Article written by Dr. Michele MONTANARO-GAUCI MD. MSc. FRCOG – Specialist Gynaecologist
A variety of contraceptive options should be available and easily accessible to women (and men) of all ages in Malta. Everyone has a right to access effective contraception, as this allows them to stay healthy, to avoid unintended pregnancies and have a safe and satisfying sexual life.
A visit to a contraception clinic will include advice, information and discussion to help choose a suitable contraceptive method from all the many options available. It also offers initiation of the chosen method and can provide subsequent follow-up consultations if necessary.
Consultations could cover topics such as natural methods of fertility awareness and family planning. Starting a contraceptive method might mean getting a prescription for a suitable contraceptive pill or a vaginal ring. It might alternatively mean choosing a longer-acting method, such as an intra-uterine contraceptive device (coil) placed in the womb, a contraceptive injection into the thigh or having an implant inserted under the skin of the upper arm. Removal of implants is also possible, as is removal of coils. All these services are offered at a contraception clinic and can easily be performed there. Local anaesthetic is used for implant insertion and/or removal. Local anaesthetic gel or local anaesthetic injection can be used for coil insertion if necessary. Sterilization is a permanent method of contraception which is achieved surgically in an operating theatre. Sterilization for a woman involves interruption or removal of the fallopian tubes. Sterilization for a man (vasectomy) involves interruption of the vas deferens tubes.
The choice of contraceptive method for a woman depends very much on her preference but it also depends on the medical history, family history, age, social history and social situation of the woman. There are some medical conditions and some situations where a type of contraception might need to be avoided for health reasons. There should be the guidance and discussion and clinical input of a trained medical professional when choosing and initiating a contraceptive method which is to be used for some time. Emergency contraceptive pills, on the other hand, can be dispensed under the direction of a pharmacist, as they involve taking only a single dose of medication and are therefore considered safe enough for the patient to use without a doctor’s consultation or prescription.
Once a regular contraceptive method has been started, in terms of follow-up, an annual check-up and review by a trained medical professional is generally required. This ensures that the method is still suitable and safe and the consultation can address any side-effects and issues which may arise. A check-up consultation can be required before a year elapses, for example to see if a coil is properly in place, to assess the effect of a contraceptive method on the menstrual period, to discuss any side-effects, to discuss a change in general health status, to remove a coil or implant at any time the woman chooses or else to change contraceptive method.
A list of the contraceptives currently in stock and available to purchase in Malta:
Male Condoms
Combined Oral Contraceptive Pills:
Nelya
Yaz
Yasminelle
Yasmin
Mercilon
Adele
Vreya
Qlaira
All the above pills contain a combination of oestrogen and a progestogen. All are very effective contraceptives if taken correctly. The best choice of pill may depend on the individual’s clinical history. The various pills differ in their exact composition and doses. Some also differ in the pill-taking pattern. Some pills should be taken every single day and some others require a seven-day break between packets.
There are some contraceptive pills which are currently temporarily unavailable in Malta due to Brexit and/or Covid 19 having affected importation and supply.
The Vaginal Ring containing oestrogen and progestogen:
Nuvaring – Inserted into the vagina for 21 days, removed for 7 days and so on.
Mini Pill or Progestogen Only Pill:
Lamya – Taken every single day with no break.
Emergency Contraceptive Pills:
Escapelle or Levonelle – one tablet of progestogen taken within 72 hours of unprotected sex
Ella One – one tablet of selective progestogen receptor modulator taken within 120 hours of unprotected sex.
Contraceptive injection (progestogen):
Sayana – Injection every 13 weeks.
Implant (progestogen):
Implanon NXT – Inserted under the skin of the upper arm, lasts for 3 years.
Copper coil (hormone-free):
Monalisa – Inserted into the womb, lasts for 10 years.
Flexi T – Inserted into the womb, last for 5 years.
Eurogine – Inserted into the womb, lasts for 5 years.
Progestogen coil:
Mirena – Inserted into the womb; lasts 5 years; helps to control heavy menstrual bleeding.
Jaydess – Inserted into the womb; lasts 3 years.
Female Sterilization / Tubal occlusion:
Laparoscopic surgery under general anaesthetic to block or remove the woman’s tubes.
Vasectomy:
Referral of male partner to urologist for minor surgery under local anaesthetic to interrupt the vas deferens tubes.
