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Did you know there are 15 methods of contraception? According to a recent survey, 75 per cent of people would answer 'no' to that question.

Despite the many options, twenty five per cent of women use the contraceptive pill, and in the under 18 age bracket that rises to one third.

Interestingly, a recent survey among men showed that nine in every ten would NOT take a male contraceptive pill if it were available - citing concerns over long term effects.

Nine in every ten men would NOT take a male contraceptive pill if it were available

Side Effects

A vast number of the contraceptive methods we use are hormonal. As a result - they affect us psychologically and physiologically.

Search 'Microgynon [or the name of any other hormonal birth control pill] side effects' and you'll find reams of forum entries created by women suffering from side effects: nausea, mood swings, bloating, and loss of libido. It has also been linked to blood clots, an increased risk of breast cancer and can increase blood pressure.

For active women, there are still more concerns.When we spoke to Dr Stacy Sims, of Osmo nutrition, she explained that the hormonal contraceptive pill raises levels of oestrogen and progestogen by 6-8 times. This decreases the ability to reach high intensities, and increases body temperature, and recovery time.

Of course, most of us are not elite athletes and would rather be 5 per cent less efficient than have an unplanned pregnancy, but few of us like to think of our moods and emotions being drastically affected by synthetic hormones.

Over-prescribed

The pill works for many women - but it's not the only option, and some people argue it is oversubscribed by an overworked NHS - as this rather hilarious poem explains:

Here's a look at the options available, with a close eye on the effect each one has on a woman with a very active, cyclist's lifestyle...

pill

The combined pill is the most popular, and contains oestrogen and progestogen - these prevent ovulation.

  • Taken daily, the pill is said to be 99 per cent effective when used correctly. It is easy to take, very convenient, and for many women has a positive impact on PMS.
  • Many women report side effects such as mood swings, weight gain, nausea, tenderness and headaches.
  • A recent study of 90 women showed that those on the pill had lower cortical thickness measurements in the brain - which scientists said would affect decision making, and emotional process as well as memory.
  • Dr Sims told us that the pill has a significant effect on performance - resulting in women being more likely to suffer from over training.
  • Slightly elevated risk of high blood pressure, blood clots and breast cancer
  • Not suitable for women over 35 or who smoke
pill

The progesterone-only pill is usually used by women who can't use a combined pill that contains oestrogen - for example if they find they have a negative reaction, or if they have high blood pressure or a history of blood clots.

Progestogen is the hormone that is released during a natural period and stops sperm from reaching an egg.

  • As the pill, it's 99 per cent effective if taken correctly and can make periods lighter, even causing them to cease altogether.
  • Suitable for women over 35 (unlike the combined pill) and those who find oestrogen hormonal methods don't work
  • Change in hormones can result in mood swings, bloating, weight gain and headaches
  • Must be taken at the same time every day - if you take it three hours late, it may not be effective
  • Progestogen increases sodium loss and increases core temperature - so it still has an impact upon ability to reach high intensity and recovery
  • Slightly higher risk of developing breast cancer than women not on the pill
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Injection

There are three types of contraceptive injection - it can last 8, 12 or 13 weeks depending upon the option you choose. The injection releases a steady flow of the hormone progestogen.

  • More than 99 per cent effective
  • Could reduce the chance of cancer of the womb and offers some protection from pelvic inflammatory disease
  • Progestogen affects athletic performance as described
  • The 12 week variety (Depo-Provera) affects your natural oestrogen levels, which can cause thinning of the bones which in active women could elevate the risk of stress fractures
  • Side effects include tenderness, mood swings, nausea, weight gain, and headaches - it can't be removed once it's been administered in the same way you can stop taking the pill
  • Can affect fertility for some time after it has worn off and can make periods disappear, or become heavier, depending on how you react

Implant

The implant works like the injection, releasing progestogen, but it lasts for up to three years (though it can be removed earlier).

The pros and cons are similar to the injection, except that the effect on periods (being heavier, lighter or non-existent) can last for around a year, usually settling down after the first 12 months.

patch

In the UK, the prescribed patch's brand name is Evra. It is a sticky patch (around 5cmx5cm) and is replaced every week, for three weeks - then you have one 'patch free week'.

  • More than 99 per cent effective when used correctly though 91 per cent effective for the average woman
  • Doesn't need to be taken daily
  • You can wear it swimming and when playing sport, it won't peel off like a plaster, but it may not be suitable for women over 35.
  • The Patch contains the same hormones as the combined pill - progestogen and oestrogen. As a result, it can have the same impacts upon mood, and athletic performance.
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When we spoke to Dr Stacy Sims about contraception and performance, it was the IUD, IUS and NuvaRing (coming up soon) that she suggested, as well as barrier methods such as condoms. Both the IUD and IUS are 'more than 99 per cent effective' and are fine for women of all ages.

In both cases, fitting usually takes between 15 and 20 minutes.

Intrauterine device (IUD)

The IUD, also known as the coil, is a plastic and copper device that is inserted into the womb by a nurse. The copper changes the make-up of the fluids in the womb and fallopian tubes, stopping sperm surviving there.

  • It can last from 5 - 10 years
  • It is non-hormonal so should not effect your natural moods or performance
  • It needs to be fitted and removed by a professional. The process can be uncomfortable (particularly in women who have not had children).
  • Some women experience cramping or bleeding in the first weeks after insertion, so active women should consider when they have it inserted
  • Periods can become heavier, and more painful. Most common reason for having an IUD removed is pain/bleeding

Intrauterine system (IUS)

The IUS is a small plastic device that is inserted into the womb, again by a nurse or doctor. Unlike the coil, it releases progestogen - but Dr Sims did comment that the dose is smaller and localised, thus has a lesser effect on the rest of the body.

  • It lasts 3-5 years
  • Needs to be fitted by a professional
  • It can make periods lighter or make them disappear altogether - can prevent ovulation
  • Fitting can result in cramps, discomfort or bleeding so active women should time the fitting around their events and training
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The NuvaRing has been available for over a decade, but it's a lesser known method.

The flexible ring is placed inside the vagina every month (with one week off) and releases a low, localised dose of estrogen and progestin to prevent pregnancy. Because the dose is low and localised, it was one of the suggestions made by Dr Sims.

  • More than 99 per cent effective when used correctly though 91 per cent effective for the average woman
  • Doesn't get in the way of sex (we've been promised)
  • You can remove and replace if yourself with ease
  • May reduce PMS and periods may be lighter
  • Thousands of women use them with no problem, but there are documented cases of women developing blood clots. It is rare, but you do need to be aware
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The Diaphragm and Cap are both barrier methods - but they're not as widely used as the humble condoms which most of us had to fit to strange phallic instruments in Sex Ed at school.

Diaphragm

  • This method is 92-96 per cent effective when used correctly, but this is reduced to 88 per cent for the average woman
  • This is a thin silicone or latex device which is inserted into the vagina before sex, and it covers the cervix so that sperm can't get into the womb. You do need to use spermicide with it, and must keep it in for six hours after sex.
  • It's not hormonal at all and therefore has no effect on mood, performance or your natural cycle
  • Comes in various sizes, must be fitted by a nurse
  • If you gain or lose a significant amount of weight, you may need it re-fitted

Cap

  • The cap is very similar to the Diaphragm, but is always made of silicone and a slightly different shape

Caya One Size Diaphragm

  • Caya became available in the UK this year and it's the first updaye to the Diaphrahm since the 1960s (almsot like women are starting to wonder if the pill isn't a magic pill after all?)
  • Caya works like a Diaphragm, but is one size fits all - so you can skip the pelvic examination and even buy them online
  • Caya is inserted much like a tampon - it's non-hormonal and can be used with 'Caya Gel' for extra protection
  • It is highly effective when used correctly, but a study found it to be 86 per cent effective in 'real life' - this is similar to the 'real life' findings for condoms and other methods

Condoms - Male and Female

  • Male condom is 98 per cent effective and female condom is 95 per cent effective - when used correctly - though this can be reduced to 79 and 82 per cent due to human error
  • Can affect sensation
  • Has no effect on hormones, regular cycle, moods or performance
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This method isn't widely used these days, but thanks to some newly created mobile apps, it's making a come-back (no pun intended).

There are no hormonal changes involved, but the method relies upon you knowing when you're fertile, and avoiding sex at those times. Apparently, it can be 99 per cent effective, but taking into account human error, can end up being more like 75 per cent effective.

Traditionally, the NHS recommend you speak to a trained fertility awareness professional before beginning, and you'd need to keep a daily record.

However, there is now "an app for that". Natural Cycles is one such app, that uses an "intelligent algorithm" based on a temperature measurement taken at the start of the day, to predict ovulation and the fertile window.

The app builds a calendar and gives you green days, and red days - when you could get pregnant.

Our initial worry was that some athletic women don't have regular cycles. What then? Natural Cycles explain that the system takes this into account and creates "a tailor-made solution for each individual."

They say: "the NaturalCycles algorithm will not yield green (non-fertile) days unless 99.9% certain you are not fertile. To capture your unique cycle pattern from the start, try and answer the questions upon registration to the best of your knowledge. "

BM1R5Y Surgeon choosing surgical scissors

We saved these two until last, because they're pretty final.

Female sterilisation - called tubal occlusion - involves the fallopian tubes being cut, and it cannot be easily reversed. Periods can continue, but you won't get pregnant.

Male sterilisation - a vasectomy - means the tubes that carry sperm from the testicles are sealed and cut. Again, it can't be easily reversed but does mean contraception will be a thing of the past.

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