Contraception guidance aims to prevent unwanted pregnancies, preserve fertility until pregnancy is relevant and promote sexual and reproductive health.
Different methods of contraception differ in terms of safety, ease of use, protection against disease and side effects. The chances of getting pregnant during unprotected intercourse are estimated at 6-7%, but highest around ovulation (20%). Fertility decreases from 28-30 years of age.
Non-hormonal contraceptives, "Natural methods"
Includes interrupted intercourse and the use of so-called "safe periods". These methods do not protect against infection and the effectiveness is low. As a result, these methods are only suitable for well-informed, stable couples, who can accept an unexpected pregnancy. The breastfeeding period without menstruation is a relatively safe period, but presupposes full breastfeeding, no menstruation and less than six months since birth. If one of these points is not satisfied, the security decreases significantly.
Intrauterine device (copper coil and hormonal coil)
The intrauterine device, IUD for short, is inserted into the uterine cavity. Pregnancy is prevented by the coil interfering with the motility of the sperm, and preventing any fertilized egg from attaching to the uterine wall.
IUDs are considered a safe method of contraception, and around three out of ten women between the ages of 20 and 43 use IUDs.
There are two main types of IUDs, copper IUDs and IUDs which are a combination of IUD and hormone therapy. The disadvantage of the copper coil is that it often causes greater menstrual bleeding, and in some cases increased pain. When using a hormonal IUD, the bleeding will in most cases be less than usual, the bleeding can also be completely absent for long periods. IUDs are probably the safest contraceptive available.
Copper coil gives contraceptive effect for five years, hormonal coil can give contraceptive effect for five years (Mirena®, Kyleena®) or for three years (Jaydess®, Levosert®)
When changing partners, it is recommended to use a condom as additional protection against sexually transmitted diseases
The barrier methods are condoms for men and pessaries for women. The condom is the only contraceptive that protects against infection. Condoms should therefore be used by anyone who has intercourse with people where the possibility of contracting a sexually transmitted disease is present.
The diaphragm is placed as a shield in front of the cervix and is intended to prevent sperm from entering the uterine cavity. It must be inserted before intercourse and stay in for a few hours after intercourse. It is a bit cumbersome to use.
The safety of barrier methods largely depends on the correct use, but when used correctly, these are considered good contraceptive methods that are free of side effects. Spermicide cream increases the safety of condoms or diaphragm use, but spermicidal cream alone is not sufficient contraception.
Birth control pills
Birth control pills contain the hormones estrogen and progestogen / progesterone. These hormones are normally found in a woman's body and are essential for ovulation and pregnancy. The contraceptive pill prevents ovulation. The structure of the uterine lining and the mucus in the cervix are also affected. Overall, this provides good protection against pregnancy. Birth control pills can in some cases cause side effects, and it may make sense to consult a doctor before choosing a birth control pill. The risk of blood clots increases from around three cases per 10,000 female years among non-users to around six cases per 10,000 female years among contraceptive users. Birth control pills have a positive effect on menstrual pain and the amount of bleeding. They may have some protective effect against ovarian and uterine cancer, and are likely to lead to a small increase in breast cancer risk.
Women over the age of 35 who smoke are not recommended to use birth control pills due to an increased risk of blood clots. This also applies to women of all ages who have had a blood clot or who are hereditarily charged with an increased risk of getting a blood clot.
The contraceptive ring (Nuvaar®, Ornibel®) contains the same hormones as the contraceptive pill and is just as effective as a contraceptive. Because the hormones are supplied directly into the vagina, you can use smaller amounts of hormones, and for that reason there are also somewhat fewer side effects. The ring is inserted once a month by the woman herself. After a week of ring-free break, where a menstrual-like bleeding occurs, a new ring is inserted into the vagina on the same day of the week and at approximately the same time
Contraceptive patches are in principle the same as birth control pills, but the hormones are supplied to the body in a different way. The patch contains estrogen + progestogen. The hormones are absorbed into the body through the skin, causing the ovulation to stop. The patch is applied to the skin on a fixed day every week for three weeks, on day 1, day 8 and day 15. The fourth week no patch is used. This week there will be a small menstrual bleeding. Effects and side effects are the same as with birth control pills. The patch is somewhat more expensive to use compared to pills.
Mini-pills are pills that only contain the hormone progestogen / progesterone, and not estrogen. These affect the lining of the uterus and the mucus in the cervix so that sperm do not penetrate to the uterine cavity. After a period of use, ovulation will also disappear in many cases. Women who use mini-pills will often experience irregular bleeding, but the drug rarely causes serious side effects. Mini-pills do not increase the risk of blood clots, and can be a good alternative to birth control pills, especially in women who smoke, are over 35 or who are in a breastfeeding period.
The contraceptive syringe contains the same type of hormone as mini-pills, and acts like the mini-pills, but more often leads to the cessation of ovulation compared to the mini-pill. The contraceptive injection is given every three months, and requires the woman to go to the doctor to get an injection. It often causes menstruation to stop after an initial period of irregular bleeding. It can take up to eight to ten months, in some cases even longer, before fertility is regained. For this reason, the contraceptive syringe is used less and less.
This is also a contraceptive that contains the same type of hormone as in mini-pills (progestin). The hormone is molded into a four-centimeter-long plastic rod that is inserted under the skin (implanted using a thick needle). Every day, a small amount of hormone is secreted from the wand. In the Norwegian market, only one contraceptive stick, Nexplanon, is sold with a duration of three years. The IUD works by inhibiting ovulation and by making the mucus in the cervix less permeable to sperm. It is a very safe contraceptive. As with the other mini-pill preparations, this causes some irregular and / or prolonged bleeding. The parking stick must be inserted and removed under local anesthesia, requires a doctor's consultation.
Emergency contraception is an emergency solution that can be used after a single unprotected intercourse. The pill is actually mini-pills with a slightly higher hormone content than the usual mini-pills.
Levonorgestrel (Norlevo®) must be taken within 72 hours (three days) after intercourse, while ulipristal (EllaOne®) has an effect of up to 120 hours (five days) after intercourse. When breast-feeding, levonorgestrel (Norlevo®) is considered safer. Both preparations can be purchased without a prescription. It is estimated that this method more than halves the chance of getting pregnant.
Support for women 16-22 years in Norway
The support provides free contraception, or contraception at a reduced price, for women in the age group 16-21 years. It applies to contraceptive pills, contraceptive patches, contraceptive syringes, contraceptive rings, contraceptive rods, hormonal IUDs and copper IUDs. In the age group 16-19 years, all funds must be free. In the age group 20-22 years, NOK 120 is given a discount per three months of use, up to NOK 480 per year (2020).
What can I do myself?
You can always take advantage of over-the-counter contraceptives such as condoms.
The "natural method" and the emergency pill are generally not recommended.
Before prescribing contraception, your doctor must talk and examine you.
The doctor assesses weight, height and BMI. Measures blood pressure and performs a gynecological examination for indication. Cell sampling is recommended in line with the screening program for cervical cancer. And sampling for chlamydia or other sexually transmitted diseases may be relevant. Abnormal vaginal bleeding should always be investigated before starting hormonal contraception. Pregnancy should be ruled out before starting with all hormonal contraceptives and IUDs.
What can Eyr help with?
- Eyr can give advice on various methods of contraception.
- Eyr can renew contraceptives and prescribe another type if a primary examination has been performed by your doctor.
- Eyr can assess whether any side effects are related to the contraceptive treatment and guide.
- Eyr can in a few cases refer to a specialist, but in general, an examination in connection with contraceptives must be performed by your own doctor. This also applies to cell samples and gynecological examinations.
- Eyr can advise on the use of emergency pill.
Reference: Norwegian Medical Handbook, NEL. Edited and medically quality assured by Dr. Theresa Franck, specialist in general medicine.