Choosing contraception can be a daunting quest. There are myriad choices out there in the multiverse. So, how do you choose the contraception that’s right for you?
Where should you even start?
You may be just starting on your contraception crusade, or you may be a weary & weathered traveller who’s tried several and still not found the one. Whichever you may be, hopefully, these tips will help to guide you on your lofty quest.
Remember, everybody is unique, so what works for Laila at the office or Alex at the nail salon may not be the right or safe choice for you. And lastly, patience is key - it takes time for your body to settle with any type!
So, let’s begin.
Tip 1: Hormones are a choice
Think of all your options as sitting on a linear spectrum, according to how invasive and long they last (see the graphic above if you’re struggling to picture it). Natural family planning, condoms, diaphragms - all ‘natural’ and ‘barrier’ methods are an initial way to avoid hormones and sit at one end of the spectrum. However, these groups are the least effective at preventing pregnancy, especially as they are often not used perfectly.
Towards the other end of the contraception spectrum is the hormone-free Copper coil, which is inserted via a quick procedure into the womb and can last 5 or 10 years, depending on the type. The most common downside to the Copper coil is its effect on bleeding - it can sometimes make periods longer and heavier. Further still, down the invasive end of the spectrum lie permanent surgical choices like female sterilisation and male vasectomy (though I would think long and hard before embarking down this road as they are often irreversible!).
All other forms of contraception sit between the ‘barrier’ methods and permanent surgeries, e.g. pills, injections, and implants - all of which contain some form of hormone in different combinations. I would stress that hormones can be a really great choice for some!
I would stress that hormones can be a really great choice for some!
Yes, they’re not without their own small risks (and you should always speak to a doctor to make sure they are safe for you), but they have many benefits, too. They can hugely help with troublesome periods and more (scroll to Number 5!). And sometimes, switching up the type or amount of hormones can be just the change you need!
Tip 2: You can take charge of your bleeds
The combined hormonal pill enables you to control the timing of your bleeds (we shouldn't call them periods as they differ from natural periods when using hormonal contraception). You can opt to have a bleed monthly, quarterly, or even no bleeding at all! An added benefit is these bleeds are typically lighter and less painful. However, before considering this option, it's crucial to consult your doctor because some medical conditions may make it unsafe, and there are some minor associated risks. There are also other hormonal methods, such as the hormonal Mirena coil, that can effectively reduce or even eliminate bleeding, although you may not have complete control over it when it occurs.
Tip 3: Some options are more reliable at preventing pregnancy
Picture our spectrum again. More or less, the further to the right you go down the spectrum towards the longer-duration options, the more effective they are. However, the single most effective type is the Implant, which is over 99.9% effective. It sits just under the skin in the inner upper arm and lasts three years, but it needs a trained doctor to insert and remove it.
Tip 4: Duration matters
How long each type of contraception lasts should also help guide your choice, especially if you’re planning a family in the near future or you’re approaching menopause. The pills can be stopped at any time and are within your control. Next along is the Injection, which lasts 3 months (though can cause a delayed return to fertility after stopping). The Implant we know already lasts 3 years, and the hormonal and copper Coils can last 3, 5, 6 or 10 years, depending on which you choose. Of course, all Implants and Coils can be removed earlier if they disagree with you, but remember my earlier tip on being patient! Doctors usually advise allowing 3-6 months for your body to settle on different types.
Doctors usually advise allowing 3-6 months for your body to settle on different types.
And lastly, sterilisation and vasectomies are considered permanent.
Tip 5: Some options can help PMS and other symptoms
Don’t be scared of hormonal contraception, as they can have many added benefits that non-hormonal options won’t have! They can often help with Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), as well as symptoms like acne, painful or heavy periods or excessive hair growth. They’re particularly useful in conditions such as Polycystic Ovarian Syndrome (PCOS) and Endometriosis. Sometimes, finding the right one for you can be trial and error, so keep exploring different routes!
Sometimes, finding the right one for you can be trial and error, so keep exploring different routes!
Tip 6: Understand the trade-off: risks and side effects
On the whole, hormonal contraception options containing two types of hormone (oestrogen and progesterone) do carry slightly more risks than one or no hormone. Still, hormonal options commonly have more benefits!
Still, hormonal options commonly have more benefits!
Once you put those risks into perspective with other day-to-day things we do, like smoking or eating an unhealthy diet, you may start to see the wood from the trees - contraception risks are often relatively small in comparison! All procedures to insert or remove the longer-acting types also carry their own minor risks. Read from reputable sources or speak to your Doctor to find out more, and always weigh them against the many potential benefits!
Tip 7: Protect yourself from Sexually Transmitted Infections (STIs)
Condoms are one of the few ways to practise safer sex, but these still don’t guarantee 100% protection from STIs, as there may still be some skin or body fluid contact. If you’re unsure about the risk, the best method is just to have an open and honest conversation with your partner about getting checked beforehand.
Everyone should feel safe when having sex. Or, at the very least, get yourself tested soon after (and definitely before having sex with someone new!). Most UK NHS sexual health clinics are walk-in services and are super discreet. See below for a link to find your nearest one.
Wishing you success on your journey
My hope is that these top tips have helped to demystify contraception in some way for you. To further empower your decisions, keep reading from reliable sources because the contraception landscape is ever-changing as we keep learning! Sexwise and Brook are reliable sexual health websites in the United Kingdom (see below in references for links). New and exciting navigation tools also lie on the horizon, like the contraception choice algorithm that Dama Health is bringing to life!
As you find your way, keep in mind that your individual needs and circumstances will naturally steer you towards the contraception that suits you best, and it's perfectly normal for your choice of contraception to evolve in tandem with shifts in your life too; remember, switching things up can be a positive thing!
Useful websites for you:
Academic Data & Guidelines: