Methods like hormonal IUDs and the vaginal ring‍

• These are designed to release hormones directly to the uterus or cervix, with the goal of staying “local.”
• Ovulation may or may not be suppressed, depending on the method and you as a human!
• They’re often described as “low impact” but there’s some grey area to that.

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Methods like the combined pill, injection and implant

• Hormones are delivered into your bloodstream and circulate throughout your entire body.
• That means they can influence your brain, breasts, skin, bones, libido, mood, appetite…pretty much everything. 
• Ovulation is usually fully suppressed.
• There’s a strong potential for both physical and psychological effects, because these hormones touch every system.

Even local methods like the hormonal IUD aren’t truly local. A portion of those hormones still enter your bloodstream. And once they’re in? They’re catching an Uber straight to your central nervous system, aka your brain, which is basically a hormone sponge.

Your brain has estrogen and progesterone receptors scattered throughout:

• Amygdala (emotion)
• Hippocampus (memory)
• Prefrontal cortex (decision-making, motivation)
• Hypothalamus (hormone regulation)
• Brainstem (autonomic nervous system)
  
  

That’s a lot of big words but in other words, your brain is not just along for the ride, it’s driving the car.

If you’ve ever said:

• “I don’t feel like myself on birth control.”
• “The IUD was meant to be low-impact, but I still felt off.”
• “It helped my skin but wrecked my libido.”
• “I feel calm, but numb.”

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You’re not imagining it. You’re experiencing the full-body, full-mind reality of synthetic hormones - even from methods that are “local”.

No matter how the hormones are absorbed, through your uterus, your skin, your gut, or a tiny implant in your arm, synthetic hormones affect all of you. That doesn’t make them bad. It just makes them pretty powerful.

Knowing how they work gives you the info you need to figure out what’s right for you!

You know when you start taking the sugar pills for 7 (or 4 days) during your pill packet? Or take out the ring for 7 days? That bleed you get? It’s actually not a real period. It’s called a withdrawal bleed (aka a fake period). 

It happens when you take a break from the hormones and your hormone levels drop from the usual flatline of consistency. 

That dip tells your body, “cool, i’ll shed the uterine lining now”. But it’s not triggered by ovulation, because you didn’t ovulate in the first place.

Fun fact: the monthly bleed was originally added to make the pill seem more “natural” when it launched in the 1960s. It reassured users (and their doctors) that their bodies were still working "as usual." Biologically, you don’t need to bleed every month on hormonal contraception unless you want to. 

Yep! Most people can safely skip their withdrawal bleed by:

• Skipping the sugar pills (pills that literally do nothing) and starting your next pack right away
• Swapping out your ring without a break
• Using extended or continuous hormonal contraception

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There’s no medical reason you have to bleed every month while using hormonal contraception, unless you like the routine, or it helps you remember what day you are up to on the pill packet. If you do skip the withdrawal bleed and there’s some spotting, this is normal! This is just your body adjusting to the hormones. It should go away after about 6 months.

The goal is to take your pill around the same time every 24 hours. You don’t have to be exact to the minute, but try not to go more than 24 hours between doses.

If you are travelling between different time zones:

• Set a daily alarm in your phone’s new local time zone to remind you
• Try sticking to a time that works wherever you are (e.g. always taking it at 8am local time)
• If you’re crossing lots of time zones or feel unsure, it’s okay to take one pill a bit early or late to reset your schedule, just don’t skip a full 24-hour window.

If you’re still unsure, bring it up with your doctor before the big trip. They can help you plan based on your travel and your specific pill type.

If you vomited more than 3 hours of taking your pill - you should still be protected. Phew!

If you vomit within 3 hours of taking your pill - it might not have been absorbed.

Here’s what to do:

• Take another pill from your pack. Ideally, you take a pill from a spare packet if you have one. 
• If you don’t have a spare, you can take the next day’s pill, but this will shorten your pack by one day, so you’ll finish a day early. If you do this, once your pack has ended, skip the sugar pills (or usual break) and go straight into your next pack without a gap.

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If you have severe diarrhoea for 24+ hours - it may not have been absorbed, especially if it’s watery or ongoing. 

• Treat this the same as missing an active pill.
• Use backup contraception (like condoms) whilst you have diarrhoea and for 7 days after it stops.

Short answer: not right away. 

The combined pill is not usually recommended during the early weeks of breastfeeding.

This is because:

• Oestrogen can slightly reduce milk supply, especially in the first 6 weeks postpartum when your supply is still being established.
• There’s also a higher risk of blood clots in the early postpartum period, and oestrogen increases that risk.

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Most health guidelines recommend waiting at least 6 weeks after giving birth before taking the combined pill and only if breastfeeding is going well and your doctor gives the all-clear.

Yes, absolutely. Everyone reacts differently to different hormone combos.

If you’re not feeling like yourself and things haven’t settled after 2–3 months, don’t suffer in silence! It’s totally fine (and common) to switch to a different brand. There’s no one “perfect pill”, just the one that works best for you.

Yes, in Australia, you can get the pill if you’re under 18, no parent permission slip required.

As long as the doctor thinks you understand how it works and can make an informed decision (this is called being “Gillick competent,” which sounds like a wizarding title but is actually a legal thing), you’re good to go.

Your appointment is confidential, which means they won’t tell your parents unless there’s a serious concern for your safety.

FYI, you’ve got every right to access contraception in a safe, respectful, no-drama space.