Long-term contraception: New methods

Contraceptive pills aren't for everyone. If you've forgotten to take your pill too many times - or can't take them - there are plenty of options.

The contraceptive patch, vaginal ring, intrauterine system (IUS) and contraceptive implants offer long-term contraception that is virtually hassle-free for months, years or forever.

If pregnancy is still a future possibility for you, make your choice carefully. With the contraceptive patch, vaginal ring, implant and IUS, fertility returns in one to two months, sometimes sooner.

Of course, just because fertility returns, pregnancy might not happen immediately, says Dr Christopher Estes, an assistant professor of obstetrics and gynaecology. "It can take time, just as with regular old birth control pills."

Contraceptive patch

For freedom from daily pills, many women are trying a contraceptive patch. You can wear this patch on your arm, your tummy or your bottom. The patch is a small, flesh-coloured square that is barely noticeable.

It's just as effective as the pill in preventing pregnancy, and it works in a similar method to contraceptive pills. Each patch releases oestrogen and progestogen through your skin for seven days. You use a patch each week for three weeks, then no patch for one week - and breakthrough bleeding, like a period, occurs.

"You have to remember it less often, so there's less chance for error,” Estes says. The risks are the same as contraceptive pills or any combined hormone method, he adds. The risk of blood clots is believed to be very slightly higher with the patch compared with the contraceptive pill but this increased level of risk is considered to be very low, and Estes still councils his patients to use it.

Long-term contraception: New methods

Compare that to the risk of blood clots during pregnancy, which is about nine times the normal risk, he says. "Even if the pill or patch increases your risk, it's still safer than pregnancy. Most women want the patch because they don't want to take the pill every day. For them, it's a more convenient option."

Dr Patti J Ross, a professor of obstetrics, gynaecology and reproductive sciences, says, "I personally don't have a problem prescribing the patch. If a woman doesn't have any other risk factors and wants to try it, that's fine."

But she's found that some patients are still concerned about the blood clot issue. Another downside: In warm climates, such as in the Mediterranean, the patch tends to get "sticky and gooey," she tells us. "That's why we have other choices, other options."

Vaginal ring

The contraceptive vaginal ring is flexible and small, and a woman can insert it directly into her vagina. Because it's not a barrier method, it doesn't have to be precisely placed. It releases the same hormones as contraceptive pills but performs this function from inside the vagina.