With the myriad of contraceptive choices now available to modern women, finding the right one for you and your body is not always easy. Whether you’re returning to using contraception after having kids, or are keen to ensure you do not have a baby when you are not ready, it is important to choose the right one for you and your body.

For many women, taking the oral contraceptive ‘Pill’ is part of their daily lives, and often women remain on the same ‘Pill’ for years. However, at different stages in a woman’s life her priorities, and her contraceptive needs, can change. When was the last time you thought about reviewing or updating your contraception? And do we really know what we’re putting in our own body when we take the ‘Pill’?

In this webTV show, expert Dr Annie Evans, Women’s Health Specialist, Bristol Royal Infirmary & Bristol Nuffield Hospitals, will be talking about the different contraceptive options available.

So if you’d like to learn more about contraception and the latest available options log on to our webTV show with Dr Annie Evans.

For more information visit: www.contraception.co.uk

H: Lis Speight, host
A: Dr Annie Evans, host

H: Hello and welcome to the Healthcare Show, I’m Lis Speight. Now then with the myriad of contraceptive choices now available, finding the right one for you is not always easy. Whether you’re returning to using contraception after having kids, or maybe you’ve had a break, whatever your circumstances it is important to choose the right contraception for you and your body. Well joining me today to discuss the options is Dr Annie Evans, who is a women’s health specialist at the Bristol Royal Infirmary and Bristol Nuffield Hospitals, welcome along Annie, great to see you today

A: Hi Lis

H: Now the combined oral contraceptive pill has been available for nearly 50 years now, so how do today’s pills differ from those available back in the 1960s?

A: Well it’s been a work very much in evolution. When the pill first came out it was very high dose and there were very few varieties, and over the course of those 50 years the idea has been to bring the doses of hormones down, make sure that it still works efficiently contraceptively, but perhaps actually offer women some add-on benefits as well as just having contraception. Other things that will improve the quality of their life. Like having shorter, lighter withdrawal bleeds which is lovely, if we have something that’s better than our own periods, then that’s going to be an added incentive for us to want to use that particular contraceptive method. So the doses of the hormones have been coming down, the doses of the main oestrogen hormone, ethinylestradiol has come down dramatically, so a modern pill is probably a seventh of the amount –

H: Wow

A: That a pill was way back then

H: So it’s evolved quite well then?

A: It’s evolved dramatically and the other hormone that’s used in the pill – because it’s called combined contraception – the progesterones, have changed with time too, to try and give us, again, some benefits to try and actually make the pill more friendly for us as women. So it’s been a real work in progress

H: Yes we are lucky aren’t we?

A: We are, we do yes

H: But it’s not just the pill is it? We have many other methods of contraceptive beyond the pill or condoms. So what are they and who are they suitable for?

A: I think that’s fascinating because when you hear women of virtually any age, but especially young women going to find out about contraception, what they tend to say is I’d like to go on the pill

H: Yes because –

A: We’re fed up with using condoms, and that’s the conversation, and my – one of the things that’s really, really been a driving force in my life is to get women to understand whatever their age, whatever their circumstances, there’s a massively bigger range of contraception than that, and we tend to think that there are only certain things that are suitable for us and that’s not necessarily the case. As users we can choose from a big, big range. So we have – nowadays not just pills but we have the same kind of hormone available – there’s patches and rings and we’ve also got little implants which get popped under the skin of the arm which release a hormone gently over about three years

H: It all sounds quite easy really!

A: Well it can be very easy and that’s the other thing of course that women would want, is something that’s easy to use. And we’ve got a whole range of inter-uterine contraception which sounds very scary, and everyone thinks oh I don’t think I want to use that, surely that’s just for women when they’ve had children

H: Right

A: But that’s not necessarily the case, and we can now even deliver some gentle hormone just directly into the womb. So there’s a big, big range of things that women can choose from

H: And are certain types of contraceptives suitable for certain women, certain lifestyles, certain age groups?

A: Well again I suppose in some ways there are things which are more useful to us at certain life stages, and if we’re very, very busy and we’re careering around and we’re working shifts and its’ going to be difficult to remember to do something at the same time every day

H: Right, that’s a good point

A: You might want to have something which is much longer acting. But the bottom line really is that so long as you haven’t got any particular risks, so long as your medical history, your personal history is not particularly risky, and your doctor or nurse has laid out the whole array of what therefore is available to you – it should be our choice which dictates what contraceptive method we use, rather than the other way round

H: And you’d go to your doctor would you to find out?

A: Well I think there are two ways around this. I mean we know that most women, most girls actually get their information first from sources such as yourself, from the media, and also from what they’ve heard, the sort of urban myths if you like, the “chat” on the street. And so they’ve already got a sort of conception of what they might want, but in reality you need then to have the conversation with the expert who will actually open a few more doors. Hopefully and show you what the full array is. Or of course in the modern world, you could go and do a little bit of research yourself and find out a bit of information perhaps online, and it’s sometimes difficult to work your way round, but the more you know, the more the conversation is going to be a useful one

H: Yes

A: When you actually have it

H: So it’s important to know your choices then? Women, after they’ve had their children, in their 40s, might think about coming off the pill because they’re worried about sort of the long term effects of taking the pill – is that right? I mean should women be worried about taking the pill long term? What would you advise women doing?

A: Not in my view, and most experts feel that unless something has changed in your medical history, unless something actually has happened and suddenly perhaps increased a risk, then you know in the modern world, let’s face it you’re still young in your 20s and 30s when you’ve had your children

H: Oh I like that

A: Still young –

H: Still young in your 40s!

A: And therefore we shouldn’t think that suddenly we have become too old for something or it’s too risky to go on taking it

H: Right

A: And I think there are a lot of women who stop their contraception because of that, who then end up with an unplanned pregnancy

H: Right

A: And in fact that can be very risk in its own right. It might be natural but it can be risky. So we have got problems not just with teenagers but also with older women, not using effective contraception and having unplanned pregnancies and either abortion or an unwanted pregnancy, and so the idea that oh you know I’ve been on it for too long is not necessarily right at all, and usually the advantages go on outweighing any kind of risk, irrespective of age

H: And when you say advantages, what do you mean by that?

A: Well a lot of people don’t realise that if you’ve been on the pill for a while you’ve actually been protected from some of the main female cancers

H: Right

A: Like cancer of the womb lining, cancer of the ovary. You’ve been protected from developing ovarian cysts, because the ovaries have been kept nice and quiet, because you don’t ovulate. You will have been protected from a particularly unpleasant condition like endometriosis, where you get some bleeding into the abdominal cavity. So all kinds of things which are positives

H: Lots of plus points there

A: Which we don’t hear about

H: Yes, yes exactly

A: You hear “oh the pill might be risky” or this contraceptive method might be risky – because what we’re dealing with are fit, well women making choices, not people who are ill coming for treatment

H: Yes that’s a good point

A: So it’s – it’s an issue really

H: Interesting stuff. And there are two types of contraceptive pill – the combined pill containing oestrogen and progesterone, hope I’ve said that right – and then there’s the progesterone-only pill. So why do we need the oestrogen component at all then? Why are all pills not just the one?

A: That’s always been an argument, it’s been said well if we can use just progesterone, why bother with the oestrogen? Well the main reason for that is that oestrogen has some benefits, it can have some really good effects in the female body, and it is an extremely effective method of contraception. It prevents the ovaries from releasing the egg

H: Right

A: But one of the things that you get with oestrogen that you don’t get with the progesterone-only method, is you get cycle control

H: Right

A: You can regulate when the bleeding is going to happen

H: Ok

A: And for a lot of women that is important, because if you’re taking a method and you’re not quite sure when you might bleed, when it might be a full period, when it might be some spotting, that can actually be quite a nuisance, and so to know that you’re going to have a bleed at the end of every packet and you can predict when it’s going to be, perhaps even avoid it, and that’s something that women don’t do enough of, is perhaps slide between packets and avoid the bleed

H: Right

A: There are lots of things that make us feel more in control

H: Yes. We like that

A: And that’s always good. Women do like that yes

H: But there have been advances in the oestrogen part of the combined pill haven’t there? Tell us about those?

A: Well this is quite recent and I think it really is quite exciting – because we’ve been talking about the oestrogen and we’ve been talking about bringing the dose down of the ethinylestradiol

H: Right

A: Because that has been an aim because with higher doses of ethinylestradiol there may come some risks and so to reduce the dose has been important. But all the way through that process there has been the idea that if we could use our own body identical oestrogen, which is estradiol,

H: Right

A: Then that might be an advantage, that’s what the female body produces anyway

H: Right so it’s accepted more readily by your body, less likely to produce side effects?

A: Well possibly and we can’t say definitely

H: No

A: But this is the aim. It’s the very gentle oestrogen that a lot of women choose to use in modern forms of HRT. And until recently it’s not been possible to use it in contraceptive form because all the second hormone that it’s been combined with, all the progesterones that they've tried, have not mixed with it to produce cycle control, so there’s been spotty bleeding, irregular bleeding and as we said that’s not what we want in an oestrogen-containing pill

H: Right

A: But with the launch of Clara, it’s been mixed with a particular progesterone, Dinagest, which has produced the really good cycle control that everyone’s been waiting for, and in fact the bleed that you get with Clara is probably lighter and shorter and less painful than even with some of the more modern pills that have been available

H: Right, sounds interesting

A: So I think that’s going to be something that women are going to be quite keen to explore

H: Yes. So if you’re interested in using this pill, go to your doctor I presume –

A: And have a chat. Absolutely

H: Ok

A: Or the nurse

H: Yes, yes

A: The practice nurse is often very good actually

H: Yes, yes. Ok. You’re watching the Healthcare Show; we’re talking about contraception today. We have with us Dr Annie Evans who’s an expert in women’s health issues. Does long term use of the pill affect women’s fertility? There’s so much talk about fertility these days isn’t there? Particularly women of a certain age

A: Women of a certain age, I know and actually there is no evidence at all that having been on the pill for – it doesn’t matter what length of time – affects your fertility when you come off it. We’ve got plenty of evidence to show that women will be just as fertile as they would have been

H: Right. That’s encouraging actually isn’t it?

A: It’s very encouraging, but the myth comes from the fact that sadly for some women, when they stop whatever contraceptive method they’ve been using and they try and get pregnant, it’s more difficult for some women than others

H: Yes

A: And so there’s grown from that the idea that if you’ve been on the pill for too long you may have suppressed your fertility a little

H: Right

A: And it is a complete myth. But of course the advice always is if you’re struggling and you’ve been trying to get pregnant for 18 months / two years, then you must go and see someone and of course in fact the older you get the earlier you should go

H: Yes

A: So that you can get some tests and get some help if you need it

H: Yes you’ve got a bit of time on your side

A: Yes

H: Ok. Useful advice there. Now I know some women complain of weight gain and mood swings when they go on the pill. Is that right and can you do anything about it or are we just all a bit grumpy all the time?

A: Well some of us are a bit grumpy, some of the time and some – but I think this is the sort of Dr Annie theory on this, I think it’s backed up with a large amount of evidence really – there is no true evidence that women gain any more weight on the pill than women who are not on the pill

H: Right

A: Very sadly, in their reproductive years, all women tend to gain weight with time

H: Middle age spread

A: Well I’m saying nothing, but the problem is if you’re on a hormonal method, it’s very, very easy to blame that

H: To blame that, right

A: And if you’re not you can’t. And so I really don’t think that that’s a – I mean for some women they will gain some weight, others will lose some, others will stay the same

H: Yes

A: And if you’re not happy and if you do feel, especially if it feels like bloating and fluid retention, that again is something to go and talk to your doctor about, because maybe you need to switch to a slightly different method, a slightly different hormone combination. But the idea that mood can change with hormones is in some way quite real

H: Right

A: We are sadly as women, maybe more hormone-sensitive than we think. And PMS is a natural female thing, so you know our own hormones change during our monthly cycle, and for some women this is quite a problem at the end of a cycle, because they will have mood change

H: Yes

A: So yes if different women take different hormonal combinations, some may experience mood change for the worse, some for the better. And you can’t always tell beforehand so again this is the time when you go and you say is this a possibility, could I try something else, might this be something completely different? And you ask for help

H: But there are lots of choices out there

A: There are

H: So if you are getting mood swings and you are putting weight on it’s worth having a go at a different brand isn’t it because you never know

A: Well it is, and we know that about a third of women who start the pill will actually stop within 6 months, and 9 out of 10 of those women stop and use a less effective method or no method

H: Right

A: So they’re not having the conversation

H: Right

A: They’re just abandoning and saying that is not for me, and that is not good

H: No

A: It really isn’t

H: Ok so go and talk to someone

A: Go and talk

H: And get it sorted out

A: Absolutely

H: And what advice would you give to women who don’t want any more children, maybe they’ve had their children and they definitely don’t want any more – what options are available for them?

A: Well classically in the UK we’re a nation where we’ve thought if you’re in a relationship we’ve thought well maybe my partner will be sterilised or I will be sterilised and let’s put an end to it all, and in the UK we do actually do sterilisation at quite a high rate. We have, in the modern world, got so many effective alternatives to sterilisation which are just as efficient and which in fact you might switch off if you decide that wasn’t the right choice

H: Yes well that’s it because you never know what’s ahead do you at the end of the day?

A: We have a 42% divorce rate in the UK

H: That’s cheery

A: And also, which could improve the quality of our life

H: Yes

A: So instead of having to put up with the hormonal changes that sadly do happen in our late 30s and early 40s, which might mean that our own periods might become heavier and longer and more painful, we could be using something contraceptively maybe an inter-uterine system that delivers some progesterone, maybe a good, modern pill which would give us a lighter bleed, a shorter bleed, a more controllable bleed. So there are lots and lots of different things, so it’s another moment in time when you think well I’ve had my children, my family’s complete, but you don’t just fall back to whatever method you used in your youth

H: Right

A: You go and have a talk. You go and say what is there, what’s available, what might be suitable, what might I like to choose at this stage in life

H: Right, ok. So don’t just leave it

A: No

H: Go and talk to somebody

A: Absolutely

H: But if you do want more advice where should you go for information on contraception? There’s a lot out there isn’t there?

A: There’s a lot out there Lis and we’ve been saying this, and of course we’re lucky in the UK because contraception is free to us

H: Yes

A: And we can get information from our own GPs, but we also in this country have the ability as women, and as couples, to go to specialist clinics, contraception and sexual health clinics which are either centrally based in cities or in the community where we can get advice again from highly trained doctors and nurses who usually offer the full range of contraception. We can go to organisations such as Marie Stopes or the Family Planning Association, who have a lot of information available. The FPA produce the leaflets that we find and can pick up from any doctors surgery, and you can go online and look up the information, and there’s recently been a new website which has been launched called contraception.co.uk, couldn’t be easier

H: Yes

A: Which again will provide a huge range of information so that we can feel that we’ve done a little bit of background research and we know a little bit, but always be open for the conversation and the information, that you’ll get from the expert in the field

H: Yes you might be surprised; they might be coming up with something you hadn’t thought of

A: Absolutely

H: Yes. Well Dr Annie Evans we’re out of time actually but thanks so much for coming in and giving us your insight, and if you want more information about your choice of contraception then you can go to the website which is www.contraception.co.uk. There’s absolutely loads of information on there about contraception for women of all ages, so why not go and take a look. Well thanks very much for watching the Healthcare Show, and we’ll see you again very soon. Bye bye

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