Contraception: an overview

A comparison of the categories rather than a recommendation. The method that suits a person at twenty is often not the method that suits them at forty, and the differences that matter are practical as much as medical.

How methods are grouped

Long acting reversible methods

The hormonal intrauterine system, the copper intrauterine device, and the implant. All are fitted by a clinician, last for years, and do not depend on remembering anything, which is why their real world effectiveness is close to their theoretical effectiveness.

The hormonal system releases progestogen locally and usually makes periods much lighter, often stopping them altogether, which is why it is frequently used to treat heavy bleeding as well. The copper device contains no hormones and can make periods heavier and more painful, particularly in the first months. The implant sits under the skin of the upper arm and releases progestogen; irregular bleeding is the commonest reason people stop it.

Fitting an intrauterine method is uncomfortable for many and painful for some. Ask in advance what pain relief is offered, because practice has been changing and options exist.

Combined hormonal methods

The combined pill, the patch and the vaginal ring all contain oestrogen and progestogen. They are effective when used correctly, and correctly means consistently. They often improve acne and reduce period pain and heaviness, and the cycle can be managed deliberately.

They are not suitable for everyone. Migraine with aura, a history of blood clots, some cardiovascular risk factors, and certain other conditions rule them out. That is why the medical history questions before a prescription are not a formality.

Progestogen only methods

The progestogen only pill and the injection. The pill has fewer restrictions than the combined pill and suits many people who cannot take oestrogen, though it requires a fairly consistent daily routine. The injection is given every few months, commonly causes periods to stop, and can take a while for fertility to return afterwards.

Barrier methods

External and internal condoms, and diaphragms used with spermicide. Less effective at preventing pregnancy in typical use than the methods above, because they depend on correct use every time. Condoms are the only method that also reduces the transmission of sexually transmitted infections, which is why they are frequently used alongside another method rather than instead of one.

Permanent methods

Tubal occlusion for women and vasectomy for men. Both are intended to be permanent and are considered when a person is confident their family is complete. Vasectomy is the simpler procedure of the two.

Fertility awareness

Tracking cycle indicators to identify fertile days. Effectiveness varies widely and depends heavily on consistent daily measurement and on abstaining or using a barrier during the fertile window. It suits people who are motivated and have regular cycles, and it is unreliable during perimenopause when cycles become erratic.

Emergency contraception

Two types of emergency contraceptive pill exist, with different time windows after unprotected sex, and both work better the sooner they are taken. A copper intrauterine device fitted within a defined window is the most effective option and provides ongoing contraception afterwards. Emergency contraception is available quickly through pharmacies and sexual health services in many countries, and the deciding factor is usually speed.

Choosing

The questions that actually determine the choice:

• How much does effectiveness matter relative to everything else, given the consequences of a pregnancy now?
• Is a daily routine realistic, or is a method that cannot be forgotten preferable?
• Are periods currently a problem in themselves, in which case a method that treats them may solve two things at once?
• Is oestrogen suitable, given the medical history?
• Is protection against infection needed, in which case condoms are required regardless of the other method?
• How soon might pregnancy be wanted, since return to fertility differs by method?

Bleeding patterns

Almost every hormonal method changes bleeding, and unexpected bleeding is the commonest reason people stop a method that was otherwise working. Irregular bleeding in the first months is usual with progestogen based methods and often settles. Knowing that in advance changes how people respond to it. Bleeding that is heavy, persistent beyond a few months, or occurs after sex should be assessed rather than attributed to the method.

Contraception in perimenopause

Fertility declines but does not end. Standard guidance is to continue contraception until twelve months after the last period for women aged fifty and over, and twenty four months for women under fifty. Some methods also help with the heavy or erratic bleeding common at this stage. Hormonal contraception can mask the pattern of periods, which is one reason menopause diagnosis in this group is discussed with a clinician rather than assumed. See perimenopause.

Last reviewed: September 2026