Contraception
Every method available in the UK, how well each one works in real life, and an honest summary of the pros and cons to help you choose.
There is no single best contraceptive. The right method is the one that suits your body, your health, your plans, and your day to day life, and that may change over time. This guide sets out the options side by side so that you can come to a consultation knowing what you would like to ask.
Choosing a method
It helps to think about what matters most to you before looking at individual methods.
How important is effectiveness?
Methods that do not rely on you remembering anything are the most reliable in everyday use.
Daily routine or fit and forget?
Some people like the control of a daily pill. Others would rather not think about it for years.
How do you feel about your periods?
Some methods make periods lighter or stop them, some make them heavier, and some make them unpredictable.
Hormones or hormone free?
Copper coils, condoms, and fertility awareness contain no hormones. Hormonal methods vary widely in dose and type.
Are you planning a pregnancy soon?
Fertility returns quickly after most methods. The injection is the exception, with a delay of up to a year.
Your medical history
Migraine, blood pressure, weight, smoking, clotting history, and other medicines all affect which methods are safe for you.
Only condoms protect against sexually transmitted infections. If you have a new partner, or more than one, use condoms alongside your chosen method.
How effective is each one?
Effectiveness is quoted in two ways. Perfect use is when a method is used exactly as intended every time. Typical use reflects real life, including missed pills and late injections. The figures show the percentage of people who avoid pregnancy over one year of use.
| Method | Perfect use | Typical use | How long it lasts |
|---|---|---|---|
| Implant | Over 99% | Over 99% | 3 years |
| Hormonal coil (IUS) | Over 99% | Over 99% | 3 to 8 years, depending on type |
| Copper coil (IUD) | Over 99% | Over 99% | 5 to 10 years, depending on type |
| Sterilisation | Over 99% | Over 99% | Permanent |
| Injection | Over 99% | Around 94% | 13 weeks |
| Combined pill, patch, or ring | Over 99% | Around 91% | Daily, weekly, or monthly |
| Progestogen only pill | Over 99% | Around 91% | Daily |
| External (male) condom | 98% | Around 82% | Each time |
| Fertility awareness | Up to 99% | Around 76% | Daily tracking |
Sources: Faculty of Sexual and Reproductive Healthcare (FSRH); NHS.uk; Trussell, Contraceptive failure in the United States, 2011. Fertility awareness figures vary widely depending on the method used and the quality of teaching.
Long acting methods
Long acting reversible contraception (LARC) does not depend on remembering to take or use it, which is why it performs so well in real life. All of these methods are reversible.
Implant
A small flexible rod placed under the skin of the upper arm under local anaesthetic. It releases a progestogen that stops ovulation.
Advantages
- The most effective method available
- Lasts three years and is quickly reversible
- Suitable for most people who cannot take oestrogen
Things to consider
- Bleeding becomes unpredictable. It may stop, become infrequent, or be prolonged or frequent
- A minor procedure is needed to fit and remove it
- Some people notice acne or mood changes
Hormonal coil (IUS)
A small T shaped device placed in the womb that releases a low dose of progestogen locally.
Advantages
- Periods usually become much lighter and often stop
- Also used to treat heavy periods and as part of HRT
- Very low hormone levels in the bloodstream
Things to consider
- Fitting can be uncomfortable
- Irregular spotting is common for the first three to six months
- Small risks of infection after fitting, expulsion, and perforation
Copper coil (IUD)
A small copper and plastic device placed in the womb. Copper is toxic to sperm and eggs. It contains no hormones.
Advantages
- Hormone free
- Works immediately and lasts up to ten years
- The most effective form of emergency contraception
Things to consider
- Periods can become heavier, longer, and more painful, particularly at first
- Fitting can be uncomfortable
- Small risks of infection after fitting, expulsion, and perforation
Injection
A progestogen injection given every 13 weeks. One version can be self injected at home after training.
Advantages
- Nothing to remember day to day
- Periods often stop after a few injections
- Not affected by other medicines
Things to consider
- Cannot be reversed once given, and side effects last for the duration
- Fertility can take up to a year to return after stopping
- Associated with weight gain in some people and a small, reversible reduction in bone density
Pills, patch & ring
Combined methods
The combined pill, the weekly patch, and the monthly vaginal ring all contain oestrogen and a progestogen. They work mainly by stopping ovulation.
Periods usually become lighter, more regular, and less painful. They can improve acne and premenstrual symptoms, and they lower the risk of ovarian, womb, and bowel cancer. They can be taken continuously to skip bleeds altogether.
Progestogen only pill
Also called the mini pill. It contains no oestrogen and is taken every day without a break. Desogestrel pills, the most commonly used type, stop ovulation and have a 12 hour window if you are late taking one.
It is suitable for most people who cannot take oestrogen, including those who are breastfeeding. Bleeding can be irregular, lighter, or stop. Desogestrel is available to buy from pharmacies without a prescription.
Combined methods are not suitable for everyone. They are usually avoided if you:
- Have migraine with aura
- Are aged 35 or over and smoke
- Have a BMI of 35 or above
- Have high blood pressure
- Have had a blood clot, or have a close relative who had one under the age of 45
- Have had breast cancer, a stroke, or heart disease
- Gave birth in the last six weeks, or are breastfeeding a baby under six weeks old
The main serious risk of combined methods is a blood clot in the leg or lung. The risk is small, roughly 5 to 12 in every 10,000 users each year compared with 2 in 10,000 non users, and is lower than the risk during pregnancy. There is also a small increase in the risk of breast and cervical cancer, which returns to normal over time after stopping. This is why we check your blood pressure, weight, and medical history before prescribing.
Barrier & other methods
Condoms
External and internal condoms are the only methods that also protect against sexually transmitted infections. They are hormone free and available without a prescription. Their effectiveness depends heavily on using them correctly every time. Oil based lubricants damage latex condoms.
Diaphragm or cap
A silicone dome placed over the cervix before sex and used with spermicide. Hormone free, but less effective than most other methods, with typical use effectiveness of around 71 to 88%.
Fertility awareness
Tracking temperature, cervical fluid, and cycle length to identify fertile days, and avoiding sex or using condoms on those days. It requires proper teaching, daily commitment, and reasonably regular cycles. Apps vary greatly in quality.
Sterilisation
Vasectomy and female sterilisation are permanent and should be considered irreversible. Vasectomy is simpler, safer, and more effective than female sterilisation, and is done under local anaesthetic.
Withdrawal
Not recommended as a method of contraception. Around one in five couples relying on it become pregnant within a year.
Emergency contraception
If you have had sex without contraception, or your method has failed, emergency contraception can prevent pregnancy. The sooner you act, the more choice you have and the better it works.
Copper coil (IUD)
Up to 5 days after sex, or up to 5 days after the earliest likely ovulation
The most effective option, preventing more than 99% of pregnancies, and it can then be kept as ongoing contraception. Its effectiveness is not reduced by body weight.
Ulipristal acetate (ellaOne)
Up to 5 days (120 hours) after sex
A tablet that delays ovulation. It is more effective than levonorgestrel. Hormonal contraception should not be restarted for five days afterwards, and it is less effective if you have recently taken progestogen.
Levonorgestrel (Levonelle)
Up to 3 days (72 hours) after sex
A tablet that delays ovulation. It is most effective the sooner it is taken. A double dose may be advised if you weigh over 70kg or have a BMI over 26, or take certain medicines.
Where to get it
Emergency contraceptive tablets are available free of charge from most pharmacies in England, as well as from sexual health clinics, GP surgeries, and NHS walk in centres. An emergency copper coil is fitted at sexual health clinics and some GP surgeries. If you are unsure which option is right for you, call us or NHS 111. Take a pregnancy test if your next period is more than seven days late or unusually light.
Special situations
After having a baby
You can become pregnant from three weeks after giving birth, before your first period returns. Progestogen only methods can be started straight away, including while breastfeeding. Combined methods are delayed for at least six weeks.
Approaching the menopause
Contraception is still needed until the menopause is confirmed. As a general rule, continue for two years after your last period if you are under 50, and one year if you are over 50. Contraception can be stopped at 55. Combined methods are usually changed to an alternative by the age of 50.
Vomiting and diarrhoea
Vomiting within three hours of taking a pill, or severe diarrhoea lasting more than 24 hours, can mean the pill is not absorbed. Treat it as a missed pill and follow the instructions in your packet.
Other medicines
Some medicines make hormonal contraception less effective, including certain epilepsy and HIV treatments, rifampicin, and the herbal remedy St John’s wort. Most common antibiotics do not. Always tell a prescriber or pharmacist what contraception you use.
Missed pills
What to do depends on the type of pill, how many you have missed, and where you are in the pack. Follow the leaflet in your packet, use condoms in the meantime, and ask us or a pharmacist if you are unsure.
Weight loss injections: Some weight loss medications can reduce the effectiveness of the contraceptive pill, and pregnancy should be avoided while taking them. Please read the contraception section of our weight loss medications guide.
When to get urgent help
If you use a combined pill, patch, or ring, call 999 or go to A&E if you develop:
- Pain, swelling, or redness in one calf or thigh
- Sudden breathlessness, sharp chest pain, or coughing up blood
- Crushing chest pain or tightness
- Sudden weakness or numbness on one side, slurred speech, or loss of vision
- A first ever migraine with visual disturbance, or a sudden severe headache
Contact us or NHS 111 promptly if:
- You have a coil and develop lower tummy pain, fever, or unusual discharge, or cannot feel the threads
- You have a positive pregnancy test with a coil in place, or with one sided tummy pain
- You cannot feel your implant, or it seems to have changed shape
- You have very heavy or persistent bleeding
Common questions
Short answers to the questions we are asked most often.
What is the most effective contraception?
The implant, the hormonal coil, and the copper coil are the most effective reversible methods, each more than 99% effective in everyday use. They work so well because they do not rely on remembering to take or use anything.
How effective is the contraceptive pill?
With perfect use the pill is more than 99% effective. With typical use, which allows for missed and late pills, it is around 91% effective. That means around 9 in 100 people relying on it become pregnant in a year.
How long after sex can I use emergency contraception?
A copper coil can be fitted up to five days after unprotected sex and is the most effective option. Ulipristal acetate (ellaOne) can be taken up to five days (120 hours) after sex. Levonorgestrel (Levonelle) can be taken up to three days (72 hours) after. The sooner you act, the better it works.
Who should not take the combined pill?
The combined pill is usually avoided if you have migraine with aura, are 35 or over and smoke, have a BMI of 35 or above, have high blood pressure, or have had a blood clot, breast cancer, stroke, or heart disease. The progestogen only pill is suitable for most people who cannot take oestrogen.
Does contraception protect against STIs?
Only condoms protect against sexually transmitted infections. If you have a new partner, or more than one, use condoms alongside your chosen method.
Next steps
A contraception consultation with us gives you time to go through your options properly, including your medical history, what has and has not suited you before, and what you want from a method. We can prescribe where appropriate, and where a method needs to be fitted we will explain how to arrange this.