From adolescence to menopause, follow-up is essential. It provides contraception, replacement therapy and cancer screening.
There are two types of contraceptive pill: the combined pill (oestro-progestative) and the progestogen-only pill.
It works by blocking ovulation, thickening the cervical mucus (the sticky substance produced in the neck of the uterus), and affecting the endometrium (lining of the womb). There is a big choice of combined pills that are classified by ‘generations’. Regarding the progestogen-only pills, we talk about micro- or macroprogestatives depending on the dosage. You will notice that certain pills come in strips of 21, and others of 28 days - this depends on the type of contraceptive.
Your pill is chosen by your gynaecologist, who takes into account your medical background and your expectations. The contraceptive pill is the most frequently prescribed means of contraception and is very effective if it is taken strictly on a daily basis. However, it is not a good option if you have problems with absorbing food (malabsorption), frequent vomiting or diarrhoea, or if you are simply too absent-minded to regularly take daily medication.
The side effects of the pill do not necessarily occur in each case but may include: nausea, painful breasts, mood swings, water retention, pelvic pain and changes in libido... These symptoms typically improve after two to three months. If such problems persist, you should consult your doctor to consider a different type of contraception and exclude the risk of another cause for the symptoms. It’s important to understand that these symptoms are not always associated with the pill.
Both types of pill are effective contraceptives, but may also have beneficial effects when it comes to premenstrual syndrome, menorrhagia (abnormally heavy bleeding during menstruation), functional ovarian cysts or acne. The pill is therefore sometimes prescribed for other reasons.
This is a combined contraceptive method containing both oestrogen and progesterone that is applied weekly. There is a lower chance of forgetting about it, and a lower risk of malabsorption as, in this case, hormone absorption happens through the skin.
This is a flexible plastic ring that has to be inserted at the bottom of the vagina, and that diffuses oestrogen and progesterone hormones through the vaginal wall. It remains in place for 3 weeks followed by a break of one week corresponding to the period of menstruation. It is placed and removed easily, in the same way as vaginal tampons.
This is a long-acting reversible contraceptive (LARC) based on progesterone. It is an intramuscular injection (meaning that it is injected into the muscles) that is given every 3 months. This is an invisible and discreet method. However, it requires more frequent consultations.
This match-sized flexible (progesterone-only) tube is placed in the arm under local anaesthetic, during a normal gynaecological visit. It is effective for three years. The implant is the most effective method of contraception. It may reduce or even totally stop the periods, but women may also experience light irregular bleeding in between, that may be annoying in everyday life. An implant is, therefore, an interesting option when there are contraindications against oestrogen; if the patient is less disciplined to take regular medication or if there is a problem of malabsorption, for example.
This is a small, T-shaped object inserted into the uterus which stays there for 3-5 years. There are two kinds of IUD. The first is the copper coil, which stops the sperm from surviving in the womb, and prevents nidation (the embedding of a fertilised egg cell). In this case, the period still occurs, and is often heavier.
The second kind of IUD is a hormonal coil (containing progesterone). This thins the endometrium (lining of the womb) and thickens the cervical mucus. As a consequence, the period may become lighter, or it may even stop. The hormonal IUD is more effective than the copper one.
The IUD is placed during a normal gynaecological visit, during the period, to make insertion easier. It is recommended to take painkillers one hour before the insertion of the IUD to reduce pain. Six weeks later, an ultrasound has to be conducted to ensure the correct positioning of the IUD.
Almost one third of patients are pleasantly surprised by the hormonal coil and enjoy seamless contraception for five years without their periods or unpleasant symptoms. However, a small proportion of patients report periods of irregular bleeding, pelvic pain, ovarian cysts or systemic hormonal effects such as headaches, acne, weight gain or mood swings.
Condoms are less effective than all other methods of contraception previously mentioned. However, their use is very important for protection against sexually transmitted diseases, and they are the only methods of contraception which is effective for this. Be careful! The so-called 'natural' methods are not reliable.
Sterilisation is a surgical procedure most often carried out by laparoscopy (by inserting a small viewing tube [laparoscope] through the abdominal wall to view the organs and permit small-scale surgery). Sterilisation provides permanent contraception. The most common types of sterilisation procedures are ‘tubal ligation’ or ‘bilateral salpingectomy‘ (for women) and ‘vasectomy’ (for men). This option can be considered when you decide, after thorough reflection, that you do not want fall pregnant in the future, and in agreement with your gynaecologist. It is important to make sure that you have considered all other methods of contraception before undergoing such a procedure. In Luxembourg, the cost of the sterilisation procedure is not refunded by CNS.
‘Relative’ contraindications are, among others: smoking, obesity, etc.
Oral contraceptives are not associated with an increased risk of cancer. Moreover, it was found that the risk of colo-rectal, uterine and ovarian cancer among pill users was lower than among pill non-users. Concerning breast cancer, studies differ to an extent, but it seems that there is a slightly increased risk linked to the combined pill. At the same time, there is a contraindication to hormonal contraceptives if the patient has had breast cancer in her personal medical history.