Hello and welcome to today's webchat. We are joined in the studio today by Dr Diana who'll be chatting us through the different types of contraception on the market and how they work.

Jenny would like to know:

Whose to blame for this lack of knowledge? Should women be more proactive about seeking new forms of contraception or should doctors make more of an effort to educate their patients about what other options are on the market?

Dr Diana

The problem lies with both the health professional and men and women. We, as patients, are often too shy or feel we cannot ask the right questions and often doctors and nurses don't tell us all the options. For the future, we hope that health professionals will give all contraceptive options (as guidance has been given from the dept of health) but also we need to make sure that men and women feel comfortable about asking questions about choice in contraception.

Our next question comes from Helen, who asks:

Are certain types of contraceptives better for you than others i.e. in relation to lifestyle and age?

Dr Diana

There are thirteen methods of contraception available in the U.K. and it is for users to make the decision about which method is most suitable for them. Some of the methods offer real non-contraceptive benefits. By this I mean helping with period problems, improving acne, getting rid of some of the mood swings and they can be used to help some gynaecological problems. For young women remembering to take the pill is difficult (actually that's true for many women) therefore there are some very effective reversible contraceptive methods available. These are often a well-kept secret. The contraceptive implant is becoming very popular because once it's fitted you can forget about contraceptive needs for three years. The injectable needs to be given every twelve weeks and some women find that they forget this appointment so having a longer acting method is ideal.

Vicky wants to know:

Do you feel that women should change the type of contraception they use every few years? What is the benefit of doing this?

Dr Diana

I think if you've found a method of contraception that suits you and works for you there is no need to change. If you're taking a pill and you can remember to take it then there is no evidence that long-term use will have effect on your health. It is far more dangerous to stop a good method of contraception because so often you can become pregnant!

Caroline says:

I've seen in the papers this week about the pill but I forget to take mine. All my doctor tells me is that there is 'the injection'. Are there any other things for me to try?

Dr Diana

Very often GPs and practice nurses only offer pills, condoms and injections as contraceptive options. There are some very good, long-acting contraceptive methods that are more effective and very well accepted. These include the contraceptive implant, the copper intra-uterine device and the hormonal intra-uterine system. If you find that your GP cannot offer these methods and you want more information then contact your local family planning clinic or the family planning association. www.fpa.org.uk

Kea has a personal query:

I'm 24 and have been on the pill for 5 years. I'm currently not a serious relationship and so would like to come off the pill but am worried that condoms may not provide enough protection. What are best options for someone in my situation?

Dr Diana

The good thing about condoms is that they do provide protection against sexually transmitted infections. All other methods do not do this. The pill will make periods lighter and less painful and will also reduce the chance of cancer of the ovary and the lining of the womb. Women in Europe would take the pill long-term even if they're not in relationships for these benefits and then use condoms with new partners. My advice is to continue with your pill as long as you are regularly seen by a health professional and make sure you always have a supply of condoms with you.

Helena wants to know:

I've heard about the coil and would like to know how it works and whom it would work best for. I've heard that it can damage your fallopian tubes. Is this true?

Dr Diana

There are two types of intra-uterine devices. The coil is the common name for the copper intra-uterine device and the hormonal intra-uterine system releases a hormone called progestrogen into the uterine cavity. The copper coil works by the copper killing the sperm before it gets to the egg. The intra-uterine system works by stopping the sperm getting to the egg as it thickens the mucus around the neck of the womb. Neither method causes damage to the fallopian tubes and unfortunately, that is caused by sexually transmitted infections. If you're choosing this sort of method most doctors would check that you have no infection as the insertion of the device may carry these germs into the uterus and increase the chance of a local infection. My advice is, if you're using one of these methods and you have a new partner, use condoms. There is also some evidence that the IUS or intra-uterine system may help protect against infections of the womb and fallopian tubes as it thickens the mucus and has a direct effect on protecting this part of the body.

Becky says:

I've considered taking the pill but am worried about the health risks. Which form of contraception has the least side effects? What's the difference between 2nd and 3rd generation pills?

Dr Diana

The method that has the least side effects is probably saying no but this is just not realistic. Of all the contraceptive methods, condoms and barrier methods have the fewer side effects (natural family planning could also be included) however; they have a high failure rate. The progestogen only pill along with other progestogen-only methods, such as the implant, injectable and intra-uterine system, have very few health risks. When people talk about second and third generation pills they are referring to the type of progestogen contained in a combined pill. All these pills contain oestrogen but the progestogen varies. Second generation progestogens were introduced in the 1970s and third generations progestogens are thought to be 'cleaner' progestogens with fewer side effects and were introduced in the 1980s. There has been discussion whether third generation progestogens cause blood clots and the evidence suggest that if they do, it's a very small increased risk. For many women the third generation pills are more acceptable as they give better cycle control and often improve acne and help with changes during the cycle.

We've got a great question that ties into our previous one as Trish asks:

I'd like to know more about Natural Family Planning. Is this an option that can work for everyone or only married couples?

Dr Diana

Natural family planning is used by about two percent of couples in the U.K. You don't need to be married but you do need to keep a diary. You should have a regular cycle and be prepared to either use condoms when you're most fertile or to not have sex. This is normally for about seven or eight days each month, just before ovulation. Unfortunately, the failure rate for this method in typical use is six to ten percent. So it's good for spacing children but not ideal if you want a method that is very safe and effective.

The contraceptive implant has been available in the U.K. since 1999 although many health professionals still have to be trained to insert and remove the implants therefore you may have to discuss this with your local family planning clinic rather than your GP. It is a very popular method amongst women of all ages and consists of a small rod, about the size of a hairgrip, that is placed under the skin of the upper inside of the arm (under local anaesthetic) and will last for three years. It is very effective with no serious long-term side effects associated with it. It can be removed at any time and a woman's normal fertility returns. The only downside is that it can cause irregular periods but for many they are prepared to put up with having no bleeds or some irregular bleeding because it is an ideal method for them.

Christina wants to know:

I have mood swings but am interested in having an implant. Would this be safer for me than the pill?

Dr Diana

Mood swings can be related to hormone changes and using something that will give you a regular level of hormone without any fluctuations (such as stopping your pill each month) may be of benefit. Using the implant would give you this option and, of course, it could be easily removed if there were problems. This is one real advantage over the injectable, which can't be removed and you have to live with the side effects until it's completely out of your body.

We're now going to do a mythbusters section, where Dr Diana will clarify the truth from the urban legends about contraception.

Esther wants to know:

Will going on the pill make me fat?

Dr Diana

There is no evidence that the pill makes you put on weight. So often women start the pill in their late teens when they are still to reach their final body weight. For some women they may feel hungrier when taking the pill and I'm afraid it is food and alcohol that makes us put on weight. Occasionally some women complain of fluid retention with combined pills so a progestogen-only method may be more suitable.

Jenna asks:

I have heard that if you take evening primrose oil with your pill, it will stop the pill working, is this true?

Dr Diana

No, there is no evidence that it has an effect but if you take St John's Wort this will make the pill less effective and you need to use condoms as well as the pill for it to be effective.

Robyn asks:

Will certain drugs affect how well my pill works?

Dr Diana

The drugs that interfere with the pill are drugs that are used for epilepsy most commonly and some anti-fungal drugs, those often given for HIV can also interfere. It's worthwhile asking your doctor when a prescription is being written for you if this will interfere with your contraceptive method. Antibiotics may have some effect when you take the combined pill but have no effect if you take a progestogen-only method.

Onya wants to know:

Does smoking affect the efficacy of the pill? I'm a ten a day girl myself.

Dr Diana

There is some evidence that smoking can increase the metabolism of the combined pill. Smokers are more often to complain of breakthrough bleeding however there is no real evidence to suggest this leads to an increased failure. I'd suggest you become a zero-a-day girl.

Louise wants to know:

Has anyone developed a wonder pill yet, which can make your boobs bigger and your hair thicker and your skin clearer?

Dr Diana

If they had, I'd be on it. The answer is no. In fact, those women who have big boobs complain that they get bigger and so often, women with no bust say that nothing's happening. There are some combined pills that may make your hair less greasy and improve acne. If you have these problems then it's worthwhile talking to your doctor and looking for pills that contain Desogestrel, Cyproterone, Drospironone.

Now back to the more serious stuff, Wendy asks:

How regularly can you use the morning after pill safely and what are the side effects?

Dr Diana

Hormonal emergency contraception (Levonelle) can be used as often as you need to but if you're needing to use it on a regular basis I'd suggest using a long-term method of contraception. The reason for this is that the failure rate is higher with using intermittent emergency contraception than one of these long-acting hormonal methods. You will also get lots of breakthrough bleeding and your periods will be all over the place. Long-term there is no danger about using emergency contraception and it will not affect your fertility or health.

With just five minutes of the chat to go, Kerry wants to know:

Do all pills have to be taken within the same time everyday or can I find one that will work better for me since I'm very forgetful?

Dr Diana

The pill is not an ideal method if you forget. The combined pill needs to be taken within twelve hours of the same time every day and the progestogen-only pills (except Cerazette) need to be taken within three hours. Cerazette does have a safety window of twelve hours. If you forget your pills for at least twelve hours on a regular basis I would suggest getting more information about the injectables and implants.

Frankie wants to know:

Is there a male contraceptive pill? Do you think women can trust men to take the pill?

Dr Diana

There is no male pill at the moment. We will probably see a hormonal contraceptive method for men in the next five to ten years. Research is investigating injections and implants for men. The real problem is that men do not want to have any 'side effects'.

Jenny, who wants to know:

Where can I go for more advice about contraception if I don't want to talk to my family doctor about it?

Dr Diana

A lot of the issues that we've covered are quite personal and it's not uncommon for people to talk to a health professional that is not their family doctor. It is particularly true for women who have an unplanned pregnancy. I would suggest finding information about your local family planning service or young people's clinics. The numbers should be in the phone book. If you're having problems locating these services then contact the FPA. www.fpa.org.uk

As our last question now, we have Jo who wants to know

How effective is the implant?

Dr Diana

The implant is the most effective method of contraception we have. It is as effective as female sterilisation. That's the beauty of the method so you actually have a real choice about when to get pregnant.

Thank you for joining us for today's webchat. If we haven't been able to get to your question please visit www.fpa.org.uk for more information.