Forty years, four decades. That’s how long the average woman’s reproductive years extend, with peak fertility occurring between the teens and late 20s.
Contraception, birth control or family planning therefore, is a dominant issue in women’s lives for a long time but how do you choose the best method for you? Are there contraceptives suited to particular ages and stages?
Dr Caitríona Henchion is medical director of the Irish Family Planning Association. She believes that choosing a contraceptive method is less related to what age you are and more to do with your life plan.
“You could have someone who is quite young but is planning to become pregnant in a year or two, whereas you might have someone a bit older who isn’t planning on having a child,” she says.
“If somebody is at the stage in their life where they don’t want to become pregnant in the next five plus years, they might be more inclined to choose a long-acting reversible method, for example.
That would be either the sub-dermal implant (SDI) that goes under the skin in the arm or one of the wide variety of intrauterine devices (IUDs) available, both hormonal and non-hormonal. The implant lasts three years and the IUDs lasts either five, eight or 10 years depending on which one you choose.”
While the above methods are considered long-term they can be reversed at any time, explains Caitríona, with ovulation usually returning within four weeks.
“Some women, though, prefer the pill or the contraceptive patch where they are in control of saying ‘I’ll just stop when I’m ready’. It’s really down to the individual.”
Another factor which determines women’s choice is whether or not they are procedure averse.
“Some would be anxious about procedures like having the coil fitted and some are needle phobic so they might not choose to have an implant,” she says. “These may just opt for a shorter-acting method even though they may really want longer-term contraception.”
Fit and forget
It is difficult to say which is most popular, she says, based on her experience at the IFPA’s clinics.
“Long-acting methods – the ‘fit and forget’ types – have become a much bigger part of what we are doing, though, since the Free Contraception Scheme started because cost is no longer an issue.
Dr Caitríona Henchion, medical director of the Irish Family Planning Association.
“With the long-acting methods there are up-front costs attached so younger women in particular may not have had the money to pay for the doctor visit, the insertion visit and the device itself so they weren’t choosing these methods so much.”
The average total cost of this type of contraceptive, nationally, is around €300, if paying privately.
The Free Contraception Scheme was introduced in Ireland in early September 2022, initially for those aged 17 to 25. It was expanded to include 26-30 year-olds in 2023 and further expanded to include women aged 31 in January 2024 and to 32-35 year-olds on 1 July 2024. Those over 35 will still have to pay if they don't have a medical card.
There have been other positives with the free scheme. “Many women of all ages have done a bit more research into what they might like because they now know that they can get whatever they want, this has encouraged people to educate themselves,” she says.
Combined or ‘mini’ pill?
So if people are using the pill which type is more popular now – the combined version (oestrogen and progesterone) or the mini one (progesterone only)?
“Many more people use the mini or progesterone-only pill now for a variety of reasons,” says Caitríona.
“The combined pill requires normal blood pressure and is not suitable for those with a history of severe migraine, for smokers over the age of 35 or those who are very overweight. That rules out several cohorts of women.”
Mini pills are now more effective than they once were, she believes. “In the past, the progesterone-only mini pill didn’t prevent ovulation and was very reliant on someone taking it at exactly the same time every day. Now there is a more commonly used one, however, that is also an ovulation suppressant, so that automatically makes it safer.”
We also advise getting regular sexual health check-ups because condoms don’t 100% protect against STIs
You still must be careful to take it at the right time, however. “Setting reminders on your phone is a good idea,” she says.
Heavy periods can be a reason why women in their early 40s opt for intra-uterine options like the Mirena coil, she says. “It is also a treatment for heavy periods so it can be really beneficial, managing both your contraception and heavy period issues with the one method.”
However, if you are absolutely certain that you do not want to have a child or that your family is complete, you can decide on a permanent method like a tubal ligation or your partner might decide to have a vasectomy.
“That does mean you have to be really, really sure,” says Caitríona. “For women this procedure isn’t as straightforward as it is for men.
“A vasectomy is often available in primary care settings but getting one’s tubes occluded or tied is a hospital-based procedure so therefore, you’re going to come up against things like waiting lists and having to have an anaesthetic.
None of the oral contraceptives or long-acting methods reduce the risk of sexually transmitted diseases, however.
“We would always say to women if you don’t feel that you are in a stable, monogamous relationship on both sides and if there is any risk of STIs, then you should consider continuing to use condoms.
“We also advise getting regular sexual health check-ups because condoms don’t 100% protect against STIs.”
Fit and forget methods
Long-acting and reversible. These include the hormonal or copper coil.Implant – a rod placed under the skin of the arm that gradually releases hormones.Injections – a hormone shot into a muscle.User-dependent methods
To be effective, these methods need perfect use. Such methods include short-acting, hormonal contraceptives which stop the ovaries from producing eggs.Combined pill, mini pill, vaginal ring, patch.Barrier methods which block the sperm from reaching the egg. Diaphragms and condoms.Fertility awareness strategies
These are non-medical strategies for avoiding pregnancy. However, they are less reliable than modern methods. Withdrawal (removal of the penis before ejaculation).Tracking ovulation. Fertility awareness apps (prediction of fertile time based on previous cycles). Emergency contraception
Effective for up to five days after unprotected sex, this post-sex contraception prevents pregnancy when regular contraception has failed or wasn’t used.Emergency contraceptive pill.Copper coil – works as a method of emergency contraception as it may stop an egg being fertilised or implanted in the uterus (womb). See citizensinformation.ie/en/health/health-services/reproductive_health/contraception. Also see ifpa.ie and hse.ie
Read more
Healthbytes: the latest in the world of healthcare
Health: it's either go - or go blind
Forty years, four decades. That’s how long the average woman’s reproductive years extend, with peak fertility occurring between the teens and late 20s.
Contraception, birth control or family planning therefore, is a dominant issue in women’s lives for a long time but how do you choose the best method for you? Are there contraceptives suited to particular ages and stages?
Dr Caitríona Henchion is medical director of the Irish Family Planning Association. She believes that choosing a contraceptive method is less related to what age you are and more to do with your life plan.
“You could have someone who is quite young but is planning to become pregnant in a year or two, whereas you might have someone a bit older who isn’t planning on having a child,” she says.
“If somebody is at the stage in their life where they don’t want to become pregnant in the next five plus years, they might be more inclined to choose a long-acting reversible method, for example.
That would be either the sub-dermal implant (SDI) that goes under the skin in the arm or one of the wide variety of intrauterine devices (IUDs) available, both hormonal and non-hormonal. The implant lasts three years and the IUDs lasts either five, eight or 10 years depending on which one you choose.”
While the above methods are considered long-term they can be reversed at any time, explains Caitríona, with ovulation usually returning within four weeks.
“Some women, though, prefer the pill or the contraceptive patch where they are in control of saying ‘I’ll just stop when I’m ready’. It’s really down to the individual.”
Another factor which determines women’s choice is whether or not they are procedure averse.
“Some would be anxious about procedures like having the coil fitted and some are needle phobic so they might not choose to have an implant,” she says. “These may just opt for a shorter-acting method even though they may really want longer-term contraception.”
Fit and forget
It is difficult to say which is most popular, she says, based on her experience at the IFPA’s clinics.
“Long-acting methods – the ‘fit and forget’ types – have become a much bigger part of what we are doing, though, since the Free Contraception Scheme started because cost is no longer an issue.
Dr Caitríona Henchion, medical director of the Irish Family Planning Association.
“With the long-acting methods there are up-front costs attached so younger women in particular may not have had the money to pay for the doctor visit, the insertion visit and the device itself so they weren’t choosing these methods so much.”
The average total cost of this type of contraceptive, nationally, is around €300, if paying privately.
The Free Contraception Scheme was introduced in Ireland in early September 2022, initially for those aged 17 to 25. It was expanded to include 26-30 year-olds in 2023 and further expanded to include women aged 31 in January 2024 and to 32-35 year-olds on 1 July 2024. Those over 35 will still have to pay if they don't have a medical card.
There have been other positives with the free scheme. “Many women of all ages have done a bit more research into what they might like because they now know that they can get whatever they want, this has encouraged people to educate themselves,” she says.
Combined or ‘mini’ pill?
So if people are using the pill which type is more popular now – the combined version (oestrogen and progesterone) or the mini one (progesterone only)?
“Many more people use the mini or progesterone-only pill now for a variety of reasons,” says Caitríona.
“The combined pill requires normal blood pressure and is not suitable for those with a history of severe migraine, for smokers over the age of 35 or those who are very overweight. That rules out several cohorts of women.”
Mini pills are now more effective than they once were, she believes. “In the past, the progesterone-only mini pill didn’t prevent ovulation and was very reliant on someone taking it at exactly the same time every day. Now there is a more commonly used one, however, that is also an ovulation suppressant, so that automatically makes it safer.”
We also advise getting regular sexual health check-ups because condoms don’t 100% protect against STIs
You still must be careful to take it at the right time, however. “Setting reminders on your phone is a good idea,” she says.
Heavy periods can be a reason why women in their early 40s opt for intra-uterine options like the Mirena coil, she says. “It is also a treatment for heavy periods so it can be really beneficial, managing both your contraception and heavy period issues with the one method.”
However, if you are absolutely certain that you do not want to have a child or that your family is complete, you can decide on a permanent method like a tubal ligation or your partner might decide to have a vasectomy.
“That does mean you have to be really, really sure,” says Caitríona. “For women this procedure isn’t as straightforward as it is for men.
“A vasectomy is often available in primary care settings but getting one’s tubes occluded or tied is a hospital-based procedure so therefore, you’re going to come up against things like waiting lists and having to have an anaesthetic.
None of the oral contraceptives or long-acting methods reduce the risk of sexually transmitted diseases, however.
“We would always say to women if you don’t feel that you are in a stable, monogamous relationship on both sides and if there is any risk of STIs, then you should consider continuing to use condoms.
“We also advise getting regular sexual health check-ups because condoms don’t 100% protect against STIs.”
Fit and forget methods
Long-acting and reversible. These include the hormonal or copper coil.Implant – a rod placed under the skin of the arm that gradually releases hormones.Injections – a hormone shot into a muscle.User-dependent methods
To be effective, these methods need perfect use. Such methods include short-acting, hormonal contraceptives which stop the ovaries from producing eggs.Combined pill, mini pill, vaginal ring, patch.Barrier methods which block the sperm from reaching the egg. Diaphragms and condoms.Fertility awareness strategies
These are non-medical strategies for avoiding pregnancy. However, they are less reliable than modern methods. Withdrawal (removal of the penis before ejaculation).Tracking ovulation. Fertility awareness apps (prediction of fertile time based on previous cycles). Emergency contraception
Effective for up to five days after unprotected sex, this post-sex contraception prevents pregnancy when regular contraception has failed or wasn’t used.Emergency contraceptive pill.Copper coil – works as a method of emergency contraception as it may stop an egg being fertilised or implanted in the uterus (womb). See citizensinformation.ie/en/health/health-services/reproductive_health/contraception. Also see ifpa.ie and hse.ie
Read more
Healthbytes: the latest in the world of healthcare
Health: it's either go - or go blind
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