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Sexual Health (young people)

The contraceptive implant

There are four methods of long-acting reversible contraception (LARC) to choose from; contraceptive injection, the contraceptive implant, the intrauterine device (IUD or non hormonal coil) and the intrauterine system (IUS or hormonal coil).  This page is about contraceptive implants. 
 
LARCs are known as “fit and forget” methods; this means once they are fitted or given, women are protected from getting pregnant until it needs replacing.

“If implanted correctly, it's more than 99% effective. Fewer than one woman in 1,000 who have the implant as contraception for three years will get pregnant.” (NHS Choices)
 
The contraceptive implant has the lowest failure rate of all methods, this means it is the most reliable, and the fewest women get pregnant whilst using it.
 
A contraceptive implant is a small, flexible rod (the size of a match stick) that is put in the upper part of the arm and works for up to 3 years. The implant contains progesterone. This stops ovulation (releasing an egg every month), thickens the mucus in the cervix (stopping sperm reaching an egg) and also thins the womb lining.


contraceptive implant

Size of the contraceptive implant

contraceptive implant

 Position of the contraceptive implant

It can be removed at any time if it doesn't suit you, but doctors recommend it is tried for three to six months before making a decision to remove it.

 

Natasha talks about the consultation with her GP where she learnt that high blood pressure and...

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Age at interview: 25
Sex: Female
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So I made an appointment with my university GP and I went in and I said, ‘I would like to get the implant’. And when I did it the implant was still new so they were still really, really excited to be able to have willing participants saying, ‘I want the implant’. And I went in and you have a consultation and they show you how it will look. They give you, I don’t know, some kind of mock up of a human arm because that is where it will go. I don’t know if you can see it on camera but can you, do you want me to show that it goes in there? Just so people can see what because this is where it will go for everyone.
 
Hang on let me see if I can take that.
 
[laugh]
 
Yeah we’ve got it right.
 
Yeah. Cool. Well that’s where it will go and they show you like a model and so you can see how it will feel. And it’s a tiny, tiny rod maybe the length of my finger that will go in your arm and it will release the chemical progesterone which is obviously a part of the pill as well. And it slowly releases it so you don’t really feel anything. You might get the occasional itching sensation but we always just chalk that up to, ‘It’s doing its job.’ And made an appointment. Got a consultation. They do all the normal things like check your blood pressure. Check that you are not overweight or anything because sometimes depending on a combination of these factors you may or may not be able to get it. It’s not as serious as if you are on the pill because you shouldn’t smoke. You can’t have a high blood pressure. So I was ok.
 
And then I made an appointment to go back a week later and they put it in. They numb the area because they put in a little bit of anaesthetic because they are actually putting something into you and then they slide it into your arm. And if you are like me I’m pretty squeamish so I just sat there thinking, ‘This is awful’ [laugh]. And they slide it in and you just have to and the feeling comes back and you get two scabs and it will and eventually it heals over.

 

 

Victoria was told that she could have the implant removed if she wasn’t happy about it.

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Age at interview: 24
Sex: Female
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You have the option to go back. If you've got any concerns, you have the option to go back even within a month and get it removed if you don't like it. It's completely up to you and any woman who says, "Oh they wouldn't take it away from me," and like, "My doctor said keep going for three months and I didn't want to." She obviously didn't go on the internet and type in Family Planning clinic in my city because it's not hard. My doctor was rubbish, gave me no information and when I contacted the reception to see when I could make the appointment she offered me one in about three months' time which I didn't want, I wanted it sooner than that. So my doctor was absolute rubbish which is why I went to my local GUM clinic. And there were two others attached to the university hospital that I could have gone to but I went to the Family Planning one just because it was closer. Three in one city and, you know, it's not a big city because I was in [city], three but you know so if you're living anywhere that doesn't have one you're probably in a village in the middle of nowhere. It's impossible to not have it done and if someone tells you they can't take it out, go somewhere else because you're entitled to have it taken out if you don't want it.

You were told that?

Yes. You don't have, they recommend that you keep it in for three months because after that the side effects will stop and you'll probably like it but if you don't want it for the three months or you put it in and suddenly you've gone up half a stone already and you're bleeding all the time, you're very welcome to have it taken out and go back on the pill or go on to condoms or go on to any other thing you want but it's your choice and it is always your choice and that's what they stressed to me which is why they were so different from my doctors. Your choice, if you want it you have it, if you don't come, we'll take it out.
 

One of the main advantages of implants is that women don't have to worry about remembering to take anything, so they are good method for people who are a bit forgetful. It is important to remember that the LARCs do not offer any protection against sexually transmitted infections. If there is any possibility of infection, condoms should be used as well.
 
There can be many reasons for a woman to change the type of contraception they use; concerns about the side effects of the pill, wanting to stop using condoms, having trouble remembering to take the pill, concerns about the effectiveness of the pill when sick, irregular or painful periods and bleeding or to reduce the risk of pregnancy. People may also want to change because they have had problems with other methods of contraception.

 

Life has a student can be hectic and that’s why Hannah has been advised to consider having an...

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Age at interview: 18
Sex: Female
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Sometimes I’m a little forgetful and a few times I have forgotten to take it which I get very annoyed at. So I’m thinking of switching from the combined pills simply because it’s. I want something that I don’t have to remember to take every day, something that I don’t have to think about every day.
 
So which one do you think you will, are you considering?
 
I was considering getting the implant, the one that lasts for three years? And that releases slowly yeah? Yeah I was thinking of getting that because then I don’t have to think about it and it would do me for like half of my time at university.
 
Have you spoken to a health professional about it or?
 
Yes I’ve spoken, I spoke to my GP and I spoke to a sexual health nurse who’s a friend of the family. And I was advised that it would be a good idea. A lot of people, it’s advised for a lot of university students at the minute because life is so hectic and with things like alcohol and stuff like that disrupting your usual food cycle so you might end up throwing up. And if you’ve taken a pill. I used to take the pill in the evenings but now that I’m drinking more alcohol if I throw up it won’t have the effect so now I have to start taking the pill in the mornings instead so I have time to absorb it. So I think if I had the injection or the implant even that would be easier.
 
How much information have the doctor or the sexual health nurse that is a friend of the family given you?
 
I think I got quite a lot of information. I didn’t quite get, because certain people have been telling me like there’s rumours like my friends have been telling me that they had friends who had the implant and it’s not as effective as the pill and they’ve got pregnant while on the implant. And I don’t know who to believe because they, they fully, they tell me that their friends have definitely got pregnant while they were definitely using the implant which obviously is a little bit worrying. But then I’ve had the health professionals that I’ve spoken to have actually told me that it is effective. It’s like almost as effective at the pill. So it’s, it’s difficult to know who to believe.

 

 

Hannah knows that if she is drunk and then sick, the effectiveness of the pill is reduced and she...

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Age at interview: 18
Sex: Female
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Well I know that when I drink alcohol and as a university student I drink a lot of alcohol and I know that when I go out and when I do drink and get drunk I will get forgetful and I will forget to take my pill if I took my pill in the evenings because I try and take them at the same time every day. And if I take my pill in the evenings and then I go out and get drunk what often happens is that I’ll get very drunk and I’ll end up being sick. And then I don’t think if it happens quick enough I was told that I wouldn’t have time to absorb the pill. So it would be as if I hadn’t taken it at all. So this was, this was a major concern of mine just in terms of if I drink alcohol and I do get sick will the pill still work but if it’s not fully in my system.

 

 

Avoiding an unwanted pregnancy is Hannah’s main priority but she has concerns about how effective...

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Age at interview: 18
Sex: Female
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I’m still not quite sure what I want to do.
 
Why don’t you...
 
So I’m still on the pill at the minute but I, I am. I’m still considering swapping to the implant.
 
What are your main sort of concerns about that, the implant?
 
My main concern is that it won’t be completely effective and that by accident I will get pregnant because the entire point of the thing is to stop pregnancy for me. That is like my biggest worry when it comes to sex and yeah. So if it’s not completely effective it’s not worth it and I don’t want to have to. Also I don’t know. I still don’t quite know how I’ll react to it. Just in terms of having something inside my skin.
 
And you know the procedure?
 
[mmm]
 
So what has your doctor recommended or advised you?
 
My GP just said if I was at university it might be a better idea because I’ll get distracted and might forget to take the pill. So something I don’t have to think about and that is with me all the time is advisable. And the nurse that I spoke to, she really suggested I take it for the same reasons basically.
 
What other type of information will help you to make up your mind about or to decide for implant or not implant?
 
I’m not sure really. I think just talking. More experience stories would be nice. People like actually meeting someone and talking to someone who’s done it or who has got it and has had lots and lots of sex with no condoms or anything and has not got pregnant and [giggle] so just, you know like kind of reassuring it works.
 
I don’t know. I have a few friends. I have one friend who is on a progesterone only pill and so she doesn’t have periods at all and I, I’m not sure how healthy that is. Because I, the pill I take just regulates like my natural body rhythms but a pill that, or and I think the implant does it as well doesn’t it? It just stops periods altogether. I sometimes think that maybe that’s a little shaky just in terms of not being completely natural as opposed to controlling a natural phenomenon stopping it altogether.
 
So is that another concern you have about the implant or not?
 
Yeah actually I’d forgotten about that one beforehand. The whole idea of, because for three years not having any periods. I mean I don’t like periods, nobody likes periods but it’s somehow natural. And like the idea that it’s, I’m stopping something that’s natural and that my body wants me to do I’m not sure how that would affect my health.

 

The implant commonly changes a woman’s bleeding pattern, including stopping periods altogether. The bleeding pattern is not an indication of whether the implant is working – whatever the bleeding pattern they are extremely effective at preventing pregnancy.
 
Some of the women interviewed chose to use implants as their method of contraception after trying the pill or condoms.

 

Describes how she realised she needed a more reliable method of contraception and discusses the role of her...

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Age at interview: 20
Sex: Female
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You were sort of not using condoms or anything?

 

No I wasn't. I just had unprotected sex every now and again but it was with the same guy because I was still with him, but then we got a bit worried and I'm thinking oh no, what if I fall pregnant, what am I gonna do then. So that's when I went to the doctor and said 'Look seriously I need something.'  

 

Because I kept on going for the morning after pill. Most of the time I went for the morning after pill and they'd say "the morning after pill's not really good, you're not supposed to really take it more than three times in a year", and I did take it more than three times in a year, you know what I mean' Yeah seriously, I did.

 

That's when they said to me you know 'You seriously need to think about long term, contraception'. So then yeah that's when Depo came in to it.  

 

Because like my GP, I've known her for a long time and she's been my childhood GP, she knew when I left home and everything so she knew she has to be there as an extra support for me as well to explain everything to me.

 

And then obviously you go to see the nurse for contraception and things like that, so she transferred me to a nurse who explained all the procedure to me.  

 

So like if I had a problem the first person I would go and see would be my GP because I can really, really trust her, she's like a friend to me, someone I can really openly talk to, so that's nice.
 
 

Describes how she decided to have an implant. (Actor)

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Age at interview: 21
Sex: Female
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Because first, before I never thought about implant, and when, when I knew it was working and everything I found it really marvellous. I was like, wow, for three years, and you don't even need to take the pill every day to remember it, and this kind of details. 

But it makes it better. And now it was nice, I felt nice when I read the prospectus about it, I found it really nice, so I thought, I'm gonna start to study next year, I'm not planning to have children the next three years and anyway, if I change my mind I can take it out. 

My metabolism will come back normal as soon as you take it off, contrary to the pill that, it takes time for the ovaries to work properly and everything. So, I don't know, I found it more safe somewhere, like for your body and everything, so I decide to change. Maybe in three months I will complain and I will say that it was a really bad idea, but I want to see '

Before changing contraception methods there are leaflets to read about what's available or health professionals to talk to at GP surgeries, Family Planning or Brook clinics. Implants don't suit everyone so it's important to get information to help make the decision.
 
Women we spoke to had different experiences of contraceptive implants. Women often reported being happy with the implant but some had stopped using it because of health concerns. Some others used implants or injections as contraception after childbirth.

 

Victoria explains why she is happy using the contraceptive implant. She plans to use it long term.

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Age at interview: 24
Sex: Female
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So the implant is your method of choice?
 
It is my method of choice for birth control. I really, I can't see anything wrong with it. It's very, very good for me and so it'll be my method of birth control from now on and if I accidentally get pregnant on it then I'm one of the unlucky ones. And I will probably stick with the implant even if I did get pregnant on it. But apparently it won't harm your baby if you're on the implant and you get pregnant.
 
You were told that?
 
Yes. It's like being on the pill and getting pregnant. It won't harm your baby, the extra hormones.
 
And I haven't had any problems with it, with it becoming infected or anything and there was that big fuss ages ago in the media about all these women getting pregnant on the implant. And it was about 586 women got pregnant on the implant out of 72, 000 women. So come on that is the actual success rate of the implant, 99.99%, it's better than the pill even. Because less than one in a thousand people gets pregnant on the implant and they all say how they couldn't feel it which is astounding to me because you are made to feel it by the person in the clinic before you're allowed to leave because you have to sign on the card that you've felt where it is. But they checked it all over, they gave me a leaflet afterwards, if I had any questions, who to contact and everything and since then it's been great, I haven't had any problems with it. I had two periods after I had it, one of which lasted seven days which was rather long for me; one of which, a month later lasted two days and I haven't had a period since, it's been absolutely fantastic. No period pains, no mood swings, no extreme weight gain, it's been the best choice I've ever made.
 
Any concerns about using the implant?
 
The only concern I really was one about when my fertility would come back but the nurse in the clinic talked me over and showed me the medical data for it and for most women it's exactly like the pill, your fertility goes back to normal after one month in 99% of cases. In 1% of cases it took six months to return to normal but that's, that's fine anyway and there's no-one who's reported any loss of fertility from it.
 
OK. There is no data on that?
 
No data on that but since it's been around since the eighties I expect we would have seen data on it by now.
 
OK. And what about long term use or….?
 
Long term use is fine. You can use it however long you want it. It lasts for three years but you can have it taken out at any time if you don't want it in, don't suffer in silence. And you then, as I said as I'm going to do you can have it taken out and a new one put in straight away, you can run them on like that and I don't think there's an upper limit of use for them. To be honest I wasn't warned about one of an upper limit of use but I'm going to use them as soon as I've stopped having children. Once I've had my children and I don't want to get pregnant again I will go back on it if I can.
 
Any other advantages for you with using the implant?
 
My mood swings stopped which was very good and the weight gain and increased appetite and nausea that I had from the pill, that all stopped which was good. I forget I've got it. I just don't realise; and the main advantage is that I don't have periods anymore because I used to get dreadful pains, I used to not feel very well with them and I've saved a mound of money on using tampons as well. I don't need to worry about 'well I'm going on holiday, am I going to have a period or anything.' Or you know
 

For Natasha, the contraceptive implant worked well for two months but then she started to...

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Age at interview: 25
Sex: Female
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And for the first couple of months it was great. It was fine but then it all started to go really, really iffy. I had a lot of breakthrough bleeding and I think, I think nearly for about two months it was like I had a period for two months. So I had two months without anything then two months with it, two weeks without, another four weeks with it. So completely ruined my entire cycle, just completely ruined it. And because I think the thing you have to remember is when you get these things put into your body they are releasing a chemical hormone into you that your body may naturally produce on a small scale but when you put it [the implant] in that amount is going to have an adverse effect on your body and the balance and everything which I think you get told but I don’t think you get told it in enough detail like.

But I found that doctors are very much, these are your options. Pick one that you think you kind of like and see how it goes. They don’t really warn you that when you put this into your body you are essentially messing yourself. You are messing up your cycle because after, I’ll get onto it, but after I took it out it took about six months for my cycle to go back to normal which, you know, it’s not very convenient really because you can’t really do anything because you don’t want to put more chemicals in after you’ve just taken chemicals out. And so that went on. So I had it in for about, I think, nearly a year before I was like, ‘No it has to stop. I’ve given it a fair shot and I don’t want to be dealing with this anymore.

So I went to my GP. I told them what was going on and they said, ‘Ok fine it sounds like you need to have it taken out’. And it’s, it was ok. I made an appointment. Went in, completely at my own, what’s the word, at my own convenience and I went to surgery and it was a really weird procedure. You lie down and of course they put in the anaesthetic again and they slowly slide it out and you can kind of. You don’t really want to see it when they slide it out because you know what it looked like going in. And yeah they took it out and there, and yeah. And it took a long time for it to heal up and like I said it took six months for me to, for my body to go back to normal.
 

Irregular bleeding is a common side effect of the implant but it doesn't mean it's not working. If this happens it is worth talking to a doctor or nurse for advice. Sometimes taking a contraceptive tablet as well as the implant can settle the bleeding down. Because the implant provides contraception, forgetting to take the pill doesn't result is an increased chance of getting pregnant.
 
We talked to women who had stopped using LARC and are now using other methods, such as one of the contraceptive pills. Many said that they find it difficult to remember taking it every day. Stefanie reminds herself with an alarm on her mobile and by keeping the pills next to her toothbrush.
 
Reasons for not using LARCs or stopping using them included: the experiences of relatives or friends, ‘horror’ stories reported by the media, concerns about LARCs' impact on fertility, and the feeling of losing control over their own bodies.

 

Sarah didn’t consider the implant as a contraceptive option because she dislikes the idea of...

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Age at interview: 20
Sex: Female
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Last time I went to my doctors to get my next packet of my pill was in the summer holidays and I was in City so I waited for my actual doctor this time and they said, I just said, “Could I get another packet?” And then he said about getting the implant in my arm and saying how it was more efficient, safer and could have it for three years and it doesn’t mean you have to remember to take a pill every day. But I said that I wasn’t really interested.
 
Why not?
 
Just because I didn’t like the fact that it’s under your skin and you can see it and feel it and the pill, I don’t mind having to take the pill every day.
 
Do you have a problem remembering taking pills?
 
No, no, well, I’ve never had any problems so.
 
Okay. So the idea of having something in your arm is sort of.
 
Well, I know people that have got them and you can it and feel it under your arm so I was sort of like, “[eeyer] No.”
 
Oh you can see and feel it.
 
Yeah, on my friends you can see it just under their arm there.
 
Okay.
 
And I think you have you have to have it in for three years, which I just prefer to stay on the pill so if, I don’t know, if I wanted to stop having, having contraception I could, whereas with the implant you have to have it in for three years. Well, that’s what I was told anyway.
 
That you have to have it for three years.
 
Yeah.
 
Can you not take it, remove it earlier if you’re.
 
What, oh well he didn’t say that you could so I don’t know if you can or can’t but he, my doctor didn’t say that.

 

Women we interviewed commented that the amount of information they got from their GPs regarding LARCs was variable and that, often, they were given leaflets to read rather than the time to talk about the different options available to them. In towns and cities, overcrowding, lack of appointments or lengthy waiting times sometimes made it difficult for women to access health services for family planning. Victoria thinks that cities offer more choice of where to go for advice than other, less populated areas.

 

Difficulties in accessing the same clinic for sexual health meant that Stefanie had the implant...

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Age at interview: 24
Sex: Female
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So why did they suggest you use both methods at the same time? What did the doctor say?

 
Part of the reason is because I have been going wherever I can be seen so it would be that I’ll go to one clinic, in [city area] because they can see me and they will advise me to. They, well actually I went in saying, ‘I wanted to try the implant’ and they gave me advice and they gave me the implants. And then I found out that it was going to be, it was making my periods really irregular. So that’s when I couldn’t get back into [city area] because they were very busy so I went to a different clinic in [city area] and they gave me a pill to help me sort it out. So it’s different people, it was never the idea to go on both at the same time originally.
 
Ah ok but did they know that you are on both or you were on both?
 
Yeah uh huh.
 
Ok and what was their opinion about it?
 
They just said it would kick start my cycle into sorting itself out and then it would hopefully after three months be more regular and normal. But, but that didn’t happen. So I went back last week actually when I saw your advert. And I asked if I could get the pill again and the nurse refused and said that I, only a doctor is allowed to give you the pill when you are on the implant already which wasn’t what happened the time before. So…
 
Ok because you were given each thing in two different clinics at that time?
 
I think so yeah.
 
So you will go back to see the doctor and discuss?
 
That’s right yes I’ve booked an appointment to just discuss all my options because I think that’s what’s most important. People just need to more than jump in like me and to just take the first person’s opinion you just do some research and find out what’s best for you because I’m a perfect example of someone who just went, ‘Yeah ok’. And did the first thing the first doctor said to me but in hindsight I wish I’d done a bit more research on each thing.

 

 
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Katie’s GP gave her leaflets to read about implants and IUDs but there was little discussion...

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Age at interview: 22
Sex: Female
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Katie' I can’t say that they really discussed it with me. I was given a bunch of leaflets and told to go off and maybe if I want, you know, if I wanted to talk about it more then come back. Well, I think I would have preferred them to have gone through each method and actually told me, you know, what they thought that the pros and cons because I’m not a doctor and I don’t know exactly.
 
So in the end I just decided to stay with the pill but I would have preferred maybe to talk about it a bit more with them.
 
So, not enough information and advice has been given to you?
 
Katie' No, I just had the leaflets and that was it and I would feel more reassured if I had actually been able to speak to them personally, you know, to their face rather than just reading the leaflets by myself.
 
Because it’s confusing with all these?
 
Katie' Yeah.
 
Different methods, yeah, and in your case.
 
Katie' I was actually it sort of had an explanation on the implant and the coil and, and that sort of thing but, at that stage, I felt that sort of the contraceptive pill was all I really sort of wanted to look at and everything else seemed a little bit more permanent especially because at the time I was only taking it for sort of period reasons rather than contraceptive reasons.
 
Katie' I would have preferred to have discussed it more. I found like the doctor was trying to rush me out, giving me leaflets. So I would have preferred to have spent more time with them but, yeah.
 
Alice' I, well, I don’t agree with that only because I had a very different experience in my doctor was incredibly helpful and sort of every time I’ve been back in to get a repeat prescription they always sort of check that I’m okay with the contraception I’m on. And they do mention the alternatives to sort of warn me and stuff so I’ve I think I’ve had quite a different experience.
 
Katie' It depends, doesn’t it, on the doctor.
 
Alice' Yeah, I’ve always felt like my doctor has sort of had time to talk to me about it.

 

The young women we talked to advised others to find out as much as possible before deciding which contraception to use. They also reminded people that everyone reacts differently so not to be persuaded by the experiences of family members or friends.

 

Chloe advises young women not to be influenced by others, or to start LARCs too young, or to use...

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Age at interview: 21
Sex: Female
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With using the injection as a contraceptive, I would just say make sure that you are comfortable within yourself and you’re doing it for you and you understand the risks. It does have different effects on different people so you can’t go by someone else’s experience to judge whether you want to but if you are to try it, I would say probably have the breaks and not for long periods of time because that’s when obviously the worser side effects are more likely to have an affect but I don’t think it’s a bad form of contraception, in moderation. And for younger women, I think that maybe they should think even more about it especially like how I was fourteen to, in the, like when you’re developing and things like that. I don’t know exactly scientifically if it does have this effect or that effect but just knowing generally that any substance that’s not supposed to be there when you’re developing or have an effect on your body.

 

Natasha advises women to make an informed choice and if in a relationship, to discuss their...

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Age at interview: 25
Sex: Female
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If you decided to become sexually active or if for some reason your doctor said that you need to go on contraception to regulate blood flow or to control your really bad skin or something then ask your doctor for all the potential options. Ask them for all the options that you can have be it the pill, the patch, there’s the injection, the IUD, all of them. Really find out about the options that are available to you because what someone tells you is usually only part of what is out there. And once someone tells you what is out there find out for yourself. Go online because it is completely anonymous. No one is going to know. Find out about these different things. Ask your friends. If you have a sister ask your sister, ask your cousins, you know, but just remember that you’re. I think it’s really hard for girls because you feel like you are alone and you’re not and you’re really, really not because I think there is a certain stigma attached to it if you go on contraception it means, ‘Oh well she is clearly spreading it around isn’t she’. Probably she is not, she’s probably trying to be safe and that is a good thing.

And if you are in a relationship talk to your boyfriend because that’s the person who should be supporting you when you do something like this You know and if you do have a really good stable loving relationship where there is mutual respect and trust have him go to the clinic with you. Have him go through the options with you like saying ‘Well I’m going to get this. Do you feel comfortable with that or would you prefer that I got this or I feel happy with this?’ You know like make it be a really collaborative process about what you are doing because at the end of the day it’s your body but if you are in a relationship with someone, you know.
 

LARCs are over 99% effective against unwanted pregnancies. But, only condoms or not having sex offers protection against sexually transmitted infections, including HIV.

Last reviewed January 2016

Last updated January 2016
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