Contraception

Choosing the right method

There is no single “best” contraceptive. The ideal method depends on many individual factors: age, medical history, tolerance of hormones, desire for a long-acting versus short-acting solution, menstrual pattern, and whether you wish to preserve fertility in the near or distant future.

A thorough consultation allows a personalised recommendation that balances efficacy, convenience, side effects, and your own priorities. Methods can be changed at any time if your needs or circumstances evolve.

Hormonal contraception

Hormonal methods work by suppressing ovulation, thickening cervical mucus, and/or thinning the endometrium to prevent pregnancy:

• Combined oral contraceptive pill (COC) — contains oestrogen and progestogen. Taken daily for 21 days with a 7-day break (or continuously). Also helps with acne, heavy periods, and menstrual pain. Contraindicated in women with a history of blood clots, certain migraines, or cardiovascular risk factors
• Progestogen-only pill (POP) — taken daily without a break. Suitable for women who cannot take oestrogen (e.g., breastfeeding, migraine with aura, cardiovascular risk). Newer formulations (desogestrel) effectively suppress ovulation
• Vaginal ring — a flexible ring inserted into the vagina for 3 weeks, then removed for 1 week. Delivers the same hormones as the combined pill with steady absorption and potentially fewer side effects
• Contraceptive patch — applied weekly for 3 weeks, then a patch-free week. Convenient for those who find daily pill-taking difficult

Long-acting reversible contraception (LARC)

LARC methods are the most effective reversible contraceptives, with failure rates below 1%. They are “fit and forget” options that require no daily action:

• Hormonal intrauterine device (IUD / IUS) — a small T-shaped device placed in the uterus that releases levonorgestrel. Effective for 3–8 years depending on the model. Significantly reduces menstrual bleeding and pain. Commonly used brands include Mirena, Kyleena, and Jaydess
• Copper intrauterine device — a hormone-free option that works through the copper’s spermicidal effect and alteration of the uterine environment. Effective for 5–10 years. Periods may become heavier initially. An excellent choice for women who prefer to avoid hormones
• Subdermal implant (Nexplanon) — a small flexible rod inserted under the skin of the upper arm, releasing etonogestrel for up to 3 years. Over 99% effective. Periods often become lighter or stop altogether, though irregular bleeding can occur in the first months

Injectable contraception

The depot medroxyprogesterone acetate (DMPA) injection is administered every 12–13 weeks. It is highly effective and convenient but may be associated with weight gain and a temporary delay in return of fertility after discontinuation. Due to its effect on bone density with long-term use, it is generally recommended for limited duration, particularly in younger women.

Barrier methods

• Male condom — the only contraceptive that also protects against sexually transmitted infections. Effectiveness depends on consistent and correct use (typical use: 87% effective)
• Female condom — an alternative barrier method that can be inserted up to 8 hours before intercourse
• Diaphragm or cervical cap — silicone devices inserted before intercourse to cover the cervix, used with spermicide. Require fitting and correct placement

Permanent contraception (sterilisation)

For women (and couples) who are certain they do not wish to have future pregnancies, permanent sterilisation is an option:

• Bilateral salpingectomy — the current recommended technique involves the complete removal of both fallopian tubes. Performed laparoscopically as a day-case procedure. In addition to permanent contraception, it has the added benefit of reducing the risk of ovarian cancer (a significant proportion of which originates in the fallopian tubes)
• Tubal ligation — clips or rings are applied to the fallopian tubes to block them. Effective but now less commonly performed than salpingectomy

Emergency contraception

Emergency contraception should be used as a backup, not a regular method. Options include:

• Levonorgestrel (Norlevo) — effective up to 72 hours after unprotected intercourse, most effective within 12 hours. Available without prescription from pharmacies
• Ulipristal acetate (EllaOne) — effective up to 120 hours (5 days) after unprotected intercourse. Available without prescription
• Copper IUD — the most effective emergency contraception when inserted within 5 days. Has the added advantage of providing ongoing long-term contraception