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Types of Contraception
Hormonal methods
The pill
There are two main types of pill, the combined pill and the progestin-only pill (mini-pill).
The combined pill
The combined pill contains two hormones, an estrogen and a progestin which prevent your body from releasing an egg each month.
You must see a doctor or nurse to be prescribed the pill, they will take your full medical history in order to find the pill which is best suited to your body. There are a number of different types of the combined pill. Not every type of pill will suit everyone so it is worth discussing different options with your doctor.
How effective are they?
If the combined pill is used properly, it is 99.97% effective (0.3 in 1000 women will get pregnant per year) 1-6
What are the advantages?
The combined pill is one of the most effective reversible forms of birth control available to women today and is also the method used most widely. The pill contains hormones that prevent pregnancies in different ways, but a woman can get pregnant again once she stops using it. In addition to protecting against unwanted pregnancy, the pill makes your periods more regular, reduces pre-menstrual complaints, period pains and cramps and gives you lighter periods. Some pills can have a positive effect on your skin and hair. The pill also has been proven to have important health benefits. For example it improves symptoms of endometriosis and polyscystic ovarian syndrome, and it offers protection against ovarian cancer and cancer of the womb.9
What are the disadvantages
Some women may have minor side effects when they first start taking the pill, but usually these subside during the first months of use. Side effects can include bleeding between periods, headaches and breast tenderness. Some brands of combined pills contain a higher dose of estrogen. If you are on this type of pill and are suffering from side effects, it might be helpful to ask your doctor if you can switch to a low-dose estrogen pill.
Very rarely, a few women might suffer from thrombosis, but this is very uncommon and much rarer than the risks of thrombosis unconnected with
the use of hormonal contraception. The risk of thrombosis depends on a number of factors, including family history, age and body weight, and increases if a combination of risk factors are present. The link between thrombosis and the pill is far less strong than for other risk factors, for example not using contraception and being at risk of pregnancy.9 Using the pill may contribute to a slight increase in the risk of having breast cancer but this risk is very small.10
The progestin-only Pill (mini-Pill)
This version of the pill contains only one hormone, a progestin. It works in a different way from the combined pill, mainly by thickening the mucus at the entrance to the womb, which makes it difficult for sperm to get through. With certain brands of progestin-only pill it may also prevent ovulation in some women. You take one pill every day until all the pills in the pack are finished. Then you start a new pack the next day. This means taking pills during a period and no gap between packs. There are different types of progestin available.
How effective are they?
If the progestin-pill is used properly, it is 99.6% effective (4 in 1000 women will get pregnant per year).1-6
What are the advantages?
The progestin-only pill offers a highly reliable form of birth control to women who cannot tolerate estrogens.
What are the disadvantages?
It's really important to take the progestin-only pill at the same time each day or it may not work. Again, it is worth discussing the different options with your doctor to find out what works best for you and your lifestyle. The margin for error is around three hours with the older type and 12 hours with the newer progestin-only pill. Periods may be irregular, with some bleeding between periods, especially for the first few months. On the other hand, some women experience no bleeding at all with the progestin-only pill.
IUS (intrauterine system)
An IUS contains a progestin instead of copper or other metals. The hormone is released very gradually into the uterus and it prevents pregnancy by thickening the mucus in the neck of the uterus, making it difficult for sperm to enter. It also has local effects on the uterus. In some women it also intermittently prevents ovulation. It generally takes a healthcare professional less than five minutes to position the IUS and it can stay in place for up to five years, but should you want to discontinue using it, it can be removed at any time.
How effective is it?
The IUS is 99.9% effective (1 in 1000 women will get pregnant per year).1-6
What are the advantages?
The IUS provides a reliable long-term contraceptive option. After the IUS has been removed, fertility levels will return rapidly to normal. After some months of adaptation, periods are usually lighter, shorter and less painful or there may be no bleeding at all. It also offers some protection against pelvic infections and cancer of the uterine lining.
What are the disadvantages?
Periods may be irregular with some bleeding in between periods and in some women also after the first three months. Initial occurrence of headaches, breast tenderness or nausea are possible. Insertion may be difficult and may be associated with some pain and bleeding. The IUS is not the method of choice in women who have not yet given birth.
Injectable contraceptives
This is a hormonal method of contraception, which is given by injection either once a month or once every three months.
There are different forms of injectables available including progestin-only and combined, which include estrogen and progestin. The injection works by preventing ovulation through the slow release of hormones into the body. They also act to thicken mucus around the neck of the womb making it difficult for sperm to enter. The injections are given by your doctor, nurse or family planning clinic so you have to remember to attend your appointment.
One-month injectable
How effective is it?
The one-month injection is 99.97% effective (0.3 women in 1000 will get pregnant per year).1-6
What are the advantages?
The injection is a semi-long-acting hormonal method providing effective contraception without the need for a daily dose of treatment.
What are the disadvantages?
Some women find that their periods become irregular on this method, or stop altogether and some women put on weight. Some women may also experience headaches, dizziness and spotty skin. Regular periods and fertility may take up to a year to return after stopping injections. The one-month injectable containing progestin only is suitable for women who can not tolerate estrogen or who are breast-feeding.
Three-month injectable
How effective is it?
The three-month injection is 99.97% effective (0.3 women in 1000 will get pregnant per year).1-6
What are the advantages?
The injection is a semi-long-acting hormonal method providing effective contraception without the need for a daily dose of treatment. The available three-month injection containing only progestin is suitable for women who can not tolerate estrogen or who are breast-feeding.
What are the disadvantages?
Some women find that their periods become irregular on this method, or stop altogether and some women put on weight. Some women may also experience headaches, dizziness and spotty skin. Regular periods and fertility may take up to a year to return after stopping injections.
Implants
This is a tiny flexible tube (some brands consist of two tubes) impregnated with the hormone progestin, which is inserted just under the surface of the skin on the inside of your upper arm. This is done under a local anaesthetic. Implants have to be put in by a trained doctor or nurse. The hormone is released in tiny doses over a three year period, after which, it is taken out and a new one inserted. This method works by inhibiting ovulation and by thickening the mucus in the neck of the womb to make it difficult for sperm to enter. Fertility will return to normal after it is removed.
How effective is it?
The implant is 99.95% effective (0.5 women in every 1000 will get pregnant per year)7
What are the advantages?
The implant is suited for women who want long-term contraception. It is also suitable for women who are breast-feeding and those who do not tolerate estrogen. It may reduce heavy, painful periods.
What are the disadvantages?
Removal can sometimes be awkward. There can be temporary side effects such as skin irritations at the application site, irregular bleeding, headaches, mood changes and breast tenderness, but usually these subside after the first few months. Some women may put on weight and some find that their periods become irregular after the first year. Some may also notice an effect on their skin.
The contraceptive patch
This is a small square stick-on patch, impregnated with the hormones estrogen and progestin which are slowly released through the skin. It is affixed to the buttocks, stomach or upper body, avoiding breasts, and has to be changed once a week for three weeks. On the fourth week, no patch is worn. The patch works by preventing ovulation (the release of an egg from the ovary) and thickening the mucus around the neck of the womb, making it difficult for sperm to enter.
How effective is it?
The patch is 99% effective when used properly (10 women in every 1000 will get pregnant per year)1-6
What are the advantages?
The patch does not have to be taken on a daily basis and provides an alternative form of combined hormonal contraception to the combined pill.
What are the disadvantages?
The patch that is currently available is non-transparent, so is visible. Some women may have side effects when they first start wearing the patch, but usually these subside after about 12 weeks. They can include bleeding between periods, skin irritations, headaches and breast tenderness.
The vaginal ring
The vaginal ring is a flexible ring approximately two inches in diameter. It is inserted into the vagina by the woman and held in place by the muscles in the vaginal wall. It is kept in place for three weeks, and then removed by the woman for a one week break. Following the week break, a new vaginal ring is inserted.
The vaginal ring provides an alternative form of contraception with a low hormone dosage which is used only once every four weeks. It contains estrogen and progestin combination,
How effective is it?
The vaginal ring is 99% effective when used properly (10 women in every 1000 will get pregnant per year).1-6
What are the advantages?
The ring provides an alternative form of contraception with a low dose of hormones. It may also help to make periods more regular, lighter and may reduce cramping.
What are the disadvantages?
It can cause vaginal irritation, discomfort or discharge. It may also cause nausea, and breast tenderness. Some women may be able to feel it.
Barrier methods
Condoms
Condoms are thin latex or polyurethane sheaths which fit over a man's penis when it is erect. It is closed at one end and usually has a 'teat' at the top to hold the sperm when the man ejaculates. The condom is rolled down over the erected penis before sexual intercourse takes place to prevent sperm from entering the woman's vagina. As soon as he has ejaculated, the man should hold the condom on his penis to prevent any sperm escaping as he withdraws.
Female condoms are also available. These are also made of rubber and fit inside a woman’s vagina like an ‘inside out’ condom. They should not be used at the same time as a male condom as they may rub together and break.
How effective are they?
If condoms are used properly, they are 93% effective (70 women in 1000 will get pregnant per year)1-6
If female condoms are used properly, they are 95% effective (50 women in every 1000 will get pregnant per year)7
Compared to modern hormonal methods, condoms are less reliable and effective in protecting against pregnancy but they are the only method that will protect against STIs, including HIV/AIDS.
What are advantages?
Condoms are the only type of contraception that can protect you against sexually transmitted infections (STIs). This is why lots of couples use a condom to protect against infections together with another more reliable form of contraception, such as the contraceptive pill, to prevent pregnancy.
What are the disadvantages?
Although they are very strong, condoms can occasionally tear. They can also come off during sex and may be weakened by oily substances such as sunscreen or non-water based lubricants, for example petroleum jelly. If this occurs during sexual intercourse, and another reliable method, such as the contraceptive pill, is not also being taken, emergency contraception should be considered.
The IUD (intrauterine device, coil)
This is a small plastic and copper T-shaped device, which is inserted into the cavity of the womb by a trained doctor or nurse. The IUD prevents pregnancy by preventing sperm and eggs from meeting by either immobilizing the sperm on their way to fallopian tubes or causing local effects on the uterus. It has two little threads that lie inside the vagina so that you can check it's in place. Different types of IUD have to be changed at different intervals of between three to ten years.
Diaphragm/cap
How effective is it?
Used properly, they are 99.5% effective (5 in 1000 women will become pregnant per year)1-6
What are the advantages?
The IUD provides a long-term contraceptive option. A healthcare professional will remove it if it is no longer required or when its effectiveness has expired and will no longer provide a method of contraception.
What are the disadvantages?
With the IUD periods may become heavier, longer or more painful. Infection of the womb can occur with this method but this is uncommon. This is not usually the method of choice for women who have not yet given birth or for women with anaemia.
A diaphragm/cap is a dome shaped circle made of rubber or silicone that you put inside your vagina to form a barrier between the man's sperm and the entrance to your cervix (womb). You need to use it together with a spermicide. You can insert it up to three hours before you have sex. First you have to go for a fitting at your doctor to make sure you get the right size. It should be checked every six months to make sure that it still fits snugly, particularly if something has changed since you last used it, for example if you've had a baby. After sex, you have to leave it in for at least six hours so that the spermicide has time to work.
The diaphragm is used more often than the cap. Your doctor or nurse will tell you which is best for you.
Spermicides
Spermicides alone are not a method of contraception. They should be used in combination with other barrier methods such as male and female condoms or the diaphragm/cap and are designed to increase the effectiveness of these methods. They work by killing sperm or reducing their mobility so they can't move up into the womb. You can buy spermicides as a foam, a gel, a cream, a pessary or a film. Some barrier methods of contraception such as some condoms are already treated with spermicide.
Using a spermicide on its own is less reliable than using it in combination with other barrier methods and will not protect you from STIs.
How effective are they?
If the diaphragm plus spermicide are used properly, 98% of women will not get pregnant (20 in 1000 women per year)1-6
If the cap plus spermicide are used properly, 9% of women will get pregnant before giving birth, and 26% of women will get pregnant after giving birth per year.8
When it's put in place properly, it doesn't interfere with sex and the man is not aware of it. It is an option for women who cannot or do not want to use hormonal contraception.
What are the disadvantages?
Some people may require practice in using this method correctly. The cap is not recommended for women who have already given birth as the rate of efficacy is not high. Women who have given birth may have scar tissue or an irregularly shaped cervix that interferes with the cap adhering to the cervix or the nearby vaginal walls. Some women are good candidates for the cap even after giving birth, but an examination by an experienced healthcare professional is necessary to determine this.
Other methods
Withdrawal method
This is one of the oldest methods of avoiding pregnancy and also one of the least reliable. When you are having sex, the man has to take his penis out of your vagina before he ejaculates. The idea is that this stops sperm from entering the woman's vagina.
How effective is it?
If the withdrawal method is used properly, it is 90% effective (100 in every 1000 women will get pregnant per year)1-6
What are the advantages?
A natural alternative to barrier methods and to hormonal methods acting on the natural hormone and fertility cycle.
What are the disadvantages?
This method requires a great deal of control from the man and frequently fails because small drops of sperm can escape from the penis into the vagina before the man ejaculates.
Natural methods
These methods involve using some means of finding out when you are at your most fertile days in your cycle, so that you take extra care or avoid sex altogether at these times.
There are a number of things you can do and ideally it's best to use a combination of them all. You could:
- Keep a daily record of your body temperature using a special fertility thermometer
- Look for changes in the stickiness of the mucus around the entrance to the womb
- Calculate when ovulation is most likely to take place by counting the number of days from your last period (this only works if your periods are regular)
- Look for other signs such as mood changes and breast tenderness which tend to happen in the second half of your menstrual cycle (measured from the start of one period to the beginning of the next)
How effective are they?
If natural methods are used properly, they can be between 91% and 97% effective (between 30 and 90 women in every 1,000 will get pregnant per year).7
What are the advantages?
It is a natural alternative to barrier methods and to hormonal methods acting on the natural hormone and fertility cycle.
What are the disadvantages?
To take all the steps above, requires a lot of motivation, and it is advisable to consult a doctor or nurse first or get good advice from a family planning clinic. Natural methods of contraception do not take into account fluctuations in the cycle. Many circumstances in everyday life can influence the rhythm of the menstrual cycle, making reliable calculation of the fertile and infertile days impossible. It is therefore a highly unreliable method of contraception and should only be used when an unplanned pregnancy could be accepted. Since intercourse is not allowed during the fertile days, your sex life may be impaired.
Sterilisation
Sterilisation is only for people who have decided they definitely do not want anymore children, now and in the future. It is considered a permanent method of contraception, although in men there is a chance that it can be reversed, but this requires a complicated operation which cannot always restore fertility.
Male sterilisation (vasectomy)
This involves a minor operation, which takes 10 - 15 minutes and is carried out under a local anaesthetic. The tubes that carry sperm are cut or sealed, so that while a man can still ejaculate, there's no sperm present. After the operation, it usually takes a few months for all the sperm to disappear from the semen altogether, so another method of contraception has to be used in the meantime. After 2 negative sperm tests, taken approximately 4 weeks apart, it's considered to be effective. Having had a vasectomy doesn't alter a man's sexual performance or enjoyment of sex.
How effective is it?
Male sterilisation is 99.99% effective (0.1 woman in every 1000 will get pregnant per year)1-6
What are the advantages?
Sterilisation is a permanent method so no other methods of contraception need to be used to prevent pregnancy, however other methods should still be used if there is a risk of contracting a STI.
What are the disadvantages?
As it is permanent, sterilisation should only be used by men who either do not want children or who have all the children they want. Sterilisation offers no protection against sexually transmitted infections, including HIV/AIDS, so a barrier method of contraception should still be used if there is a risk of STI transmission.
Female sterilisation
This is the only permanent method of contraception available to women and if this is something you must consider very seriously as this method is not reversible at all. You will find that you need to have counselling first, to try to ensure there are no regrets later in life.
The operation involves cutting or blocking the fallopian tubes so that the egg cannot travel down to meet sperm.
Sterilisation may be done under either a local or general anaesthetic. Time spent in hospital is between one to three days.
Sterilisation works immediately after the operation. Periods continue as usual but some women may find their periods are heavier.
How effective is it?
Female sterilisation is 99.9% effective (1 woman in every 1000 will get pregnant per year)1-6
What are the advantages?
Sterilisation is permanent, so once the procedure is complete no other methods of contraception will need to be used to prevent pregnancy. However, sterlisation offers no protection against STI transmission.
What are the disadvantages?
This is the most permanent method of birth control and should not be considered if you are in any doubt about whether you may want to have children, or more children later. Options such as the IUS which are reversible offer comparable efficacy rates to sterilisation but without having to undergo this procedure. Sterilisation does not protect against STIs so a barrier method of contraception should be used if there is a risk of transmission.
Emergency contraceptives
If you've had unprotected sex for any reason or you suspect your chosen method of contraception has failed, you can still get contraception which can stop you getting pregnant. An emergency contraceptive is only intended as a backup method when something has gone wrong and is not something you should use regularly.
Emergency pills (or “morning-after” or postcoital pills) can be taken up to 72 hours or three days after intercourse. However, the sooner you take it, the more effective it is. Emergency contraceptive pills taken within 72 hours of unprotected sex reduces the risk of pregnancy by at least 75%.7
OR
You can have an IUD fitted up to 5 days after unprotected sex. The IUD is a small plastic and copper device that is put into a woman's womb by a specially trained doctor or a nurse.
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- Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Stewart F, Nelson A, Cates W, Guest F, Kowal D. Contraceptive Technology; Eighteenth Revised Edition. New York NY: Ardent Media, 2004
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