Issues around sexual and reproductive health comprise a significant part of our work at the Student Health Service (SHS). Last Trimester I wrote about sexual health – now I will look at contraception.
Contraceptive methods can be divided up into barrier methods and hormonal methods. Barrier contraception includes condoms, diaphragms and caps, whereas hormonal methods involve the use of oestrogen and\\or progesterone. Hormonal methods include the Combined Oral Contraceptive pill (COC), the Progesterone Only Pill (POP), the Emergency Contraceptive Pill (ECP) and the Depo Provera (DP) injection. Other non-hormonal methods include the Intrauterine Device (IUD) and Fertility Awareness.
Condoms are widely used to prevent pregnancy and help reduce the transmission of some sexually transmitted infections. However, if condoms are the only method of contraception used it is important to remember that a condom has to be used every time you have sex. If, for some reason, a condom is not used or there is an accident, and you want to avoid pregnancy you will require the emergency contraceptive pill (ECP). The sooner you take the ECP the more effective it is in preventing a possible pregnancy. It is recommended that you start taking the ECP within 72 hours of unprotected sex, if you do your risk of pregnancy will be reduced to 1-2%
Emergency contraception is widely available. If you require the ECP contact the SHS, we are open Monday – Friday and during term time we are also open at the Kelburn campus on Saturday mornings from 9 am to noon. Other places where you can get the ECP include FPA, the Afterhours Medical Centre and you can also buy it over the counter from some pharmacies.
If you would like reduce your risk of becoming pregnant you may wish to take a regular form of contraception. The most commonly prescribed method of contraception at the SHS is the COC.
The COC is a safe medication and, if taken correctly, is 99% effective in preventing pregnancy. Prior to prescribing the COC it is important that both a medical history and recordings such as height, weight and blood pressure are taken to ensure that there are no medical reasons why a woman should not be prescribed the COC. The doctor or nurse will ask if you have any ongoing health conditions and if you are currently taking any other medications. They will also ask about both your medical history and that of your family.
The COC contains oestrogen and progesterone, which are like the hormones produced by the ovaries. The main way the COC works is by preventing ovulation, which is the release of an egg from an ovary each month. One of the most frequently asked questions regarding the COC is whether or not it will affect fertility later in life when a woman may wish to become pregnant and long term studies shows that the COC does not negatively impact on your future fertility. The reality is that depending on where you are in your pill packet if you miss an active pill, you may become fertile and therefore you may not be protected against pregnancy. Students who are prescribed the pill will be taught about the ‘Seven Day Rule’, which includes what action to take if you miss active pills. Recently there have been a few changes to the ‘Seven Day Rule’. For students who are already taking the COC, please continue with the previous ‘Seven Day Rule’ and discuss the rule changes at your next appointment.
Apart from missing active pills there are a few other things, which interfere with the effectiveness of the COC. The pill is affected by various medications including antibiotics to treat infections, tablets for conditions such as tuberculosis, epilepsy and fungal nail infections. Care should be taken when using over the counter medications in combination with the COC, as some of these, including St John’s Wort, may make the pill less effective. Women taking the COC used to be warned not to drink grapefruit juice or take high dose Vitamin C as well but now it is recommended that if you wish to have either of these items just take them at the opposite time of day that you take your pill, i.e. juice or Vitamin C tablet with breakfast, COC with dinner. Finally, the COC will not work if it is not adequately absorbed. Therefore, if you experience vomiting or diarrhoea that lasts more than 24 hours you will need to follow the seven day rule or take the ECP if you did have sex without a condom and you want to reduce your risk of becoming pregnant.
It is recognised that when women first start taking the COC they may notice some symptoms such as nausea, breast tenderness or irregular bleeding. These symptoms usually improve with time. However, if the symptoms are severe or if they do not improve with time you can either try another type of pill or change to another contraceptive method. Typically when you first start taking the COC you will be prescribed three months of medication. If after three months you are happy with your pill you will be prescribed six months of the COC. The price of the most commonly prescribed COCs are subsidised and cost $3 per prescription at the pharmacy, which is the same as a condom prescription.
If you are considering pregnancy and or not using any contraception you may wish to consider making an appointment to discuss pre-pregnancy care. The appointment will include checking if you have immunity against Rubella, a discussion regarding lifestyle issues such as the use of drugs, smoking and alcohol and how they can affect the foetus, pre natal nutrition including Folic Acid supplementation. It is recommended to take a low dose Folic Acid (0.8mg) tablet daily for four weeks prior conceiving and for the first three months of pregnancy to help reduce the small chance of having a baby with a neural tube defect such as spina bifida. Folic acid is found in foods such as fruit including tomatoes, cereals, dried beans, peas.
The doctors and nurses at the SHS are experienced with speaking with students regarding sexual and reproductive health including unplanned pregnancy. If you have questions or concerns about these subjects please contact us to make an appointment.