Different Types of Contraception

When you think about contraception, the options that probably spring to mind are condoms and the pill. However, there are lots of other choices out there.

Which Type of Contraception is Right for You?

Finding the right contraception can be a very personal process. Some factors that you might want to consider when comparing the options include:

• Will you have to pause before sex to find and use the contraceptive?
• How often do you need to take the contraceptive?
• How long will the effects last?
• How easy will it be for you to use?
• Will it fit in with your lifestyle?
• Are there any side effects?

Barrier vs. Hormonal Contraceptives

Most forms of contraception can be divided into two basic types: barrier methods and hormonal contraceptives. Barrier contraception works by physically blocking the path of the sperm so that it can’t reach the egg. Hormonal contraceptives use synthetic versions of the female hormones that control the menstrual cycle. The hormones they contain can prevent ovulation so that there is no egg available to be fertilised by the sperm.

Barrier Methods

Barrier contraception comes in several different forms. The most commonly used is the male condom, but there are other choices if you want to avoid taking a hormonal contraceptive.

• Male condoms have to be placed onto the penis before sex. When used correctly, condoms can prevent 98% of pregnancies and protect against STIs.
• Female condoms are made from a similar material to male condoms, but they are placed inside the vagina instead. Female condoms are 95% effective and can protect against STIs.
• Diaphragms are small domes that can be placed against the cervix to stop sperm from reaching the egg. Unlike female condoms, a diaphragm can be put in several hours before sex and is re-useable, but it won’t protect against STIs. When used correctly, it can prevent 92-96% of pregnancies.

Most of us will make the occasional mistake, so contraception tends to be a little bit less reliable in real life. For a typical user, the effectiveness will be about:

• 82% for male condoms
• 79% for female condoms
• 71-88% for a diaphragm

Hormonal Contraception

Hormonal contraception is currently only available for women. It uses the synthetic female hormones oestrogen and progestogen to prevent pregnancy and cannot protect you against STIs. Some hormonal contraceptives only contain progestogen. It can be safer to take a progestogen-only contraceptive if you smoke, are over 35, are overweight, or have certain health conditions such as migraines or a high risk of blood clots.

Hormones can have a dramatic impact on your body. Your periods could be lighter or might even stop altogether. You might experience other side effects too, including headaches, mood changes, breast tenderness, nausea, and changes in blood pressure. If you experience serious side effects or they don’t go away within a few months, you may need to change to a different contraceptive. Sometimes another type of hormonal contraception will be a better fit for you.

Various different types of contraception are available that deliver the hormones in different ways:

• The Pill: needs to be taken at the same time every day
• Mini-Pill: a progestogen-only pill that must be taken at the same time every day
• Patch: a sticky patch that is worn on the skin for a week before it needs to be replaced
• Ring: a soft plastic ring that is placed inside the vagina, it can be worn for a month before it needs to be replaced
• Injection: a progestogen shot that can protect you for up to three months, but you’ll have to go back to the clinic when you need another injection.

The contraceptive pills, patch and ring can prevent more than 99% of pregnancies when used correctly. With typical use, they are still about 91% effective. The contraceptive injection is 94% effective with typical use.

Long-Acting Reversible Hormonal Contraception

Long-acting reversible contraceptives (LARCs) can be very effective and convenient. Once fitted, they can provide long-term protection. The effects will disappear immediately when they are removed. Hormonal LARCs come in two forms, both of which rely on progestogen alone.

• Implant: a small plastic device that is inserted under the skin, it can last for up to 3 years
• Intra-Uterine System (IUS): a plastic T shaped device that sits inside your womb, it can work for up to 5 years

The IUS and implant are more than 99% effective. Since you don’t have to do anything to ensure they are working, there is no risk that you’ll forget your contraception or use it incorrectly. This makes LARC methods the most reliable.

Another LARC Option: the IUD

The Intra-Uterine Device (IUD) is unique because it doesn’t fit into either category. It isn’t a barrier, but it doesn’t use hormones either. Instead, it releases small amounts of copper that make it harder for sperm to reach the egg or for fertilised eggs to implant in the womb. Like the IUS, it is a small device that sits inside the uterus. It can work for up to 10 years, is more than 99% effective and can be used as a form of emergency contraception.

Alternatives

If none of these options feel right for you then there are some less common choices that might help:

• Natural Family Planning: keeping track of your menstrual cycle using traditional methods or a birth control app so that you can avoid sex when you are fertile. It doesn’t work well if you have an irregular menstrual cycle and requires a lot of time and effort. Although natural family planning can be up to 99% effective, it is only about 75% effective for a typical user and can be even less.
• Female Sterilisation: an operation to seal the fallopian tubes so eggs cannot reach the sperm. It is permanent and more than 99% effective.
• Vasectomy: an operation to block or cut the tubes so that sperm can’t leave the body. It is permanent and even more effective than female sterilisation.

The best contraception for you will depend on many factors, from how good you are at remembering to take the pill to the way your body responds to the hormones. If you need help choosing then it’s a good idea to get contraception advice from a doctor who can help you find the best fit.

Which factors matter most to you when you’re choosing contraception?