How to Choose the Right Contraceptive
Any sex education course you attend will be very clear about one thing: how to not get pregnant. And the answer to this question will most likely be, use a condom or take the pill.
Let’s pause here for a second. At this point, usually, there’s already some confusion - so if I take the pill, don't I need to use a condom?? Everyone, and especially young people, should know that there are other contraceptive options.
Index:
Combined pill
Progestogen-only pill
Contraceptive patch
Vaginal ring
Contraceptive implant
Contraceptive injection
Condom
Contraceptive diaphragm or cap
Sponge
IUD
IUS
IUB
Natural methods (fertility awareness)
Surgical methods (sterilisation)
I’d like to point out one thing, to erase any possible doubt: not getting pregnant and protecting yourself from STIs are two different things, and it’s important to never underestimate either one of them.
The condom (for male or female) is the only existing method to protect yourself from sexually transmitted infections and diseases. The other methods of contraception prevent you from getting pregnant but not from getting STIs. That’s why you should use both during sexual intercourse.
On the other hand, the condom (both for male and female) is the only product that prevents pregnancy and getting/transmitting STIs, when used correctly.
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You may also like: Sex Education - ep. 4: Staying safe: a guide to preventing STIs
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Here is a list of questions to consider when choosing the right contraception for you:
- How effective is it? (does it works correctly)
- How safe is it? Are there any side effects for me or for my partner?
- How much does it cost?
- How easy/practical is it to use?
- Is it reversible? So, when I stop using it, will I be fertile again?
- Is it the right one for my body?
Every single one of us is different and choosing what contraception is best, is up to you. Just be sure to make a well-informed choice.
Contraception is free for most people in the UK. Currently there are a range of different contraceptive options available, and the type that works best for you, will depend on your health and circumstances. Once you have collected your research, you can go to your GP or local contraceptive (or family planning) clinic to discuss your choices.
Contraception services are free and confidential, including for people under 16 years old, unless doctors/nurses believe there's a risk to your safety and welfare. You can get free contraception and condoms from most GP surgeries (talk to your GP or practice nurse), community contraceptive clinics, some genitourinary medicine (GUM) clinics, sexual health clinics (these offer contraceptive and STI testing services) and some young people's services.
The Contraception choices tool can help you find out which methods of contraception suits you best. Finally, you can also find out more about all methods of contraception by contacting Brook (the young people's sexual health charity for under-25s) , fpa (provider of information on individual methods of contraception) or the National Sexual Health Line on 0300 123 7123.
Hormonal contraceptives
These methods are hormone-based and if you think they suit your needs you can visit a GP, contraceptive nurse (sometimes called a family planning nurse), or sexual health clinic and discuss this option. Contraception is free for everyone through the NHS.
Let’s debunk some myths: it’s not true that hormone-based contraceptives alter the chance of getting pregnant once you stop taking them.
Combined pill (or simply “the pill”)
It contains artificial versions of female hormones oestrogen and progesterone, which are produced naturally in the ovaries.
Effectiveness: over 99% (if taken correctly).
Safety: the pill may not be right for you if you are pregnant, smoke (or stopped smoking less than a year ago), are 35 or older, are very overweight, take certain medicines, are familiar with blood clots and have had strokes or some kind of cancer. Be sure to talk to your GP or practice nurse, to be advised on your personal situation. Vaginal dryness is a common side effect of taking hormonal contraceptives (but it can easily be solved).
Cost: contraception is free to everyone through the NHS.
Convenience: you should take the pill every day at the same time. One of the most common types is the monophasic 21-day pill: one pill is taken each day for 21 days and then no pills are taken for the next 7 days (when you’ll get your period). The other one is the Every Day (ED) pill, with 21 active pills and 7 inactive (dummy) pills in a pack; you should take one pill each day for 28 days with no break between packets of pills.
Reversibility: when you stop taking the pill you’ll be fertile again.
Progestogen-only pill (containing only progestogen, also known as mini pill)
Effectiveness: over 99% (if taken correctly).
Safety: it’s recommended for people who can’t/don’t want to take the pill with oestrogen and progesterone; it’s not recommended for people who have hypersensitivity to progesterone. Vaginal dryness is a common side effect of taking hormonal contraceptives (but it can easily be solved).
Cost: contraception is free for everyone through the NHS.
Convenience: you should take the pill every day at the same time. You can choose between the 3-hour progestogen-only pill (should be taken within 3 hours of the same time each day) or the 12-hour progestogen-only pill (should be taken within 12 hours of the same time each day). There are 28 pills in a pack of progestogen-only pills, so there’s no break between packs.
Reversibility: when you stop taking the pill you’ll be fertile again.
Contraceptive patch (it contains oestrogen and progesterone)
It’s a small sticky patch that releases hormones into your body through your skin and prevents pregnancy. In the UK, the patch's brand is Evra.
Effectiveness: over 99% (if used correctly).
Safety: if you're thinking of using it, a GP or nurse will need to ask about you and your family's medical history. You may not be able to use the patch if you are pregnant,breastfeeding, smoke (or stopped smoking less than a year ago) and are 35 or older, you are very overweight, if you have or have had blood clots, heart problems or some kind of cancer.
Cost: contraception is free for everyone through the NHS. When you first get the contraceptive patch you will be given a 3-month supply, to see how you get on with it. If there are no problems, you can be prescribed the patch for 6 months to a year.
Convenience: apply your first patch and wear it for 7 days. On day 8, change the patch to a new one. Do this for 3 weeks, and then have a patch-free week (when you get your period - although this may not always happen). You can put it onto most areas of your body, as long as the skin is clean, dry and not very hairy. There’s only a 2% chance that the patch will come off.
Reversibility: when you stop using the patch you’ll be fertile again.
Vaginal ring (it contains oestrogen and progesterone)
The vaginal ring (NuvaRing) is a small, soft, plastic ring that you place inside your vagina, that releases a continuous dose of the hormones.
Effectiveness: over 99% (if used correctly).
Safety: unlike the pill, the ring still works if you have sickness (vomiting) or diarrhoea.
Cost: you can get contraception for free, even if you're under 16 - not all clinics are able to provide the vaginal ring, so it's worth checking first.
Convenience: one ring provides contraception for a month - you leave it in for 21 days, then remove it and have a 7-day ring-free break (when you get your period). It’s suitable for the people who have confidence with their bodies, because it needs to be inserted inside the vagina. You shouldn’t feel it or feel pain, during penetrative sex.
Reversibility: when you stop using the ring you’ll be fertile again.
Contraceptive implant (only progesterone)
The contraceptive implant (Nexplanon) is a small flexible plastic rod that's placed under the skin, in your upper arm by a doctor or nurse.
Effectiveness: more than 99% effective.
Safety: it can be useful for women who can't use contraception that contains oestrogen. Your periods may become irregular, lighter, heavier or longer. It leaves a little scar where implanted, you can feel it when touched.
Cost: you can get the contraceptive implant for free, even if you're under 16 - some (but not all) GPs or practice nurses are able to fit and remove implants, so you'll need to check at your GP surgery. Alternatively, most sexual health clinics will be able to do this for you.
Convenience: the implant is inserted under your skin, with a local anesthetic - it only takes a few minutes to put in and feels like having an injection. Nexplanon works for 3 years before it needs to be replaced and it can be removed at any time, by a specially trained doctor or nurse.
Reversibility: when you remove the implant you’ll be fertile again.
Contraceptive injection (only progesterone)
This is an injection of progesterone that can last from 8 to 13 weeks, depending on which injection you have. Not all injections are available at all clinics.
Effectiveness: more than 99% effective.
Safety: it can be useful for women who cannot use contraception that contains oestrogen and it’s not affected by other medicines. Your periods may become more irregular, heavier, shorter, lighter or stop altogether.
Cost: you can get the contraceptive injection for free, even if you're under 16. There’s a new kind of injection, Sayana Press: it’s similar to Depo-Provera injection but you'll be taught how to give yourself the injection, rather than having a doctor or nurse give it to you.
Reversibility: yes but it can take up to 1 year for your fertility to return to normal after the injection wears off.
Barriers
These contraceptives do not contain hormones, but they create a temporary physical barrier to prevent sperm to get to the uterus. So, we are not referring to reversibility because there’s no influence on fertility. Side effects for these kinds of contraceptives are very few, usually related to intolerances to materials or allergies.
Condom (male or female)
Effectiveness: 98% effective if used correctly, but statistics reveal that it drops to 85% because it’s not always used in a correct way. The female condom is 95% effective.
Safety: most condoms are made of latex but if you're sensitive to latex, you can use polyurethane or polyisoprene condoms instead.
Cost: you can get free condoms from contraception clinics, sexual health clinics and some GP surgeries. Otherwise, you can also buy condoms from pharmacies, supermarkets, websites, vending machines, in some public toilets and some petrol stations. Always buy condoms that carry the BSI kitemark and the European CE mark. This means they've been tested to the required safety standards.
Contraceptive diaphragm or cap
A contraceptive diaphragm or cap is a circular dome made of thin, soft silicone that’s inserted into the vagina before sex, covering the cervix.
Effectiveness: when used correctly with spermicide, a diaphragm or cap is 92-96% effective.
Safety: you can put in a diaphragm or cap with spermicide any time before you have sex, but more spermicide is needed if it's been in place for more than 3 hours. The diaphragm or cap needs to be left in place for at least 6 hours after sex. They are usually made of latex or silicone, so be careful if you are allergic.
Cost: contraception is free for everyone through the NHS.
Convenience: when you first start using a diaphragm or cap, a doctor or nurse will examine you and advise on the correct size. You need to use it with a gel that kills sperm (spermicide). You only have to use a diaphragm or cap when you have sex, but you must leave it in for at least 6 hours after the last time you had sex. You can leave it in for longer than this (max 30h for diaphragms and 48h for caps, including the minimum of 6h), but do not take it out before. Then you can wash it and use it again.
Sponge (not available in the UK)
It’s similar to the menstrual sponge, it should be used with a spermicide and positioned at the end of the vaginal canal. It’s no longer available in the UK but it’s a low effective method.
The coil
The coil is a T-shape device that's put into your womb (uterus) by a doctor or nurse. Some of them release hormones (IUS) but others don’t (IUD).
Before your coil is fitted, a GP or nurse will check inside your vagina to check the position and size of your womb. The appointment takes approximately 20-30 minutes for IUD and 15-20 minutes for IUS; the fitting itself takes no longer than 5 minutes.
Having an IUD/IUS fitted can be uncomfortable, and some people might find it painful, but you can have a local anaesthetic to help. Discuss this with a GP or nurse beforehand. You can ask to stop at any time. You may get period-type cramps afterwards, but painkillers can ease the cramps. You may also bleed for a few days after having an IUD/IUS fitted. Once an IUD/IUS has been fitted, it'll need to be checked by a GP after 3 to 6 weeks to make sure everything is fine.
It's not common, but the IUD/IUS can be rejected (expelled) by the womb or they can move (displacement).
IUD (it releases copper, no hormones)
Effectiveness: when inserted correctly, IUDs are more than 99% effective.
Safety: it’s not suitable for people allergic to copper. An IUD can usually be fitted 4 weeks after giving birth (vaginal or caesarean). If you get an infection when you have an IUD fitted, it could lead to a pelvic infection if not treated.
Cost: you can get the IUD for free, even if you're under 16.
Convenience: it can be placed and taken out at any time by a specially trained doctor or nurse. It protects against pregnancy for between 5 and 10 years. An IUD has 2 thin threads that hang down a little way from your womb into the top of your vagina. The GP or nurse that fits your IUD will teach you how to feel for these threads and check that it's still in place. Your partner should not be able to feel your IUD during sex.
Reversibility: it's possible to get pregnant straight after it's removed.
IUS (it releases progesterone)
Effectiveness: when inserted correctly, IUSs are more than 99% effective.
Safety: same as the other contraceptive methods based on progesterone; an IUS can usually be fitted 4 to 6 weeks after giving birth (vaginal or caesarean). If you get an infection when you have an IUS fitted, it could lead to a pelvic infection if not treated.
Cost: you can get the IUS for free, even if you're under 16.
Convenience: it can be placed and taken out at any time by a specially trained doctor or nurse. It protects against pregnancy for between 3 and 5 years, depending on the brand. An IUS has 2 thin threads that hang down a little way from your womb into the top of your vagina. The GP or nurse that fits your IUS will teach you how to feel for these threads and check that it's still in place. Your partner should not be able to feel your IUS during sex.
Reversibility: it's possible to get pregnant straight after it's removed.
IUB (not available right now on NHS - may be available through private providers)
IUB (IntraUterine Ball) is a copper IUD which upon insertion in the uterus takes a three-dimensional spherical “ball” form. It was on course to be rolled out in January 2021, but unfortunately, the spread of Covid-19 has grounded everything to a halt; hopefully it should become soon accessible to everyone.
Natural methods (fertility awareness)
There are different natural methods to check the changes to your cervical secretions (cervical mucus) - Billings method -, the daily readings of your body temperature, the coitus interruptus or contraception monitor test sticks (not as reliable as the other methods). Some are more trustworthy than others, for example the symptothermal method that combines some of these natural methods.
Alot of experts avoid including natural methods as contraceptive options because they are not very reliable. Still, natural methods are included as an option to women in some places.
Surgical methods (sterilisation)
These 2 are permanent methods of contraception: female sterilisation and male sterilisation (vasectomy).
Female sterilisation is an operation in which the fallopian tubes are blocked or sealed to prevent the eggs reaching the sperm and becoming fertilised. Once you're sterilised it's very difficult to reverse it, so consider all options before making your decision. Sterilisation reversal is not usually available on the NHS.
A vasectomy (male sterilisation) is a surgical procedure to cut or seal the tubes that carry a man's sperm to permanently prevent pregnancy. In most parts of the UK, a vasectomy is available free of charge from the NHS. But waiting lists can be several months, depending on where you live. It's possible to have a vasectomy reversed. But the procedure isn't always successful and it's rarely funded by the NHS.
As both methods are permanent surgeries, doctors may ask about your circumstances, provide information, and may recommend counselling before agreeing to the procedure. You should only have a sterilisation if you're certain you don't want any more children or don't want children at all.