Hi everybody and welcome back. It's dr. Renée and this is part two of my current
VLOG series on contraception. And this week we're going to cover the combined
hormonal methods of contraception. And you might just think that's the pill
because it's the one most people know, but there are actually some other things
which are quite interesting in the way that they deliver the hormones. So hopefully I
can shed some light on all of them for you today. So to start with, what is
combined hormonal contraception? Well it's contraception that contains both of
the hormones oestrogen and progestogen, both of those hormones occur naturally in
a woman's body. The progestogen in the combined methods is actually a synthetic
form of progesterone. And then the other hormone that we naturally have is oestrogen.
So how do they work? So we'll start with the pill because they're all
slightly different. So the combined hormonal contraceptive pill works by
thickening up the mucus at the opening to the womb, which is where a pregnancy
would occur. And what that does, is it makes it more difficult or impossible
for the sperm to actually get through and enter the womb meet an egg. But
should a very brave and valiant sperm get through to meet an egg it, also
thins down the lining of the womb so that it's actually not conducive to a
pregnancy; it's thin and probably too thin for implantation to occur. So that's
the theory behind it. You get packs of 21 or 28 , and I'll come on to why they're
different in a second, because in the main you take a pill or combined
hormonal pill once a day for 21 days. And then you stop and you have a break for
seven days and in that time your period will come. And then you start again on
day one, which is 7 days after stopping. So those are the packs with 21 in them,
and that gives you the power to have the break and stop and have your period.
There are however some options where we can give a woman 28 tablets. So she takes
a tablet every single day for the entire year, never stops, never has a break.
However, if you're on those tablets you will still have your period in the seven
days, as if you'd taken a break, because those last seven pills don't have any
hormone in them, they're just sugar pills. And those are really good for women that
won't remember to stop or start their new pill in the seven days. So this way,
they can just carry on without having to think about it, or plotting a diary or
anything like that. So there are two types: phasic and
monophasic and the difference between these is that the fluctuations of the
hormones. So they can either be fairly standard all the way through or they can
fluctuate to more mimic your natural cycle. So you start normally on the first
day of your period, that's day one. And if you start from day one or any day up to
day five you're protected against pregnancy immediately. If however you
start on any day after day five of your cycle you're not protected immediately,
you'll need other contraception for about seven days. So if you've just given
birth, you can start the combined hormonal pill 21 days after you've given
birth but if you're breastfeeding you should wait for six weeks. If you miss a
pill there are different rules depending on exactly when you miss them in
the cycle and how many. But when you get prescribed the pill you're prescriber
will go through these with you. And in terms of effectiveness, it's 99%
effective against pregnancy, so really high about as high as you can get. So what
are the myths and side effects and risks of taking the pill? Well it can
definitely improve heavy or painful periods, and we often use it for that. It
can help with pre-menstrual syndrome. Sometimes it can help with endometriosis.
It can however lose its effectiveness if you get diarrhoea and vomiting, so that
always needs to be borne in mind. There is no evidence at all on the pill that
you gain weight. And I known lots of women say they do, but there is no
evidence for it. My theory is that you're in a new relationship so you're happy
and you eat more, so it's happy weight! But obviously I have no evidence for
that either! So side effects of the pill: so minor side effects that are often reported are mood swings, nausea mood swings nausea breast tenderness and
breast tenderness and headaches. Most of those will actually go after a few months. The nausea we can
help by taking it on food, taking it at a different time of day. But those are the
minor risks that are reported. A very low risk, but still a present one is
blood clots and cervical cancer - putting you more prone to cervical cancer. But
those risks are very very low indeed. There is of course no protection against
sexually transmitted infections when you on the pill. So if you want complete
protection you would still have to use a barrier method of contraception, so a
condom for example. It's not suitable for women who are over 35 and still smoke; so
if that's you, you will not be able to have the combined pill. The reason for
that is it puts your blood clot risk up too much to make it worth taking that risk.
If you've got certain medical conditions, so for example migraine with aura, breast
cancer in the family or you have had it. A high BMI, so your your weight puts you into the obese category.
You have heart disease. If you have high blood pressure, liver problems or a history
of blood clots you won't be able to have the combined pill. There are lots of others
as well but there's a really good table that your GP will use to just check those
things with you. Most people that we see can have it. Some medications also
interfere with the pill, so your GP will speak to you about that. And the good news is
that it seems to protect against endometrial ovarian and colon cancer. So
there are some side effects, but they're not massive. And there are so many
different pill, we have so many to choose from, that if you're not getting on
with one it's always worth switching to another one to see if it suits you
better; slightly different types of progestogen, slightly different doses of
oestrogen may actually have an entirely different effect. So don't give up, trial ad
error is sometimes the way forward. And now we have the next
method, which is the contraceptive patch. It's a sticky see-through
patch that you put somewhere on your body. Usually at the top of the buttocks so it's hidden away. In the UK it's
called Evra. You don't have to worry, it sticks quite well; you can swim, bath,
shower, play sports, go to steam rooms, so normal life continues.
It works in exactly the same way as the pill. It releases oestrogen and progestogen
into the bloodstream. You have to change the patch weekly for three weeks and
then you leave it off for a week and that's when you'll have your period. If
you start it on day 1 to 5 of your cycle you will be immediately protected
against pregnancy, but if you start it after day 5, just as with the pill, you
will need extra contraception for 7 days. It's more than 99% effective. There are
missed patch rules but your prescriber will talk to you about those, because they're
slightly more complex than the pill and depend when you've missed a patch or
how long for etc. So what are the myths, risks and side effects of the patch? Well
they can help heavy or painful periods, just as the pill. They're not affected by
diarrhoea and vomiting, which the pill is, so that's really good. You don't get any
weight gain when you're on the patch. It is affected by some medications as with
the pill. So again it's not suitable for women over 35 years who are smokers, have migraines with aura,
or have a high BMI (so overweight), have a liver disorder, a history of blood clots or breast cancer, heart disease or
hypertension. Minor side effects: you can get a slightly raised blood pressure. You
can get blood clots but again the risk is really tiny. The risk is greater if
you're pregnant, just to put it into perspective.
Some people get skin irritation from the patches. Same as the pill, you can get
headaches, nausea, breast tenderness, mood changes. But these tend to settle as
with the pill. And again it may protect against ovarian, endometrial and
colon cancer. So very similar to the pill, just slightly different in the way that
you use it. And then finally there's something called the vagina ring, which
delivers both of those hormones to the uterus.
In the UK that's called nuvaring. It's a small soft plastic ring. It's very thin,
it's only about five millimeters thick it looks a bit like piece of calamari,
about this big. And you squeeze it in half and you pop it inside the vagina
and it sits there quite happily releasing a continual doses of oestrogen and
progestogen. You only use one ring a month, which is great, and it doesn't fall out.
Well, occasionally it can, and you just pop it back. You leave it in for 21 days and
then you take out for seven and that's when you have your period. It prevents
ovulation, and it thickens the cervical mucus, just as in the others, and thins
the lining of the womb. So you have the added bit here of it preventing
ovulation. You can insert it any time during your cycle but again between days
one and five you're protected immediately but after day five you'll
need an extra seven days of contraception. You can't use it if you've
had, as in with the others, a past history of deep vein thrombosis,
migraines with aura, breast cancer, diabetes, if you're over 35 years old and you
smoke, you have liver disease, heart disease, high blood pressure, and some
other rare disorders. It is more than 99% effective again. The other good thing in
terms of the myths and the risks and the side effects
is that it again is not affected by diarrhoea and vomiting - so that's only the
pill. It can ease premenstrual tension symptoms. Bleeding is generally lighter
and less painful. You can get a temporary increase in vaginal discharge, breast
tenderness and headaches, but that tends to settle as with the others. So how do
you decide? Well again, I guess the most important question is how important is
it to you not to get pregnant? And these are all up they're, all three
methods that deliver combined hormones, at the 99 plus percent effectiveness, so
that's as good as you're going to get. So from that perspective they're all
as good as each other. Will you remember it every day?
That's really important. So are you going to need 28 pills in a pack? Is the
patch easier from that perspective or is the ring even easier because you just leave it
there for three weeks? Do you have medical conditions that might be a
contraindication? And you can sort that out with your prescriber. Do you smoke? Are you overweight? Can you not use
hormones for whatever reason; do you not get on with them? So as in part one
of this, there's an excellent toolkit to help you work out which contraception is
best for you and I'll put that in the notes afterwards, so you can just go in there,
program in all the things that are important to you and it will come up
with its best suggestion for you. And it's from the Family Planning
Association so it's from a reputable source and it works really well. So I'd
recommend that. So hopefully, now you've learned something today about the
combined methods which you didn't know before and it may now be that you have a
choice that you didn't think you had. So please ask me any questions afterwards as
always. Make any suggestions for future VLOGs, and if you want a contraception
you can go to a local family planning clinic, just Google for that: sexual
health clinics in your local area, your GP and even your pharmacy can sometimes
counsel you and prescribe. So I hope that's helped and I look forward to seeing
you for part three, which will cover the progesterone only methods. And again
there's more than just pills. Okay, take care for now.