The Pill (birth control pill) is one of the most popular contraceptive methods in the world, particularly among teenagers and women in their early twenties.

It contains two hormones: oestrogen and progestogen. These prevent the growth and ripening of egg-cells in the ovaries and so stop ovulation occurring. Correctly used, the combined Pill is almost 100% effective.
Most packs contain 21 tablets, one of which should be taken at about the same time every day for 21 days (usually either in the morning or in the evening).

When you start using the Pill, you should take the first tablet on the first day of your period. You then take one tablet a day until the pack is empty. During the following seven days menstrual bleeding usually occurs and no tablets are taken. After seven days without tablets, the first tablet of the next pack should be taken. This will be on the same day of the week as the first tablet of the first pack. Your period will usually have finished by this time, but even if not, you should start the next Pill pack

Your doctor will prescribe the Pill if it is suitable for you. You may suffer some minor complaints such as bleeding between periods, nausea, headache or breast tenderness in the first few months of Pill use, because your body has to get used to the hormones in the Pill. These complaints usually disappear spontaneously and are no reason for concern.

After adjusting to the Pill, most women find their cycles are more regular and their periods shorter, lighter and less painful. In rare cases, the Pill may cause serious side effects, such as thrombosis in women who are especially susceptible. Before prescribing the Pill, the doctor will try to ensure that the woman is not susceptible. The Pill is fine for most women and does not have any harmful effect on their health. Every Pill-pack contains instructions for use and you should read and understand these instructions to avoid any mistakes.

IUDs (sometimes called coils) are small plastic devices of varying shapes and sizes are placed in the uterine cavity (womb) to prevent pregnancy.

The most modern IUDs include copper for increased contraceptive efficacy and they can be left in the uterus for a period of 5 to 10 years.
Tthe precise mechanism of how copper IUDs work is still not certain (most likely preventing the egg and sperm from meeting and interference with implantation of the fertilised egg).

The IUD does not guarantee absolute protection against pregnancy but is still one of the most effective methods of contraception, because user failures are practically non-existant. Currently more than 106 million women worldwide use IUDs.

The ideal candidate for an IUD is a woman who

• has given birth to at least one child
  
• has normal menstrual periods without pain or heavy menstrual flow
  
• is having a monogamous relationship
  
• has access to medical care to treat potential problems.

There are also Pills containing only one hormone - progestogen. They work mainly by making it impossible for sperm-cells to penetrate the mucus in the entrance of the uterus (cervix). They also inhibit ovulation, but not to the same extent as the combined Pill.

The progestogen-only Pill is particularly suitable for women who cannot take the oestrogen hormone in the combined Pill such as women over 35 who smoke, and women who are breast-feeding.

The progestogen-only Pill is very slightly less effective than the combined Pill and for almost all teenage girls the combined Pill is a more suitable contraceptive. Progestogen-only contraception can also be given in the form of injections or implants under the skin.

Most women's menstrual cycle lasts between 24 and 32 days and starts with menstrual bleeding. Ovulation takes place between day 12 and 18. Egg-cells die if not been fertilized within 24 hours of ovulation and sperm-cells can fertilize an egg-cell for a period of about three days after ejaculation, although cases of fertilization nearly a week after intercourse have been reported.

With the rhythm method sexual intercourse is timed to avoid the fertile period but this leaves only a short "safe" period and is completely unreliable for women who do not have a regular cycle.

The rhythm method is only suitable for women who have a very regular cycle and who are able to do the complicated calculations it involves. There are ways of making the rhythm method more reliable. The exact moment of ovulation can be calculated by taking the body temperature regularly every day or by inspecting the cervical mucus (the mucus in the entrance of the uterus).

With or without temperature taking or cervical mucus inspection, the rhythm method is not a suitable or reliable contraceptive method for teenagers.

Withdrawal is widely used by teenagers, especially during their first sexual experience because their "first time" often comes unexpectedly, so they are unprepared for contraception.

The withdrawal method relies on the penis being withdrawn from the vagina before orgasm. This is difficult and requires a lot of self-control on the part of the man. Also, some sperm-cells are often released before ejaculation takes place. This method is highly unreliable.

A condom is a sheath of thin latex rubber, which must be rolled onto the erect penis. It traps the sperm-cells during ejaculation so that they cannot enter the vagina. Condoms come in various shapes, sizse and colours, lubricant coated or unlubricated and can be bought in most chemist's shops and pharmacies and pub toilets

Contact between the penis and vagina should be avoided before the condom is put on, which should be well before intercourse. After ejaculation the erect penis complete with condom must be withdrawn, otherwise the condom may slip off into the vagina. Most condoms now available are reliable and rarely leak, it is safest to check the condom afterwards by filling it with water.

Condoms used on their own are fairly reliable. however some sperm-cells may still enter the vagina because of intimate contact before the condom has been put on, or occasionally due to tearing or leaking. Using spermicides at the same time increases the reliability of the condom. These usually contain nonoxynol 9 - a sperm-killing chemical and cream or foam must be applied inside the vagina before intercourse NOT inside the condom. Any sperm-cells entering the vagina will be destroyed.

The condom's major advantage over all other contraceptive methods is that, because they also form an impenetrable barrier to the bacteria and viruses which cause such diseases as gonorrhoea, syphilis, chlamydia and AIDS, they provide almost 100% protection against sexually transmitted diseases. AIDS is a fatal disease and infected people can carry and transmit the AIDS virus without being ill or even without knowing they are infected.

A diaphragm is a flexible rubber cap which prevents sperm-cells entering the uterus by sealing off the top of the vagina. A diaphragm measures between six and ten centimeters across and is made of thicker rubber than condoms and surrounded by a flexible rubber-covered metal ring to keep it correctly positioned in the vagina. A doctor should fit a diaphragm as the size of the vagina varies from woman to woman. If the diaphragm is too small, it will not completely seal off the entrance to the uterus, too large and it will be painful.

A woman can insert the diaphragm herself after it has been fitted by a doctor. This must be done well in advance of intercourse and any contact between penis and vagina must be avoided before the diaphragm is in place. The most practical way (unlike the condom) is to insert it before foreplay. You should always use a diaphragm together with a spermicidal cream or foam because the risk of sperm-cells leaking between the diaphragm and the vaginal wall cannot be completely eliminated. The cream or foam must be applied to both sides of the diaphragm and the diaphragm must be left in place for at least six hours after intercourse. When used with a spermicidal cream or foam the diaphragm is a very reliable contraceptive method but unlike a condom it does not protect against sexually transmitted diseases.

Both men and women can be sterilised. Sterilisation is a surgical procedure which cannot be reversed, this contraceptive method is only for men and women who are absolutely certain that they do not want any more children or any at all.

Sterilisation in men
In men, sterilisation is performed by cutting a small piece out of the sperm ducts. The sperm-cells produced in the testicles can no longer be transported to the seminal vesicles. Consequently a man who has been sterilised does not have any sperm-cells in his ejaculation. It has no effect on orgasm and soon after the operation, the testicles will stop producing sperm-cells. Those that are still present dissolve and are absorbed by the body. Sterilisation can be done in an outpatient's department and only a local anaesthetic is needed. Sterilisation in men is a 100% reliable contraceptive method if the operation has been successful.

Sterilisation in women

Sterilisation in women is done by cutting or blocking the Fallopian tubes. Ovulation (the monthly release of an egg-cell from the ovary) is not affected by sterilisation but the egg-cell cannot be reached by sperm-cells and so cannot be fertilised. It dissolves in the Fallopian tubes and is absorbed by the body. For sterilisation a woman is usually admitted to hospital for one or two days, and a general anaesthetic is needed. A successful operation gives 100% reliable contraception.

Despit precautions something may still go wrong. Withdrawal may have been too late, a condom may have leaked or have been used incorrectly or the Pill may have been forgotten. If there is a reason to think that sexual intercourse was insufficiently protected see a doctor immediately or the next day at the latest. The doctor can prescribe the morning-after Pill within 48 hours of unprotected intercourse.

The morning-after Pill is completely different from the normal Pill. High doses of female hormones (either oestrogen alone or oestrogen + progestogen) are taken for one or more days, and then stopped abruptly. The hormones make the inner lining of the uterus become very thick then abruptly stopping the hormones causes the inner lining to break down and results in a menstrual bleeding. If an egg-cell has been fertilized it cannot be implanted in the inner lining of the uterus.

The high doses of hormones can cause nausea or even vomiting, making the morning-after Pill an unpleasant experience which is best avoided.
The copper IUD is a possible alternative to the morning-after Pill. Insertion can take place 120 hours after unprotected intercourse to effectively prevent pregnancy. It is particularly good for women who may wish to continue the IUD as a long-term method of contraception.