Contraception - Hormonal treatments

Hormonal treatments are available for women through injection, or by hormonal releasing implants inserted under the skin. The injection form of contraception can give protection from pregnancy for up to 3 months. The implant can protect against pregnancy from between 3-5 years. They are one of the most effective forms of contraception with an efficiency of up to 99%. Sounds perfect doesn't it? However there are some side effects that can affect some women, and can last throughout the entire duration of the injection or implant.

How does it work?

It stops the production of the hormone called pituitary gonadotrophin; this hormone is produced in the brain. Preventing this hormone production decreases the chance of a woman's egg from maturing and/or ovulating. So if there is no egg or no mature egg, fertilisation of that egg cannot take place. It also thickens the mucus in the uterus making implantation of a fertilised egg difficult.

What time of the month can you have the injection?

The time of the injection needs to take place during the first 5 days of menstruating, and is then given at 3 regular monthly intervals, this can then continue while the woman wants to protect herself from pregnancy.
If you choose the implant protection, it can last between 3-5 years. Fertility returns as soon as the implant is removed. If the implant is not being tolerated well, it can be removed at any time.

Side effects

Common side effects are:

  • Depression
  • Migraine
  • Weight gain
  • Amenorrhoea (absence of periods)
  • Breakthrough bleeding
  • Nausea and/or vomiting
  • Hypertension (high blood pressure)
  • Breast changes (increase in size or tenderness)
  • Can take up to a year to become pregnant when ceasing the hormonal treatment.

There are other various potential side effects, they will be listed on a leaflet, or your doctor will discuss them with you before commencing the treatment. You may have no side effects from this form of contraception, or you may suffer some. It would be highly doubtful and extremely unlucky if you had more than a few. If you were to suffer some of these side effects, they may disappear as your body adjusts to the hormonal treatment.

More serious but rare side effects

  • Deep vein thrombosis (clots in the leg that can reach the heart, brain or lungs, which can be potentially fatal).
  • Anaphylaxis (Entire body allergic reaction that can be fatal).
  • Spontaneous abortion (miscarriage - if by some chance you do fall pregnant).
  • Jaundice (poor liver function - first sign is yellow colouration of the eyes).

Your doctor will assess your health before commencing the treatment and if you were at risk of certain conditions would then decide against the use of this form of contraception.

Do not take hormone treatment if you suffer from any of the following:

  • Depression (it could make it much worse, and once you've had the injection, there's no turning back for around three months, again the implant can be removed if this is a problem).
  • Migraines (it may increase the incidence of migraines if you are already a migraine sufferer, and just like depression, they are likely to last the duration of the hormonal treatment).
  • If you have had any circulatory problems
  • If you think you may already be pregnant
  • Liver disease
  • Those who are at risk of breast or ovarian cancer.
  • If you are breast feeding
  • Diabetes (although you may be able to have this treatment, but it must be done under close supervision with your doctor).
  • Reproductive cancer
  • Undiagnosed genital bleeding

It is extremely important you are completely honest with your doctor about the state of your health and conditions you may suffer from. As taking this hormone treatment with some of these conditions can cause horrific side effects that can be potentially fatal.

It all sounds a bit scary, but it's not!

This form of contraception can be wonderful, with very little maintenance on your part. If you have found very few side effects with a standard contraceptive pill, then it is unlikely you will have any problems with this form of contraception. This hormonal treatment is kind of like having to take the pill every day without having to. The hormone progesterone is what is in most standard contraceptive pills; therefore it can't all be bad. The reason you must be cautious with this treatment is that it is in your system for such a long time (3 months for the injection, or years for the implant. Although this hormone implant can be removed at any time).

So what are the benefits?

  • You don't need to worry about any maintenance, just visiting your doctor every three months.
  • It can actually reduce your chances of endometrial (in the uterus), renal (kidneys) and breast cancer.
  • It potentially can make your boobs bigger (so no boob job needed for those who want larger breasts)!
  • You may cease to get periods, or they may be lighter.
  • It is a completely private form of contraception. Only you and your doctor need to know.
  • It has very little chance of failing to work (1-% failure rate - which is pretty good).

Now as this form of contraception only protects you against pregnancy, and not sexually transmitted diseases (STDs) or HIV, if you are sleeping with different partners it is probably the wrong choice of contraception. That is unless you get the men you sleep with to get tested for these things (which may prove hard). So unless you're sleeping with a partner you trust, then I suggest you use condoms for casual sex. Hormonal treatment is a great method of contraception that should be considered, if you do not plan on getting pregnant for a while, and you have very few health problems. For more information see your doctor.

- Louise Ganey