Contraception

Contraception types are generally broken down into hormonal and non-hormonal methods.

Hormonal methods work by changing your oestrogen and/or progesterone levels in women to prevent an egg leaving the ovary, to thicken cervical mucus and thin the womb lining. Hormonal methods can also reduce premenstrual stress, reduce acne and reduce the symptoms of endometriosis and polycystic ovaries.

Non-hormonal methods, with the exception of the IUD, rely on barriers that prevent sperm joining the egg, or natural methods that prevent the sperm and egg meeting such as withdrawal.

No contraceptive method is 100% effective but in general, when taken correctly hormonal methods have a higher percentage. The combined pill, for example, has 99% effectiveness rate when taken properly.

The combined pill is a small easy to swallow tablet that is usually taken for three weeks before a week's break. This process is then repeated. There are a couple of brands of combined pill that are taken for 28 days without a seven-day break.

During this week you are likely to have a withdrawal bleed similar to a period, but not always. The combined pill contains the hormones oestrogen and progesterone. It is very popular and used worldwide to prevent pregnancy.

Combined pill overview

Effectiveness - When used correctly the combined pill is over 99% effective. You should take it at the same time each day, but if you forget, vomit and/or have diarrhoea then you should use barrier contraception for seven days after you stop being unwell.

How it works - The pill works by releasing oestrogen and progesterone into your system. This stops an egg leaving the ovaries. It also makes vaginal mucus thicken so sperm cannot enter the womb, and it thins the lining of your womb so that an egg cannot implant there.

Pros - The combined pill is highly effective and easy to take. It can also treat acne, heavy periods and the symptoms of PMS. Women experiencing problems with polycystic ovaries or endometriosis find the pill can lessen symptoms. You are also able to take pills back-to-back to delay your period up to three months at a time.

Cons - You have to remember your pill each day and you may experience side effects from the hormones. These are likely to wear off after three months as your body adjusts. There is no protection against STIs and a slightly elevated risk of blood clots and some cancers, but this risk is very small.

The mini pill is similar to the combined pill but contains no oestrogen. This makes it suitable for women who cannot take the combined pill, such as smokers, the overweight, and those who have migraines. It's also known as the progesterone only pill or POP pill.

Mini pill overview

Effectiveness - The mini pill is over 99% effective when used correctly. It needs to be taken at the same time each day. If you forget or you vomit and/or have diarrhoea then you should use barrier contraception for two to seven days after you stop being unwell. The length of time depends on your brand of pill. Unlike the combined pill there is no seven-day break.

How it works - The mini pill works by thinning the womb lining and thickening the cervical mucus. Some higher dose mini pills can also prevent ovulation and therefore periods.

Pros - It is very effective and easy to take. Higher dose pills can prevent periods, but all mini pills may reduce your period's severity and reduce PMS. It has very few side effects and can be taken by the majority of women.

Cons - You need to take the mini pill at the same time each day. It doesn't protect against STI and you can't use it to manage effectively periods.

The contraceptive patch is a combined hormonal contraceptive. It includes both oestrogen and progesterone. It's a good alternative for women who easily forget a daily pill because the patch is simply attached to your body for three weeks before having a patch-free week.

Contraceptive patch overview

Effectiveness - The contraceptive patch is over 99% effective when used correctly. It works by preventing ovulation, thickening the cervical mucus and thinning the womb lining. It is much like the combined pill but with hormones delivered in a different format.

How it works - The patch should not be attached to the breasts but to a product-free arm, leg, buttock or stomach. It is small, about the size of a plaster, and is highly unlikely to fall off.

Pros - The patch is easy to use and has a high effectiveness rate. The hormones can help with PMS symptoms, endometriosis, and polycystic ovary syndrome. It also reduces acne and avoids any gastro upsets caused by swallowing a pill. The patch only needs changing once every three weeks, and if you are unwell you don't need to worry about using barrier contraception.

Cons - Some women have irritation where the patch attaches the hormones involved can cause breast ache, nausea, and inter-period bleeding. This should settle down after three months of use. Because it contains oestrogen the patch slightly raises the risk of blood clots and some cancers.

The contraceptive ring is a circle of soft plastic that is inserted into the vagina. It releases the same hormones as the combined pill and patch. It's not as popular as the pill forms of contraception, but its gaining users due to its effectiveness rate and low maintenance regime.

Contraceptive ring overview

Effectiveness - The contraceptive ring, also known as the vaginal ring, is 99% effective when used properly.

How it works - A ring only needs to be inserted once a month. It contains oestrogen and progesterone hormones which are gradually released to prevent ovulation, thicken cervical mucus, and thin the womb lining.

Pros - It is low maintenance. You leave a ring in place for three weeks before having a seven-day break. If you have sickness or diarrhoea the ring is not affected, unlike contraceptive pills. As with the combined pill and patch the ring can improve acne, endometriosis, polycystic ovary symptoms and reduce menstrual cramps. It can also lessen your flow and delay periods. The hormones also reduce your risk of endometrial and ovarian cancer.

Cons - It can be tricky to fit at first and may on occasion be removed by a tampon or felt by your partner during sex. The ring may cause mild side effects of tender breasts, nausea, and breakthrough bleeding, but these should clear up after three months of use. The risk of a blood clot is raised slightly when you take oestrogen based contraception.

For more information on alternatives to the pill including the patch and ring, you can visit our information page.

Male and female condoms are the only contraceptives that protect against STIs. If you are having casual sex always protect yourself with a condom, even if you are taking a hormonal form of contraception against pregnancy. Condoms are made from latex or polyurethane.

Condoms overview

Effectiveness - Male condoms are 98% effective when used correctly. They work by providing a barrier against sperm entering the womb.

How it works - A male condom should be unrolled onto an erect penis so it covers all the skin. Be cautious not to cut or pierce condoms. After sex, the penis should be withdrawn with the condom still in place.

Female condoms are a sheath that lines the vagina. They can be inserted before sex at the start of an evening. They are 95% effective when used properly.

Pros - Male condoms are easy to find and simple to use. They don't require hormonal changes to a woman's body and protect against STIs.

Cons - They can split or fall off if not used correctly. Some people have allergies to the materials and some people feel that sensation is lessened.

The contraceptive injection is an injection of the hormone progesterone. Brands last for different intervals of time but they can last for eight to thirteen weeks.

Progesterone prevents pregnancy by thickening cervical mucus and thinning the womb lining so a fertilised egg can't implant there. The injection can prevent ovulation in some woman.

Contraceptive injection overview

Effectiveness - The contraceptive injection is over 99% effective when it's used correctly.

How it works - Your doctor or contraceptive nurse will administer the injection into a buttock or upper arm.

Pros - It is very effective against pregnancy and lasts for months at a time. If you are sick or have diarrhoea it is not affected. Because the injection does not contain oestrogen it is suitable for women with oestrogen risks.

Cons - You will need regular injections and the area can become sore. If you experience side effects then it's not possible to remove the progesterone from your body. Side effects are not experienced by all women but may include bloating, spotting, nausea. Used long term it may cause osteoporosis (thinning bones).

The contraceptive implant is a small flexible plastic rod that's inserted into your upper arm by a doctor or trained nurse. The implant is progesterone only. It's not visible, but you will be able to feel it with your fingers if you press the area.

Contraceptive implant overview

Effectiveness - It's over 99% effective.

How it works - The implant releases progesterone into your body to thicken cervical mucus and thin the womb lining. It may also stop ovulation in some women. It works in the same way as the mini pill but lasts for three years.

Pros – The implant won't need changing for three years but it can be removed at any time. Women with oestrogen issues can use the implant. If you are unwell the implant is not affected.

Cons - It requires a small procedure under local anaesthetic to place the implant in your upper arm. Some women may experience side effects such as bloating, nausea and spotting but this should go after three months of use.

The intrauterine device is a tried and tested T-shaped contraceptive that is placed in your womb to prevent pregnancy. You may know it better as the coil. An IUD is made of plastic and contains copper. It can remain in place for five to ten years.

IUD overview

Effectiveness - The IUD is over 99% effective and last for years once in place. It is the longest lasting contraceptive.

How it works - The IUD contains no hormones but uses copper to prevent pregnancy. Copper changes the fluids in your womb making it impossible for eggs and sperm to survive. It can also prevent fertilised eggs implanting in the womb.

IUDs are fitted by a trained nurse. The T-shaped plastic rod is pushed through the vagina, cervix and into the womb. It can take fifteen to twenty minutes to fit the IUD.

Pros - It is highly effective and lasts for many years. Your fertility will return as soon as the IUD is removed. If you are unwell it does not affect the IUD and because it contains no hormones it does not change your mood or raise your risk of blood clots.

Cons - It can be uncomfortable to fit and may occasionally cause damage to the womb or introduces an infection. Some women find their periods become heavier, longer and more painful but this doesn't happen to everyone.

The Intrauterine System (IUS) is the same shape as an IUD, but it contains hormones instead of copper. An IUS only contains progesterone so it's suitable for most women and will last three to five years.

IUS overview

Effectiveness - The IUS is over 99% effective.

How it works - It works by thickening cervical mucus, thinning womb lining and potentially preventing ovulation. A trained doctor or nurse will need to fit an IUS into the womb in the same processes an IUD fitting.

Pros - It contains only progesterone and last for years once in place. Unlike the IUD it can make periods lighter and reduce symptoms of PMS, polycystic ovaries and endometriosis.

Cons - Spotting between periods is a potential side effect along with nausea, bloating and sore breasts. These symptoms should pass after six months. The IUS can be removed at any point if it no longer suits or you decide to conceive.

A diaphragm or cap is a small flexible latex dish-shaped device that is inserted into the vagina before sex. It must be used with spermicide and the fit you correctly.

Diaphragm/cap overview

Effectiveness - The diaphragm and cap have one of the lowest contraceptive effectiveness rate at 92-96% with proper use.

How it works - If you want a diaphragm or cap you need to see your doctor for a fitting as the correct size is needed to cover your cervix.

Pros - Can be inserted hours before sex and left in place afterwards. You don't need to reinsert it if you have sex a second time. It uses no hormones so is suitable for all women.

Cons - A diaphragm or cap needs to be fitted correctly and this will take practice. You must use spermicide with the diaphragm and use a second application if you have sex again. If you lose or gain weight you will need a re-fitting to ensure it still fits correctly.

Emergency contraception is available if you've had unprotected sex. It's available in two forms: a pill and the IUD. If you find yourself using emergency contraceptives regularly you should find a permanent method to suit you.

Emergency contraception overview

Effectiveness - Emergency contraception is available over-the-counter or online. The sooner you take the pill the more effective it is. Up to 12 hours after sex is most effective but it can be used up to five days after sex.

How it works - Emergency contraception contains the same hormones as the combined pill but at a much higher dose. It works by delaying ovulation and may also alter the womb lining so an egg can't implant there.

The IUD can be inserted up to five days after unprotected sex.

Pros - Emergency contraception can prevent a pregnancy if your contraception has failed or you've had unprotected sex. It is widely available and effective if taken soon after sex.

Cons - It can make you feel unwell producing some side effects including headaches, nausea, vomiting, dizziness, and fatigue. If you vomit you will need a second dose.

For more information on emergency contraception, visit your specific page.

Natural methods of contraception include withdrawal before ejaculation and monitoring your cycle to find safe times to have sex.

Natural methods overview

Effectiveness - Natural methods can be effective but they are more liable to mistakes. Withdrawal relies on male self-control and fertility awareness relies on bodily signs.

How it works - Body signs means plotting your temperature and cervical fluids to find safe times. When you are ovulating you need to avoid sex or use a condom.

Pros - It involves no hormones or barrier methods. There are no side effects.

Cons - Withdrawal can be mistimed and fertility signs can be misread, particularly when they are disrupted by stress, illness or travel.

Sterilisation refers to ending your fertility through surgery. It is permanent and must only be undertaken if you are certain about your decision.

Sterilisation overview

Effectiveness - Female sterilisation is over 99% effective. Male sterilisation, known as vasectomy, is over 99% effective.

How it works – For female sterilisation, a surgeon blocks or cuts the fallopian tubes under general anaesthetic so that eggs cannot travel from the ovaries to the womb. For male sterilisation, a surgeon cuts, seals or blocks the tubes that carry sperm under local anaesthetic.

Pros - Sterilisation is permanent with a very rare failure rate. Once done you do not have to think about contraception against pregnancy again. The recovery time is quick and there are no hormones involved. Women will still ovulate and have periods until menopause. A man will still ejaculate fluid, but it will not contain sperm.

Cons - It is permanent and should not be carried out if you are unsure about wanting children.

During menopause women stop ovulating and eggs do not leave the ovaries. Menopause is the absence of periods, but the run-up to menopause can take years. During peri-menopausal, women can still become pregnant as they are still ovulating, even if this is infrequently.

In general if you are under 50 you should use contraception for two years after your last period. If you are over 50 you should use contraception for a year after your last period.

Combined contraception is not recommended for women over the age of 35 as it can lead to a higher risk of complications. This includes the combined pill, patch and ring, however, your doctor may continue to prescribe it if you are risk-free e.g. you are not overweight, don't smoke and have a low risk of blood clots.

Progesterone only forms of hormonal contraception can be taken for a longer period of time, up to the age of 50. This includes mini pills, implant, injection, and IUS.

Barrier methods of condoms and diaphragms and cap can be used at any age.

During pregnancy you only need contraception to avoid developing an STI. Use condoms to protect yourself and your baby during this time.

After giving birth you can use condoms straight away. You can become fertile again rapidly after giving birth even if you are breastfeeding and haven't had a period.

Three weeks after giving birth you can use:

• Contractive implant and mini pill

If you are not breastfeeding you can also use:

• Combined pill, vaginal ring, and contraceptive patch

Six weeks after giving birth you can also use:

• Contraceptive injection
• Diaphragm or cap but you may need a different size

Six to eight weeks after giving birth you can also use:

• An IUD or IUS

Breastfeeding can prevent ovulation and provide contraception but only if your baby is under six months old, you haven't had a period since the birth and you are solely breastfeeding. Speak to your nurse before using breastfeeding as a contraceptive.