Longer acting contraceptive methods may be more appropriate if convenience is an issue. Contraceptive effects are not user dependent and can last several years for progestogen implants, hormonal coils (intra-uterine system/IUS), copper coils (intra-uterine device/IUD). However, initial insertion or injection can be painful, with the possibility of heavier periods initially. there is also a risk an IUS or IUD can fall out, particularly in the first three months after insertion.¹⁰

The subdermal implant releases etonogestrel to suppress ovulation, thicken cervical mucus and modify the endometrium. It provides “very effective” contraception for three years, with only 0.05% of users having unplanned pregnancies in the first year. While the implant is licensed for use in 18-40 year olds, the Faculty of Reproductive and Sexual Health (FSRH) supports use from the onset of periods (menarche) to 55 years, in part due to the low number of contraindications.¹⁵

However, side effects include the possibility that bleeding become unpredictable with changes in the pattern including spotting or amenorrhoea (an absence of periods). While headache is commonly reported, causation has not been established. There may also be skin changes including worsening or improved acne.

The IUS and IUD carry a risk of penetrating through the womb wall (fewer than 2 in 1,000 insertions) and the very rare risk of ectopic pregnancy.¹⁰