Emergency contraception either delays the release of an egg or makes it less likely that it buries itself in the lining of the womb and can be used after you have had unprotected sex or your usual type of contraception has failed (burst condom, missed pill).
The 2 forms of emergency contraception are the emergency contraceptive pill and the copper IUD.
Emergency contraceptive pill
Should be taken within 72 hours of unprotected sex
Chance of getting pregnant: 2% for women of average weight and 6% if overweight
Copper IUD
Can be inserted within 5 days of ovulation (day 19 of a 28-day cycle) and are recommended for women over 70kg
Withdrawal is sometimes called 'coitus interruptus' and means the man pulls his penis out of the vagina before he ejaculates.
It takes a lot of self-control and can fail if the man does not withdraw fast enough or some sperm leak out before he ejaculates.
This is not a very reliable contraceptive method.
Chance of getting pregnant: 25%.
Sterilisation
Sterilisation is a permanent method of contraception which stops a sperm and egg from coming together.
In women, it is called tubal ligation or sterilisation. In an operation, clips are put on the (fallopian) tubes to stop the egg getting to the womb.
In men, it is called vasectomy. Under local anaesthetic the tubes (vas deferens) which carry sperm to the penis are cut so there is no sperm in the man's ejaculatory fluid (ejaculate). Although it can sometimes be reversed it should be considered permanent.
Abstinence (not having sex) is the only 100% sure way of preventing pregnancy and STIs. Vaginal sex is the only way you can get pregnant, but STIs can be transmitted through vaginal, oral and anal sex.
It is an option for couples who do not want to have sex because they don't feel ready or they don't want to use other forms of contraception, or for religious or any other personal reason.
Credits: Health Navigator Editorial Team. Reviewed By: Sue Tutty: GP Liaison for Women’s Health, CMH
Last reviewed: 04 Apr 2018
Long-acting reversible contraception (LARC)
Once in place, this type of contraception lasts for a long time. There are two types of LARC in Aotearoa New Zealand
The implant – currently this is the Jadelle which lasts for 5 years.
The intra-uterine device (IUD) that lasts for 5-10 year.
They are called 'fit and forget' contraception because you don’t need to remember it every day or every month. LARCs are the most reliable form of contraception that is available and are immediately reversible on removal.
Contraceptive implant
A contraceptive implant, which releases progestogen, is inserted under the skin of the upper arm. Insertion and removal of the implant have to be done by a healthcare professional. It is more reliable than sterilisation yet immediately reversible. The contraceptive implant currently available in New Zealand is the Jadelle. An implant does not provide any protection against STIs. The most common side effect of the implant is irregular bleeding.
Intrauterine methods (devices placed inside the uterus) contain copper or progesterone hormone that make it hard for the egg to bury itself in the lining of the womb and may damage or kill the sperm preventing fertilisation. They must be fitted by a doctor or nurse. There are two main types:
Intrauterine contraceptive devices are small, plastic and copper devices put into the uterus (womb). They have a small nylon 'tail' that comes out through the opening of the womb and which is used to remove the device. They are effective as soon as they are inserted and are usually changed every 5 to 10 years.
The most common side effect is your periods may become longer and heavier. There is a small (1%) risk of pelvic infection when the IUD is inserted so should not be inserted if you have symptoms of a genital or pelvic infection. If you become pregnant with an IUD in, see your doctor immediately.
Intrauterine systems are small plastic systems which are inserted into the uterus and release progesterone. They are suitable for women with heavy periods, because they usually make the periods lighter, or may result in you having no periods. They are also used as a treatment for menorrhagia (heavy periods).
Chance of getting pregnant: less than 1%.
Contraceptive pills
There are two types of oral contraception available in New Zealand. These are:
thecombined pill,known as ‘the pill’, which contains the hormones oestrogen and progestogen
theprogestogen-only pill, known as 'the mini-pill', which contains only progestogen.
Combined pill ('the pill')
The combined pill contains the female hormones oestrogen and progestogen and stops the ovaries from releasing an egg each month. The combined pill makes periods more regular and can be used to treat heavy or painful periods.
Most people can take the combined pill however if you have had a heart attack, stroke or blood clot in your legs or lungs or your parents or brothers or sisters have had a blood clot in their legs or lungs, you are over 35 and smoke, are overweight, have migraines or are taking some medications, over-the-counter preparations or herbal remedies you should discuss this with your health care provider.
The combined pill needs to be taken daily so has a user failure rate of 8% compared with a failure rate of 1% if taken perfectly.
The progestogen-only pill works by making the mucous in the opening of the womb thicker and changing the lining of the womb, making it less likely that a sperm fertilises an egg or that the embryo buries itself in the womb lining. It usually has fewer side effects than the combined pill and no risk of blood clots. It may cause irregular bleeding and is not quite as effective as the combined pill. It can be used while you are breastfeeding.
Depo-Provera is progestogen given as a three-monthly injection and works by stopping the ovaries releasing an egg each month. The common side effects include irregular bleeding, no periods, or a change in weight. There may be a delay in the return to fertility after stopping this method.
Barrier methods of contraception stop the sperm from reaching the woman's tubes. They also give some protection against STIs. However, they can interrupt sex and be fiddly to put on until you get used to them. You must remember to have them with you and to use them every time.
Currently they only recommended barrier method is male condoms. Female condoms, diaphragms and spermicides are no longer recommended as reliable contraception.
Male condoms
Male condoms are usually made of latex rubber and act as a thin rubber barrier put on over a man's erect penis before intercourse to stop the sperm going into the woman's vagina. The man also has to withdraw soon after climaxing and hold the condom on his penis while withdrawing, to prevent any leakage of sperm.
Condoms can also help prevent STIs and may be used for this reason alone, along with other methods of contraception.
Condoms should always be used with lubricants to make them less likely to break. Use only water-based lubricants – other types can damage the condoms.
Some thrush treatments can also damage condoms (ask your pharmacist for advice).
Latex-free condoms are also available for people who are allergic to rubber. Condoms are available from multiple places but are cheaper on prescription.
Chance of getting pregnant: 2–15% depending on correct use. Read more about condoms.
The following barrier methods are no longer recommended:
Female condoms: These are a lubricated condom made of thin polyurethane used by a woman by inserting it into your vagina before sex. It can help protect against STIs as well as against pregnancy. The female condom is available on the internet but is relatively expensive. The quality of products bought on the internet cannot be guaranteed and are not recommended. Diaphragms: A diaphragm or cap is a circular dome made of soft rubber put into your vagina to cover the neck of your womb (cervix) and prevent semen from getting through to fertilise an egg. Diaphragms are not recommended as a method of contraception as they are not easily available, can be difficult to use correctly and have a high rate of unintended pregnancies. Read more about diaphragms and caps. Spermicides: These include creams or gels that kill sperm. Spermicides should only be used with diaphragms. Spermicides are no longer recommended for use with condoms. The quality of products bought on the internet cannot be guaranteed and are not recommended.
What is emergency contraception?
Emergency contraception can be used after unprotected sex if you don’t want to get pregnant. Emergency contraception does not protect you against sexually transmitted infections (STIs).
Unprotected sex means either:
you haven't used protection, such as a condom or a regular contraceptive pill (‘the pill’)
your normal contraception/ārai hapū fails, eg, a condom splits
you have missed one or more of your regular contraceptive pills (the exact number of missed pills depends on which type of pill you are taking and whether you usually take them every day or have a break each month)
you usually take regular contraceptive pills (‘the pill’) but have been vomiting or had diarrhoea
you have missed your contraceptive injection
you have been forced to have sex without contraception.
How do I choose the right emergency contraception for me?
There are 2 main types of emergency contraception:
copper intra-uterine device (IUD) – a small object that is placed inside your uterus (womb)
emergency contraceptive pill (ECP).
When you talk to a nurse, doctor or pharmacist about getting emergency contraception, they will ask you a few important questions. These may seem like personal questions, but they want to make sure you get the emergency contraception that works best for you. The most effective emergency contraceptive is the IUD, but the ECP can be effective and convenient in many situations.
Read more about emergency contraception, including the factors to consider and how they may affect your choice of emergency contraception.
Fertility awareness
This is also called natural contraception. It means working out 'safer' times to have sex.
You need detailed advice on this method – it takes commitment and great care.Natural Fertility New Zealandcan provide skilled help and support.
If you have a very regular cycle, eggs will be released (ovulation) about 14 days before your next period and can be fertilised for up to 2 days afterwards. A sperm can fertilise an egg 4 or 5 days after you have sex. So if you have a 28-day cycle, you can get pregnant from day 10 to day 17. If your cycle is shorter or longer, count back 14 days from your period.
You can also tell when you are ovulating by taking your temperature every day with a special ovulation thermometer that shows fractions of degrees. You can also look at how much and how thick the discharge from your vagina is at different times of the month.
This method is also used by some women to help them conceive, by identifying their fertile times.
Resources
Methods of contraception
Contraception Chart An A3 chart covering different methods of contraception, how they work, health concerns, advantages and disadvantages. Contraception ChartA4 chart from Counties Manukau, 2017
Long-acting reversible contraception
Types of long-acting reversible contraception in NZ:
The combined oral contraceptive pill contains both progestogen and oestrogen. It is a very reliable form of contraception and can be 99% effective. The following pamphlet explains how it works and who it might be suitable for.
As its name suggests, the progestogen-only pill contains progestogen only. These resources help explain how the progestogen-only pill works and who it might be suitable for.
This pamphlet contains key messages about the emergency contraceptive pill (ECP) including when to use it, how it works, how soon to take it, how effective it is, side effects and where it is available from.
This resource was developed through worldwide collaboration between the Johns Hopkins Bloomberg School of Public Health, the World Health Organization (WHO), the United States Agency for International Development (USAID), and over 30 other organisations around the world (see Collaborating and Contributing Organizations). It offers clinic-based healthcare professionals in developing countries the latest guidance on providing contraceptive methods.
LARCs are the most effective reversible contraception available:
Recommend LARCs as first-line options for women of all ages, including adolescents and nulliparous women.
Jaydess®is indicated for contraception only; it is less likely than Mirena®to cause amenorrhoea.
Mirena®is indicated for contraception, treatment of idiopathic menorrhagia, and prevention of endometrial hyperplasia, making it a useful option in women with PCOS or obesity.
LARCs are fully funded and insertion costs may be subsidised or free – check yourHealth Pathwaysfor subsidised insertion options.
Continuous OC pill regimens are safe and acceptable (Goodfellow Gem, 29 January 2020)
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
