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Hormonal contraceptives work by altering your body chemistry to prevent ovulation (the release of eggs that can be fertilised by sperm) and/ or to thin the lining of the uterus to prevent the implanting of a fertilised egg and thicken the cervical mucus to provide a barrier to sperm (some progesterone-only preparations do not prevent ovulation).

Major advantages of hormonal contraception are that it is woman-controlled and that it requires no administration at the time of having sex. Hormonal contraceptives can be taken as daily tablets (the Pill), as patches, as implants under the skin, as periodic injections or as emergency contraception - the ‘morning after’ pill.

A hormone-releasing contraceptive device can also be inserted into the womb.

There is some evidence that hormonal contraception can increase HIV ‘shedding’ in your genital tract vaginal region), so if your partner does not have HIV, you may want to discuss how this may affect his or her risk of acquiring HIV with your doctor.

The convenience of hormonal contraceptives is unparalleled for women who don’t experience side effects. There are some potentially serious associations to consider, however, and smoking increases these risks considerably.

Risks with hormonal contraception

Hormonal contraceptives increase your risk of cardiovascular disease (heart disease and stroke) that may be of particular concern for women who have high levels of lipids (fats in the blood) caused by anti-HIV medications.

The combined Pill is formally classed as carcinogenic as the incidence of liverA large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood., breast cancer and cervical cancer is increased in women taking it. The risk of getting breast cancer increases by 24 % in women taking the Pill. This may be a matter of concern particularly for women who have other risk factors as well, such as having a strong family history of the disease or having identifi ed that you carry one of the genesThe most basic unit of genetic information. associated with breast cancer.

On the positive side, women taking the combined Pill are less likely to get ovarian or endometrial cancer as there is a protective effect. Weighing up the risks of these serious medical conditions is something that needs to be discussed in detail with your doctor when you are planning your contraception.

Side effects with hormonal contraception

Side effects include weight changes, breast tenderness, mood changes and an increased risk of blood-clot formation. Obesity, a family history of blood clots, long-term immobilisation and varicose veins are associated with a greater risk of side effects, and if more than one of these factors applies, the combined Pill should not be used (see page 46-47 for the different types and delivery systems of hormonal contraception).

Some women experience quite pronounced side effects with longer-lasting contraceptives like the implants and injectable forms. These side effects may include changes to menstrual patterns.

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