Choosing contraception: methods, effectiveness and what to consider
Quick answer
The most effective contraceptives are long-acting methods such as the implant and intrauterine devices, which prevent more than 99% of pregnancies because they do not depend on remembering anything. Pills, patches, rings and condoms work well too but are less effective in everyday use. Only condoms also protect against sexually transmitted infections.
Key points
- Long-acting reversible contraception (LARC), such as the implant, IUD and IUS, is more than 99% effective.
- Methods you must use correctly every day or every time, such as the pill or condoms, are less effective in typical everyday use than in perfect use.
- Your health, plans for future pregnancy, side effects and personal preference all shape the right choice.
- Only condoms protect against sexually transmitted infections, so many people use them alongside another method.
- A doctor, nurse or family planning clinic can help you compare options, usually free or at low cost.
What types of contraception are there?
Contraceptive methods work in different ways: some release hormones that stop ovulation or thicken cervical mucus, some create a physical barrier, and some are permanent procedures. The main groups are:
- Long-acting reversible contraception (LARC): the implant, a small flexible rod placed under the skin of the upper arm; the hormonal intrauterine system (IUS); and the copper intrauterine device (IUD). Each lasts for several years and can be removed at any time.
- The contraceptive injection, given every few weeks or months depending on the type.
- Pills: the combined pill, containing estrogen and progestogen, and the progestogen-only pill.
- The patch and vaginal ring, which release hormones similar to the combined pill.
- Barrier methods: external and internal condoms, and the diaphragm or cap.
- Fertility awareness methods, which involve tracking signs of the menstrual cycle to identify fertile days.
- Sterilisation: tubal occlusion for women and vasectomy for men, both intended to be permanent.
What is the difference between perfect and typical use?
Perfect use describes how well a method works when it is used exactly as instructed every time. Typical use reflects real life, including missed pills, late injections or a condom put on too late. For methods that depend on daily or regular action, the gap between the two can be large.
Long-acting methods have almost no gap because, once in place, there is nothing to remember. That is why health services describe them as the most effective reversible options.
- Implant, IUS and copper IUD: more than 99% effective.
- Sterilisation: more than 99% effective.
- Injection: more than 99% with perfect use, about 94 to 96% with typical use.
- Combined pill, progestogen-only pill, patch and ring: more than 99% with perfect use, about 91 to 93% with typical use.
- External condoms: about 98% with perfect use, about 82 to 87% with typical use.
- Fertility awareness methods: effectiveness varies widely and depends heavily on training, cycle regularity and consistent tracking.
How do you choose the right method for you?
There is no single best method, only the one that suits your body and life right now. It is normal to try more than one before finding the right fit.
Some health conditions affect which methods are safe. For example, estrogen-containing methods such as the combined pill, patch and ring may not be suitable for people who have migraine with aura, a history of blood clots, or who smoke and are over 35. Clinicians use international medical eligibility criteria, based on WHO guidance, to check this, so be open about your health history and any medicines you take.
- How effective you need it to be, and how easy it is for you to use consistently.
- Your plans for pregnancy: most methods allow fertility to return quickly once stopped, but after the injection it can take up to a year.
- Possible side effects and benefits, such as changes to bleeding patterns or lighter, less painful periods.
- Whether you prefer a hormone-free option, such as the copper IUD or condoms.
- Whether you also need protection from STIs.
- Cost, availability where you live, and whether you are breastfeeding.
Which contraception protects against STIs?
Only condoms, external or internal, reduce the risk of both pregnancy and sexually transmitted infections. Hormonal methods, intrauterine devices, fertility awareness and sterilisation prevent pregnancy but give no protection against STIs, including HIV.
Many people use a highly effective method such as an implant or IUS to prevent pregnancy, together with condoms with new or casual partners. Regular STI testing remains important whichever method you use.
Where can you get contraception?
Contraception is available from family doctors and GPs, sexual health and family planning clinics, community health services and, for some methods, pharmacies. In the UK, contraception is free through the NHS, and some pharmacies can provide the pill without a GP appointment. In India, government health facilities offer free methods, including condoms, oral pills, the copper IUD, an injectable contraceptive and sterilisation.
A clinician or pharmacist will advise on how to start your chosen method and whether you need extra protection, such as condoms, for the first few days.
When to see a doctor
- Seek urgent care if you use hormonal contraception and develop chest pain, breathlessness, a painful swollen leg, or a sudden severe headache.
- See a clinician promptly if you have an IUD or IUS and develop severe pelvic pain, fever or unusual discharge.
- Book an appointment if you have heavy, prolonged or unexpected bleeding, or think you might be pregnant.
- Ask for advice before stopping a method, or if side effects are affecting your daily life.
Frequently asked questions
What is the most effective form of contraception?
Long-acting reversible methods, namely the implant, the hormonal IUS and the copper IUD, are the most effective reversible options, preventing more than 99% of pregnancies. Sterilisation is similarly effective but intended to be permanent. These methods work so well because they do not rely on remembering to take or use something each day or each time.
Does contraception affect future fertility?
For most methods, fertility returns soon after stopping, often straight away. The exception is the contraceptive injection, after which it can take up to a year for periods and fertility to return to normal. Sterilisation is intended to be permanent. If you are planning a pregnancy in the near future, mention this when choosing a method.
Do I need condoms if I already use another method?
Possibly. Pills, implants, injections and intrauterine devices prevent pregnancy but do not protect against sexually transmitted infections. If you have a new partner, more than one partner, or do not know a partner's STI status, using condoms as well lowers your infection risk. Regular STI testing is also a good idea.