Take some time to review the birth control methods you have used to see if there is a link between usage and your bladder infection problems starting. Studies on diaphragms, spermicide in condoms and IUD/IUDs have shown that they can increase the incidence of urinary tract infections. We discuss the issues surrounding each type with regards to UTI as well as the advantages and disadvantages of each method of contraception.
Oral contraception
There are two types of oral contraception available:
- Combined pill – the most common oral contraceptive is a combined pill with oestrogen and progesterone to prevent egg release (ovulation) and pregnancy.
- The Progesterone-only pill also known as the mini pill which prevents sperm passing through the cervix and can also stop egg release (ovulation).
Combined pill
Combined pill
There are many different brands of the combined pill, made up of three main types – combined 21 day pills, phasic 21 day pills and everyday (ED) pills.
21-day pills
This is the most common type. Each pill has the same amount of hormone in it. One pill is taken each day for 21 days and then stoped for the next seven days. Microgynon, Marvelon, Yasmine and Cilest are examples of this type of pill.
Phasic 21-day pills
Phasic pills contain two or three sections of different coloured pills in a pack. Each section contains a different amount of hormones. One pill is taken each day for 21 days and then stopped for the next seven days. Phasic pills need to be taken in the right order. Logynon is an example of this type of pill.
Every day (ED) pills
There are 21 active pills and seven inactive (dummy) pills in a pack. The two types of pill look different. One pill is taken each day for 28 days with no break between packets of pills. Every day pills need to be taken in the right order. Microgynon ED is an example of this type of pill.
Progesterone pill
The “traditional” progestogen-only pill (POP) prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg. The desogestrel progestogen-only pill can also stop ovulation. Progestogen-only pills contain the hormone progestogen, but don’t contain oestrogen.
How do the synthetic hormones in the pill affect the body?
Birth control pills disrupt the body’s normal hormone production with synthetic versions of oestrogen (oestrogen) and progesterone (called progestin) which suppresses ovulation, tricking the body into thinking it is pregnant all month.
Depending on the type of birth control pill you are taking, it can either increase or decrease the effects of your natural hormones (oestrogen and progesterone) in the body. Added to this, every women’s ability to process these synthetic hormones is different so side effects will not be the same for all.
Diaphragms and caps
A contraceptive diaphragm or cap is a circular dome made of thin, soft silicone that’s inserted into the vagina before sex. It covers the cervix so sperm can’t get into the womb (uterus) to fertilise an egg. You need to use it with a gel that kills sperm (spermicide). Diaphragms and caps come in various sizes and your GP will need to examine you to prescribe the appropriate size for you.
Why is there a link with UTIs if you use a diaphragm or cap?
Bladder infections can be a problem for some women who use a diaphragm or cap. A study published in 2000 which included a review of the use of diaphragms or caps has reported an increase in UTIs. This is due to the use of spermicide alongside the diaphragm or cap which affects beneficial vaginal flora, altering its PH and allowing an upsurge in UTI causing bacteria and fungal infections such as candida/thrush. Personal hygiene when inserting the diaphragm or cap is also critical as unwashed hands and the genital area can cause bacterial transfer into the vagina and urethra.
Key points
You only have to use a diaphragm or cap when you have sex, but you must leave it in for at least 6 hours after the last time you had sex. You can leave it in for longer than this, but don’t take it out before.
You need to apply more spermicide if:
- you have sex again with the diaphragm or cap in place
the diaphragm or cap has been in place for three hours or more before you have sex
- Don’t take the diaphragm or cap out to reapply spermicide.
You shouldn’t use a diaphragm or cap during your period as there is a possible link with toxic shock syndrome (TSS), a rare condition that can be life threatening.
Most women are able to use a diaphragm or cap, but it may not be suitable for you if you:
- have an unusually shaped or positioned cervix (entrance to the womb), or if you can’t reach your cervix
- have weakened vaginal muscles (possibly as a result of giving birth) that can’t hold a diaphragm in place
- have a sensitivity or an allergy to latex or the chemicals in spermicide
- have ever had toxic shock syndrome
- have repeated urinary tract infections
- currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap)
aren’t comfortable touching your vagina
- have a high risk of getting an STI – for example, if you have multiple sexual partners
Research shows spermicides that contain the chemical nonoxynol-9 don’t protect against STIs, and may even increase your risk of getting an infection.
A diaphragm or cap may be less effective if:
- it’s damaged – for example, it’s torn or has holes
- it’s not the right size for you
- you use it without spermicide
- you don’t use extra spermicide with your diaphragm or cap every time you have more sex
- you remove it too soon (less than 6 hours after the last time you had sex)
- you use oil-based products, such as baby lotion, bath oils, moisturiser or some vaginal medicines (for example, pessaries) with latex diaphragms – these can damage the latex
If any of these things happen or you’ve had sex without contraception, you may need to use emergency contraception.
Advantages and disadvantages
Advantages of a diaphragm or cap:
- you only need to use a diaphragm or cap when you want to have sex
- you can put it in at a convenient time before having sex (use extra spermicide if you have it in for more than 3 hours)
- there are usually no serious associated health risks or side effects
- you’re in control of your contraception
Disadvantages of a diaphragm or cap:
- it’s not as effective as other types of contraception, and it depends on you remembering to use it and using it correctly
- it doesn’t provide reliable protection against STIs
- it can take time to learn how to use it
- putting it in can interrupt sex
- latex and spermicide can cause irritation in some women and their sexual partners
Condoms
Condoms are a “barrier” method of contraception. They are made of very thin latex (rubber), polyurethane or polyisoprene and are designed to prevent pregnancy by stopping sperm from meeting an egg.
Why is there a link with UTIs if you use a condom?
Spermicide usage can increase UTI risk. A study published by the American Medical Association in 1998 noted that the risk of UTI was significantly increased by the usage of condoms coated with spermicide. The most popular spermicide used for condoms is Nonoxynol-9. This chemical can disrupt your vaginal flora and to suppress the growth of beneficial Lactobacilli. Perhaps switch to non-lubricated condoms to see if that helps.
Other contraceptive products use Nonoxynol-9 including contraceptive film, sponges, suppositories, creams, and tablets. Always check the label and discuss alternatives with your GP or prescribing physician.
Some lubricants also have issues due to Glycerin or Sorbitol addition in their ingredients. These can disrupt your natural vaginal flora. Natural alternative lubricant options include Sylk, Uberlube or Yes. Note that water based lubricants are compatible with natural rubber, latex and polyisoprene condoms and sex toys but oil based ones are not.
Advantages and disadvantages
Advantages and disadvantages of condoms
Some advantages of using condoms:
- When used correctly and consistently, they are a reliable method of preventing pregnancy.
- They help to protect both partners from STIs, including chlamydia, gonorrhoea and HIV.
- You only need to use them when you have sex – they do not need advance preparation and are suitable for unplanned sex.
- In most cases, there are no medical side effects from using condoms.
- They are easy to get hold of and come in a variety of shapes, sizes and flavours.
Some disadvantages include:
- Some couples find that using condoms interrupts sex – to get around this, try to make using a condom part of foreplay.
- Condoms are very strong but may split or tear if not used properly. If this happens to you, practise putting them on so you get used to using them.
- Some people may be allergic to latex, plastic or spermicides, but you can get condoms that are less likely to cause an allergic reaction.
- When using a condom, the man has to pull out after he has ejaculated and before his penis goes soft, holding the condom firmly in place.
Key points
Condoms come lubricated to make them easier to use, but you may also like to use additional lubricant (lube). You can use any type of lubricant with polyurethane condoms that aren’t made of latex. However, if you’re using latex or polyisoprene condoms, don’t use oil-based lubricants – such as lotion, body oil or petroleum jelly (Vaseline) – because they can damage the condom and make it more likely to split. Water-based lubricants are safe to use with all condoms. If you are using medication for conditions like thrush, such as creams, pessaries or suppositories – this can damage latex and polyisoprene condoms, and stop them working properlySome condoms come with spermicide on them. You should avoid using this type, or using spermicide as a lubricant, as it doesn’t protect against STIs and may increase your risk of infection.
IntraUterine Device (IUD)
An IUD is a small T-shaped plastic and copper device that’s put into your womb (uterus) by a doctor or nurse. It releases copper to stop you getting pregnant, and protects against pregnancy for between 5 and 10 years. It’s sometimes called a “coil” or “copper coil”. The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive. It can also stop a fertilised egg from being able to implant itself.
Advantages and disadvantages
Advantages and disadvantages of the IUD
Although an IUD is an effective method of contraception, there are some things to consider before having one fitted.
Advantages:
- It protects against pregnancy for 5 or 10 years, depending on the type.
- Once an IUD is fitted, it works straight away.
- Most women can use it.
- There are no hormonal side effects, such as acne, headaches or breast tenderness.
- It does not interrupt sex.
- It’s safe to use an IUD if you’re breastfeeding.
- It’s possible to get pregnant as soon as the IUD is removed.
- It’s not affected by other medicines.
Disadvantages:
- There’s a small risk of getting an infection after it’s been fitted. If you get an infection when you have an IUD fitted, it could lead to a pelvic infection or UTI if not treated.
- If you have an IUD fitted, you may have a slightly higher chance of getting thrush that keeps coming back. This is because candida spores can anchor to the strings of the IUD and despite treatment, the spores can keep causing reinfections. Speak to a GP if you have an IUD and keep getting thrush. You might want to think about trying a different type of contraception.
- There’s a small risk that your body may push out the IUD or it may move. Your doctor or nurse will teach you how to check it’s in place.
- It can be uncomfortable when the IUD is put in, but painkillers can help.
- It may not be suitable if you have had previous pelvic infections.
- It does not protect against sexually transmitted infections (STIs), so you may need to use condoms as well.
- Your periods may become heavier, longer or more painful, though this may improve after a few months.
- Most women who stop using an IUD do so because of vaginal bleeding and pain, although these side effects are uncommon.
Key points
If you’re 40 or over when you have an IUD fitted, it can be left in until you reach the menopause or you no longer need contraception. Check your IUD is in place a few times in the first month and then after each period, or at regular intervals. An IUD has 2 thin threads that hang down a little way from your womb into the top of your vagina. The GP or nurse that fits your IUD will teach you how to feel for these threads and check that it’s still in place. It’s very unlikely that your IUD will come out, but if you cannot feel the threads or think it’s moved, you may not be protected against pregnancy. See a GP or nurse straight away and use additional contraception, such as condoms, until your IUD has been checked.
IntraUterine System (IUS)
An IUS is a small, T-shaped plastic device that’s put into your womb (uterus) by a doctor or nurse. You may know it by the term Mirena Coil. It releases the hormone progestogen to stop you getting pregnant and lasts for 3 to 5 years, depending on the brand. It thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the lining of the womb so an egg is less likely to be able to implant itself. For some women, it can also prevent the release of an egg each month (ovulation), but most women continue to ovulate.
Advantages and disadvantages
Advantages and disadvantages of the IUS
Advantages:
- It works for 5 years or 3 years, depending on the brand.
- Your periods can become lighter, shorter and less painful – they may stop completely after the first year of use.
- It’s safe to use an IUS if you’re breastfeeding.
- It’s not affected by other medicines.
- It may be a good option if you cannot take the hormone oestrogen, which is used in the combined contraceptive pill.
- It’s possible to get pregnant as soon as the IUS is removed.
Disadvantages:
- There’s a small risk of getting an infection after it’s been fitted. If you get an infection when you have an IUS fitted, it could lead to a pelvic infection or UTI if not treated.
- If you have an IUS fitted, you may have a slightly higher chance of getting thrush that keeps coming back. This is because candida spores can anchor to the strings of the IUS and despite treatment, the spores can keep causing reinfections. Speak to a GP if you keep getting thrush. You might want to think about trying a different type of contraception.
- Your periods may become irregular or stop completely, which may not be suitable for some women.
- Some women experience headaches, acne and breast tenderness after having the IUS fitted.
- Some women experience changes in mood and libido, but these changes are very small.
- An uncommon side effect of the IUS is that some women can develop small fluid-filled cysts on the ovaries – these usually disappear without treatment.
- An IUS does not protect you against STIs, so you may need to use condoms as well.
- If you get an infection when you have an IUS fitted, it could lead to a pelvic infection if it’s not treated.
- Most women who stop using an IUS do so because of vaginal bleeding and pain, although this is less common.
Key points
It can be used by women who cannot use combined contraception (such as the combined pill) – for example, those who have migraines. Most women can use an IUS, including those who are HIV positive. A GP or nurse will ask about your medical history to check if an IUS is suitable contraception for you. If you’re 45 or older when you have the IUS fitted, it can be left in until you reach the menopause or no longer need contraception. The IUS may not be suitable if you have:
- breast cancer, or have had it in the past 5 years
- cervical cancer or womb (uterus) cancer
- liver disease
- unexplained bleeding between periods or after sex
- arterial disease or a history of serious heart disease or stroke
- an untreated sexually transmitted infection (STI) or pelvic infection
- problems with your womb or cervix
Why is there a link with UTIs if you use an IUD or IUS?
Research published by the Contraceptive Delivery System Journal in 1983 showed that oral contraception or IUD contraception may turn the vaginal PH alkaline which can increase the risk of candida/thrush or bacterial vaginosis.
The Mirena coil, because it is a progesterone-only form of birth control is often prescribed for endometriosis or heavy periods can cause problems due to the reduction of oestrogen that can lead to urogenital atrophy and changes in vaginal PH allowing an increase in vaginal and bladder infections.
Fungal spores on an IUD/IUS can also cause candida upsurges. If candida is an ongoing issue, consider removing the IUD/IUS and switching to another form of contraception. More about candida or thrush.
Implants
The contraceptive implant (Nexplanon) is a small flexible plastic rod that’s placed under the skin in your upper arm by a doctor or nurse. It releases the hormone progestogen into your bloodstream to prevent pregnancy and lasts for 3 years. The implant steadily releases the hormone progestogen into your bloodstream, which prevents the release of an egg each month (ovulation).
It also thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the lining of the womb so a fertilised egg is less likely to implant itself.
Advantages and disadvantages
Advantages:
- it works for 3 years
- it doesn’t interrupt sex
- it’s an option if you can’t use oestrogen-based contraception, such as the combined contraceptive pill, contraceptive patch or vaginal ring
- it’s safe to use while you’re breastfeeding
- your fertility will return to normal as soon as the implant is taken out
- it may reduce heavy periods or painful periods
Disadvantages:
- you may experience temporary side effects during the first few months, like headaches, nausea, breast tenderness and mood swings
- your periods may be irregular or stop altogether
- you may get acne or your acne might get worse
- you’ll need a small procedure to have it fitted and removed
- it doesn’t protect you against sexually transmitted infections (STIs), so you may need to use additional contraception (such as condoms) as well
Key points
It can be useful for women who can’t use contraception that contains oestrogen and can be taken out if you have side effects. A common side effect is that your periods stop (amenorrhoea). It’s not harmful, but you may want to consider this before deciding to have an implant.
Most women can be fitted with the contraceptive implant but it may not be suitable if you:
- don’t want your periods to change
- some medicines can make the implant less effective. These include complementary remedies, such as St John’s Wort, some antibiotics such as rifabutin or rifampicintake and medicines for HIV, epilepsy and tuberculosis. If you’re taking any of these medicines, you’ll need additional contraception (such as condoms), or you may wish to use a different method of contraception that isn’t affected by your medicine.
- have unexplained bleeding in between periods or after sex
- have arterial disease or a history of heart disease or stroke
- have liver disease
- have breast cancer or have had it in the past
- have a medical condition that may affect which contraception you can use – speak to your GP or practice nurse, or visit your nearest sexual health clinic to discuss further
Why is there a link with UTIs if you have a contraceptive implant or injection?
Because the Depo Provera injection and Nexplanon hormonal implants are designed to lower oestrogen production, this can change the vaginal ph and the reduction of the mild antimicrobial protection that sufficient oestrogen levels offer in the vaginal and urinary tracts. It may alter the vaginal microbiome, the valuable community of beneficial microbes that protect against bacterial and fungal upsurges which can cause infections.
These injections and implants contain medroxyprogesterone which has been shown to increase inflammation in vaginal cells. A study published in 2013 examined women using the Depo-Provera injection and noted that inflammatory markers in the vagina were raised.
Key points
Depo-Provera is most commonly given in the UK and lasts for 13 weeks. Occasionally, Noristerat may be given, which lasts for 8 weeks. Sayana Press also lasts for 13 weeks, but it’s a newer type of injection so is not available at all clinics or GP surgeries. You usually have the Depo-Provera and Noristerat injections in your bottom, but you can have them in your upper arm. You can have the Sayana Press injection in your tummy (abdomen) or thigh and would normally learn to do this yourself.
Advantages and disadvantages
- each injection lasts for either 8 or 13 weeks
- it does not interrupt sex
- it’s an option if you can’t use oestrogen-based contraception
- you do not have to remember to take a pill every day
- it’s safe to use while you’re breastfeeding
- it’s not affected by other medicines
- it may reduce heavy, painful periods and help with premenstrual symptoms for some women
Disadvantages:
- your periods may change and become irregular, heavier, shorter, lighter or stop altogether – this can carry on for some months after you stop the injections
- Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones, but it does not increase your risk of breaking a bone. Sometimes the doctor may recommend that you stop after 2 years so there’s no long-term effect on your bones.
- it does not protect you against STIs
- there can be a delay of up to 1 year before your periods return to normal and you can become pregnant
- some people may put on weight when they use Depo-Provera or Sayana Press contraceptive injections
- you may experience side effects like headaches, acne, hair loss, decreased sex drive and mood swings
- any side effects can continue for as long as the injection lasts (8 or 13 weeks) and for some time after
Find out more about the effects of a changing vaginal ph and microbiome
Find out about your monthly cycle and UTI.
