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Hormonal

Combined oral contraceptives

Combined oral contraceptives (COCs), more commonly known as the ‘pill’ combines two hormones, oestrogen and progesterone. There is no upper age limit for the use modern low dose pills in healthy, non-smoking women. The pill has particular health benefits for preimenopausal women including relief of pre-menstrual symptoms and maintaining regular bleeds less painful and heavy than a true period. However, as you become older your fertility declines and you are much less likely to have a baby without using any contraception. Therefore, it is not necessary to use as effective a contraception when you are 45 as when you are 24. If you wish to continue the pill, discuss with your doctor the lowest dose pill available.

Progesterone - only method

These only contain a single hormone, progesterone. Each of the progesterone-only method works in a slightly different way. Progesterone-only methods can be prescribed to many women who cannot use combined oral contraceptives, including smokers. With the exception of the progesterone-only pill, these methods are even more effective than the combined pill.

Progesterone - only pill

The progesterone-only pill (POPs), also known as the mini-pill, is taken every day and contains a very low dose of progesterone. For women over 35, the POPs is as effective as combined oral contraceptives. The main potential problem with POPs is irregular bleeding. This may be resolved by changing to a different type of POP. In contrast, many older women find their periods stop. If you experience this, don’t worry as it actually means that POP is more effective.

Injectables

There are two types of injectables, depot medroxyprogesterone acetate (DMPA/Depo Provera) and norethisterone acetate (NETA). Like the combined pill, injectables work by inhabiting the monthly release of the egg from the ovaries. Both preparations are given by deep intramuscular injection every 12 weeks (Depo Provera) or every 8 weeks (NETA). Injectables can relieve premenstrual symptoms and heavy painful periods but their use can be associated with weight gain and irregular bleeding- although this usually resolves with continued use.

Implants

Implantation is a single rod, about the size of a hairgrip, which contains progesterone. The implant is injected just under the skin on the inner side of the upper arm. This provides a highly effective contraceptive, lasting for up to three years. It works by switching off the menstrual cycle, similar to the combined pill and injectables. Implants can relieve many period related problems, particularly heavy, painful periods although the main draw backs can be weight gain and irregular bleeding, which can be frequent and prolonged in up to 20% of users.

Intrauterine system

The levonorgestrel intrauterine system (IUS) is a small t-shaped device containing progesterone, since the hormonal effect is essentially within the womb it is associated with few side-effects. The IUS is as effective as sterilisation but is easily reversed by the removal of the device. It is also an effective treatment for heavy, painful periods. In addition to its uses as a contraceptive, the IUS can also be used together with natural oestrogens supplements as a hormone replacement therapy (HRT). Occasionally, irregular, frequent, or prolonged bleeding can occasionally necessitate removal of the device.

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