and oral sex
- Easy to obtain (may be purchased by anyone, in a variety of retail locations, also funded on prescription)
- Easy to use
- No adverse effects (unless allergic to latex)
- May prevent cancer of the cervix (by protecting against HPV infection)
- Can be used with other forms of contraception
|
Contraceptive and STI protection can fail if condom slips, breaks or is used incorrectly
|
Latex allergy (use a latex free variety) |
Combined oral contraceptive (COC) |
Pros |
Cons (and considerations) |
Contraindications |
- If taken correctly is 99% effective in preventing pregnancy
- Regular withdrawal bleeds, usually lighter and less uncomfortable than normal menstrual period
- May reduce iron deficiency
- May reduce the future risk of endometrial and ovarian cancer
- Some COC types can improve acne
- Several brands fully funded
|
- Does not provide protection from STIs
- Must be taken daily (ideally at a similar time of day) to be effective
- Initial adverse effects may include; bleeding, nausea, breast tenderness, headaches, changes in mood and libido
- Increases risk of venous thromboembolism (VTE)
|
- History of migraine with aura
- Current or past history of VTE or known thrombogenic mutation (N.B. screening for this is not appropriate)
- Valvular and congenital heart disease
- BMI ≥40
|
Progestogen only pill (POP) |
Pros |
Cons (and considerations) |
Contraindications |
- If taken correctly, Noriday (fully funded) or Microlut are 96-99% effective and Cerazette more than 99% effective
in preventing pregnancy
- Serious adverse effects are extremely uncommon
- Decreased risk of ectopic pregnancy
|
- Does not provide protection from STIs
- Must be taken at the same time every day (increased risk of pregnancy if Noriday or Microlut taken more than three
hours late or Cerazette taken more than 12 hours late)
- May cause irregular bleeding or spotting
- May cause adverse androgenic symptoms, e.g. acne, weight gain, mood changes
|
Generally not recommended if current VTE and not recommended to be continued if migraine with aura
develops after initiation |
Intrauterine contraceptive device (IUCD) |
Pros |
Cons (and considerations)
|
Contraindications |
- 99% effective in preventing pregnancy
- Can stay in place for five years or more
- Does not involve hormones (contains copper)
- Can be used to prevent pregnancy after unprotected sexual intercourse
- Fully funded (Multiload Cu-375)
|
- Does not provide protection from STIs
- Increased risk of pelvic infection during insertion (about 1%)10 – prior screening for infection (and
treatment) necessary
- May cause increased bleeding and cramping during a period
- May cause pain during insertion or removal
- Insertion may be difficult in young adolescents or those who have never had a vaginal examination
- Device more likely to be expelled in nulliparous women
- Risk of vasovagal or cervical shock
|
- Current chlamydia, gonorrhoea, purulent cervicitis or pelvic inflammatory disease N.B. use is not recommended if
very high likelihood of exposure to gonorrhoea or chlamydia infection
- Unexplained vaginal bleeding
- Uterine cavity abnormality
|
Levonorgestrel Intrauterine System (LNG-IUS) – Mirena |
Pros |
Cons (and considerations)
|
Contraindications |
- > 99% effective in preventing pregnancy
- Can stay in place for five years
- After approximately one year, periods are lighter or absent
|
- Does not provide protection from STIs
- Currently unfunded unless specific criteria met, i.e. heavy menstrual periods and ferritin <16 mcg/L (approximate
cost $300)
- Increased risk of pelvic infection during insertion –prior screening for infection (and treatment) necessary
- May cause adverse androgenic symptoms, e.g. acne, weight gain, mood changes
- May cause pain during insertion or removal
- Insertion may be difficult in young adolescents or those who have never had a vaginal examination
- Risk of vasovagal or cervical shock
|
- Current chlamydia, gonorrhoea, purulent cervicitis or pelvic inflammatory disease N.B. use is not recommended if
very high likelihood of exposure to gonorrhoea or chlamydia infection
- Unexplained vaginal bleeding
- Uterine cavity abnormality
Generally not recommended if current VTE and not recommended to be continued if migraine with aura develops after
initiation |
Long-acting implantable progestogen (reversible) contraceptives e.g.
Jadelle, Implanon |
Pros |
Cons (and considerations) |
Contraindications |
- >99% effective at preventing pregnancy
- Jadelle (2 rods) lasts up to five years (fully funded)
- Implanon (1 rod) lasts up to three years
- Can be removed at any time and the effects are fully reversible
|
- Does not provide protection from STIs
- Involves minor surgery (with local anaesthetic) to place or remove rod(s) under the skin of the upper arm
- Menstrual irregularities are frequently reported
- May cause adverse androgenic symptoms, e.g. acne, weight gain, mood changes
- Implanon is not funded (approximate cost $380), insertion and removal of Jadelle and Implanon may incur an additional
cost
|
Generally not recommended if current VTE and not recommended to be continued if migraine with aura
develops after insertion |
Progestogen injectable: depot medroxyprogesterone acetate |
Pros |
Cons (and considerations)
|
Contraindications |
- Almost 99% effective in preventing pregnancy
- Lasts for 12 weeks
- Reduces the risk of endometrial cancer
- May decrease pre-menstrual syndrome
- May be useful for girls who have heavy or painful periods - amenorrhoea occurs in around half of all users in the
first year
- Fully funded
|
- Does not provide protection from STIs
- Theoretical concern that optimal peak bone density not achieved in adolescents
- May initially cause irregular or prolonged bleeding (treated by using the COC for one month or having the next
injection earlier)
- May cause adverse androgenic symptoms, e.g. acne, weight gain, mood changes
- Return to fertility after discontinuation delayed for six to eight months (but can be up to 18 months)
|
Current advice is to consider second-line in young adolescents, i.e. use
only if other methods have been discussed and considered unsuitable (due to effects on bone density)
Generally not recommended if current VTE and not recommended to be continued if migraine with aura develops after
insertion. |