Alternatives to the pill

• The Patch – combined hormonal contraceptive that sticks to skin with the hormones being absorbed.
• The Ring – a combined hormonal contraceptive inserted in the vagina similar to a tampon.
• The Implant – a progesterone only contraceptive rod placed in the upper arm periodically.
• The Injection – a progesterone only injection in the upper arm or buttock every two to four months depending on the type.
• An Intrauterine System (IUS) – a thin plastic rod containing progesterone placed in the womb.
• An Intrauterine Device (IUD) – a thing plastic rod containing copper placed in the womb
• Condoms – a latex or polyurethane sheath placed inside the vagina or over the penis.
• Caps and Diaphragms – latex or plastic barriers placed in the womb to shield the cervix. Often used with spermicide to be effective.
• Natural methods – withdrawal or ovulation monitoring (fertility awareness). Some apps can help with this but it is not a reliable method.
• Emergency Contraception – a high dose pill of combined hormones to delay ovulation only after unprotected sex and not as a form of long-term contraception.
• Sterilisation –cutting of fallopian tube or sperm carrying tubes in both women and man. It's often a permanent method as the surgery can be quite invasive.

These methods are all viable options and you will need to choose the one that suits you best. This page will concentrate on the combined hormonal alternative to the pills – the patch and the ring.

The contraceptive ring releases hormones into the body in the same way as the contraceptive pill does, but you do not need to swallow a pill every day.

• The ring is inserted into the vagina and lasts for three weeks.
• For the fourth week, the ring is taken out and you will experience a withdrawal bleed (period).
• The new ring is then inserted for the next month.

When used correctly, the contraceptive ring is 99% effective. As the hormones are absorbed directly into the bloodstream, some women find they have fewer side effects, especially if they experienced side effects digesting a contraceptive pill.

How the contraceptive ring works

The vaginal ring is a soft plastic circle that is impregnated with synthetic oestrogen and progesterone. It is colourless and measures around 54 mm when laid flat. It's inserted by hand and once in place, it needs no further action for the following three weeks. You don't need a doctor to insert a contraceptive ring.

The sex hormones progesterone and oestrogen are slowly released into your bloodstream. It works the same way as the pill:

• Firstly, it prevents ovulation (so an egg is not released).
• It thickens cervical mucus so sperm cannot enter if an egg is released.
• It changes the womb lining so an egg cannot survive there.

It's possible to take the contraceptive ring without a break so you can skip your period, although this should not be done more than three times in a row.

How to use the contraceptive ring

The contraceptive ring is 99% effective but it must be taken correctly or the effectiveness rate will fall and put you at risk of pregnancy.

Inserting a contraceptive ring is similar to using a tampon:

• Remove the ring from its packet
• Push together to make a thinner 8 shape
• Get into a comfortable position for insertion
• Push the ring inside your vagina until you can't feel it

The ring does not to be circular when it's in place. When the ring is inserted, you shouldn't be able to feel it and you can carry on any day-to-day activities such as swimming and running. Penetrative sex is also not affected by the ring.

Removing the contraceptive ring

After three weeks you will need to remove the ring by hooking your index finger around and gently pull it out. After a seven-day break, during which you are likely to have a withdrawal bleed similar to a period, you should insert another ring even if you are still bleeding.

Pros of contraceptive ring

• When used correctly, its effectiveness rate is just as high as the combined pill at approximately 99%.
• It's much lower maintenance - it requires less effort than the pill because you can forget about it for three weeks.
• It is easy to use and if you are unwell (vomiting or diarrhoea) its effectiveness is not altered, unlike the pill.
• The combined hormones mean you have control over your fertility and your menstrual cycle. You can skip a period on occasion.
• The hormones can make your periods lighter, shorter and reduce PMS.
• Women who experience polycystic ovaries, endometriosis and acne may find their symptoms lessen.
• Combined contraceptives provide a level of protection against ovarian and endometrial cancer.

Cons of contraceptive ring

• There is no protection against sexually transmitted infections. Only barrier contraceptives like condoms can prevent STIs.
• You may experience some side effects like bleeding between periods, bloating, headaches and nausea. This often settles down as your body becomes accustomed to hormones but speak to your doctor if they last more than three months.
• On a rare occasion, the ring may fall out. For example, if you are still bleeding and a tampon pulls it clear. Follow the advice below if this is the case.
• Some couples report that they can feel the ring during sex. Readjust the ring if this is the case for you.
• As with all combined contraception there are some slightly increased risks. These include a small increase in your blood clot risk, a slight rise in the risk of breast and cervical cancer and a slightly raised risk of benign liver tumours.

If the ring falls out

• If the ring has been out for more than three hours during the first two weeks, you will not be protected. Put a new ring in and condoms for the following seven days. If it is within three hours, rinse the ring and reinsert it.
• If the ring has fallen out in the third week, dispose of it completely. You can now either place a new ring in straight away and skip a period OR choose to have a seven-day interval slightly early before continuing again as normal. Use condoms for the following seven days.
• If you forget to insert a new ring on the eighth day, insert one as soon as you can and use additional barrier contraception for the following seven days. If you've had sex during this period, you may need emergency contraception.
• If you forget to take the ring out during the seven-day interval after the three weeks, take the ring out and continue the seven-day interval as normal. You should still be protected against pregnancy. If you forget to take the ring out for over four weeks, take the ring out and insert a new ring immediately. Use condoms for the following seven days.

The contraceptive patch is a sticky patch placed on your skin to deliver the hormones oestrogen and progesterone. It's just as effective as the pill with a rate of over 99% and delivers the same benefits in terms of menstrual cycle control and reduction in PMS symptoms.

How the contraceptive patch works

The patch measures 5cm x 5cms which is placed flat anywhere on the skin that is not rubbed by clothing. It prevents pregnancy in the same ways as the pill and the ring by using two hormones progesterone and oestrogen to alter how your hormones work.

• The patch prevents ovulation (release of an egg)
• Thickens cervical mucus so sperm cannot enter the womb
• Changes the womb lining so an egg cannot survive there

How to use the contraceptive patch

It is very simple to use the patch correctly:

• Choose a location that is flat without hair.
• The patch needs to lay flat to deliver all its hormones so a crease such as a knee or elbow is not suitable.
• Most women use their upper arms, buttock, thigh or back.
• Avoid wearing tight clothes in these locations.
• Ensure your skin is dry and free from powder or lotions otherwise the patch won't stick correctly.
• Gently open the packet and peel the transparent cover away from the patch.
• Press firmly for ten seconds to ensure it is fully attached.
• Once it's in place you can peel back the outer film.

Once the patch is in place it will work for one week. You need to replace it every seven days for a maximum of three weeks. After three weeks you should take a seven-day break.

After seven days have passed attach a new patch. You can choose a different location each time to minimise irritation.

Pros of the patch

• 99% effectiveness rate when used correctly
• It's a weekly task rather than a daily one, meaning you may be less likely to forget it.
• The patch is discreet and very unlikely to fall off, including showering and swimming.
• If you vomit or have diarrhoea, the effectiveness of the patch is unaffected.
• It can lighten, shorten and make periods regular as well as reducing PMT, like the combined pill.
• It can lessen the symptoms of endometriosis, acne and polycystic ovary syndrome. Like the ring and combined pill, it may reduce the risk of womb and ovarian cancers.

Cons of the patch

• You can place your patch in a discreet area but it may still show whilst swimming or during sex. It is also only available in one colour (beige).
• You need to change the patch each week. This is still fairly frequent compared to long-term methods such as the IUD, ring and injection.
• It can cause irritation and itching in the local area if you have sensitive skin. It's a good idea to move the area each week to avoid this.
• Some women experience side effects such as headaches, nausea, breakthrough bleeding and breast tenderness. If it doesn't settle after three months, speak to your doctor about an alternative contraceptive.
• The patch does not protect against sexually transmitted diseases (STIs). Only condoms can do this.

What if the patch falls off?

• If the patch has been off for under 48 hours, stick it on as soon as possible if it is still sticky. If it isn't, replace it with another patch and continue as normal. Don't try and stick the patch to your skin with a plaster or bandage. You will still be protected.
• If the patch has been off for over 48 hours or you're not sure, apply a new patch as soon as possible and continue for the full cycle again. Use condoms for the following seven days. If you've had sex during this time, you may need emergency contraception.
• If you forget to take the patch off within 48 hours (8-9 days in total) continue with a new patch. You are still protected. If you forget to take the patch off over 48 hours (10 days plus), apply a new patch and this will be day one again. Continue for seven days and change. Your usual change date will alter and you will need to use condoms for the following seven days.
• If you forget to put a new patch on after a seven0day interval and it's within the first 48 hours, apply a new patch. You will still be protected. If it is over 48 hours, apply a new patch and use condoms for the following seven days. If you've had sex during this period, you may need emergency contraception.

The patch and ring are prescription only items. If you want to start using the patch or ring, speak to your doctor who is able to issue a prescription depending on your suitability. Some women who are sensitive to oestrogen, have aura-migraines, are overweight, smoke or have a history of blood clots are not likely to be suitable.

However, there are many contraceptive options available, some of which do not contain combined hormones. Speak to your doctor or contraceptive nurse about what best suits you.