Contraception in Vienna
Contraception is a very personal decision. Women today have many options, and that is exactly what often makes the choice difficult. The pill is still one of the commonly used methods, but there are many alternatives. These include hormone-free methods such as the copper IUD (coil) and the copper chain, as well as the hormonal IUD, the ring, the patch, the implant and various barrier methods. In my private practice in 1090 Vienna, I take the time to go through the suitable options with you. A good method of contraception should suit your body, your circumstances and your personal wishes.
When should you come for contraceptive advice?
A consultation is worthwhile if you are starting contraception for the first time, are unhappy with your current method or your circumstances have changed. Many young women, for example, no longer want to take the pill and are looking for a hormone-free alternative. Others suffer from heavy or painful periods and want to know whether a hormonal IUD could help. After giving birth, the question often arises of which methods are suitable while breastfeeding. If your family is complete, permanent methods can also be discussed.
A consultation is also worthwhile if you have side effects. Headaches, mood swings, bleeding between periods or changes in libido can be a reason to review your current method.
Individual risk assessment is particularly important if you have migraine with aura, high blood pressure, a previous thrombosis or certain risk factors in your family. Smoking from the age of 35 should also be taken into account when choosing a method. In these situations, preparations containing oestrogen, such as the combined pill, the ring or the patch, may be unsuitable or contraindicated. Which alternative is safe depends on your individual risk profile.
What methods of contraception are there?
Broadly, methods can be divided into hormonal, hormone-free and permanent. The reliability of a contraceptive method is often described using the Pearl Index. It states how many out of 100 women become pregnant within one year despite using the method. In everyday life, however, theoretical reliability is not the only thing that matters. Methods that do not require daily or regular use are less prone to user error.
Pill, ring, patch and implant
The combined pill contains an oestrogen and a progestogen and works mainly by preventing ovulation. Taken correctly, it is very reliable and can improve period pain, the heaviness of your periods and, in some cases, acne. At the same time, it increases the risk of venous thrombosis. Possible risk factors must therefore be taken into account before it is prescribed.
The progestogen-only pill contains no oestrogen and can also be used while breastfeeding and in many cases where oestrogen is contraindicated.
The contraceptive ring and the contraceptive patch also contain oestrogen and progestogen. They do not have to be used every day, but in principle they carry similar oestrogen-related risks to the combined pill.
The contraceptive implant is inserted under the skin of the upper arm and continuously releases a progestogen. It is one of the very reliable long-acting methods. The three-monthly injection is also a progestogen-based method, but because of its possible effects on bone density and other side effects, it has to be weighed up for each woman individually.
Hormonal IUD
The hormonal IUD is a small T-shaped plastic device that continuously releases a small amount of levonorgestrel in the uterus (womb). Depending on the model, it works for three to eight years.
Periods often become much lighter and, in some women, may stop altogether. The hormonal IUD can therefore be a good option, particularly for heavy periods. Period pain caused by endometriosis can also be relieved in suitable patients.
Copper IUD and copper chain
The copper IUD and the copper chain provide contraception without hormones. Copper mainly impairs the motility and function of sperm and so primarily prevents fertilisation. Depending on the model, copper devices can remain in the uterus for several years. A possible disadvantage is heavier, longer or more painful periods.
The copper chain consists of small copper elements on a flexible thread and is anchored in the wall of the uterus. It is a possible alternative to the conventional copper IUD. Which type is suitable depends, among other things, on the size and shape of your uterus and on your personal wishes.
Women who have not yet given birth can, in principle, also use a copper IUD, a copper chain or a suitable hormonal IUD.
Condoms and natural methods
As well as providing contraception, condoms can reduce the risk of sexually transmitted infections. They are therefore particularly important with new or changing sexual partners, if necessary in addition to another method of contraception.
The diaphragm and the cervical cap are also barrier methods and need to be used correctly.
With the symptothermal method, basal body temperature and cervical mucus in particular are observed in order to identify fertile and infertile days. Used consistently and with good training, it can be reliable. However, cycle fluctuations, for example while breastfeeding, can make it more demanding to use.
I would not recommend pure calendar or cycle-tracking apps, which merely calculate ovulation from past cycle data, as a sole reliable method of contraception.
Permanent contraception
If you are certain that your family is complete, sterilisation may be an option. In women, the fallopian tubes are usually closed, cut or completely removed during a laparoscopy (keyhole surgery). The procedure is intended as a permanent method and should therefore be considered carefully.
Vasectomy in men is also a very reliable permanent method of contraception. It is usually a more minor operation than female sterilisation and can therefore also be a sensible option once your family is complete. After a vasectomy, however, additional contraception must be used until a semen analysis has confirmed that no sperm capable of fertilisation are present.
What is my approach?
Everything begins with a detailed conversation. I would like to know what experience you have had with contraception so far, whether and when you would like to have children, and whether you have symptoms such as heavy or painful periods. Pre-existing conditions, medication, blood pressure and relevant conditions in your family are just as important. This usually already narrows down the choice.
Which examination is needed depends on the method you would like. For the pill, ring or patch, a gynaecological examination or an ultrasound is not necessarily required. Before fitting an IUD or copper chain, I carry out a gynaecological examination and assess the uterus. If an infection is suspected, this is investigated accordingly. A cervical smear (Pap smear) can be taken at the same time if it is due anyway, but it is not a requirement for contraception.
If you decide on the pill, ring or patch, you will receive precise instructions on how to use it. With methods containing oestrogen, I check your blood pressure in particular. Further follow-ups depend on how well you tolerate the method and on your individual risk profile.
Fitting an IUD or copper chain
An IUD or copper chain can be fitted as soon as pregnancy has been reliably ruled out. It is often fitted during or shortly after your period, but fitting is not necessarily restricted to this time.
The fitting itself usually takes only a few minutes. I use a speculum to bring the cervix into view, measure the uterus and insert the contraceptive device through a thin applicator. The copper chain is anchored in the upper part of the wall of the uterus.
How painful the fitting feels varies greatly from woman to woman. If needed, pain-relieving measures or a local anaesthetic can be used. Afterwards, I check the position. A first follow-up can take place after a few weeks, and further follow-ups can usually be combined with your gynaecological check-up. The Austrian public health portal recommends a follow-up after a few weeks and annually thereafter.
What are the side effects and risks?
Preparations containing oestrogen, such as the combined pill, the ring and the patch, increase the risk of venous thrombosis. Particular attention is therefore paid to additional risk factors such as smoking, older age, migraine with aura, high blood pressure or a personal history of thrombosis.
Progestogen-based methods can lead to irregular bleeding. Depending on the preparation, other side effects may also occur. With the hormonal IUD, spotting and bleeding between periods are common in the first few months. Later, periods usually become much lighter or stop altogether.
The copper IUD and the copper chain can make periods heavier or more painful. With IUDs, there is a small risk that they are expelled or change position. Very rarely, the wall of the uterus can be injured during fitting.
If pregnancy occurs despite an IUD, the location of the pregnancy should be checked at an early stage. Overall, IUDs also lower the risk of an ectopic pregnancy in the fallopian tube. However, if pregnancy does occur with an IUD in place, the relative proportion of ectopic pregnancies is higher.
Why Prof. Obwegeser?
I have been a specialist in gynaecology and obstetrics since 1993 and worked at the University Department of Obstetrics and Gynaecology at Vienna General Hospital (AKH Wien) from 1989 until the end of 2023. In the hormone outpatient clinic, I dealt intensively with hormonal disorders and fertility problems. This experience still helps me today in choosing a contraceptive method for each individual patient.
In 2003, I founded the ZEM outpatient clinic for cysts, endometriosis and fibroids and headed it until the end of 2023. There, too, hormonal treatment played an important role for many patients, for example for heavy bleeding or endometriosis symptoms.
In my practice, what matters most to me is that you understand what the different methods can do, what risks they carry and which one suits your personal situation. If your current method is no longer suitable, or if an unplanned pregnancy occurs, I will also discuss the next steps with you openly and objectively.
What do the consultation and the fitting cost?
I run a private practice without a health-insurance contract. After your appointment, you will receive an invoice, which you can submit to your health insurer for reimbursement. The amount reimbursed depends on your insurer and the services provided.
The cost of the contraceptive itself, such as a hormonal IUD, copper IUD or copper chain, may be added to this. We will be happy to tell you the exact amount for your needs in advance by telephone.
Can I have an IUD or copper chain as a young woman who has not given birth?
Yes. Women who have not yet given birth can, in principle, also use a hormonal IUD, a copper IUD or a copper chain. Which option is most suitable depends, among other things, on your wishes, any symptoms you have and your anatomy.
Does the pill make you infertile?
No. The pill does not cause permanent infertility. After stopping it, fertility returns quickly in most women. If your periods do not return for a prolonged time, the cause should be investigated by a gynaecologist.
How quickly am I fertile again after an IUD is removed?
Fertility usually returns quickly after a copper or hormonal IUD is removed. In principle, pregnancy can occur as early as the first cycle after removal.
Is the hormonal IUD a good option for endometriosis or heavy bleeding?
The hormonal IUD is an established treatment option for heavy periods. Period pain caused by endometriosis can also improve with a levonorgestrel-releasing intrauterine system. Whether this method is suitable for you depends on your individual findings and your wishes.
Does the fitting hurt?
How much pain women feel during fitting varies greatly. Some feel only a brief pulling sensation, others considerably stronger cramping pain. If needed, pain-relieving measures or a local anaesthetic can be used. Mild lower abdominal discomfort may continue for some time after the fitting.
From 1989 to 2023 at the University Department of Obstetrics and Gynaecology at Vienna General Hospital (AKH Wien), senior consultant from 1994; founder and long-standing head of the ZEM outpatient clinic for cysts, endometriosis and fibroids.
If you would like unhurried advice on your contraception, call us on +43 1 317 660 0 or write to ordination@prof-obwegeser.at. Appointments are made by prior arrangement by telephone. My practice is at Hörlgasse 14, Top 11, 1090 Wien. Please note: the entrance is at Liechtensteinstraße 8.