If you’re sexually active and can get pregnant, then contraception is something you’ve probably had to consider at some point. Finding the right form of contraception can be confusing and daunting, especially since there are many effective options available for people with a uterus.

While condoms are the only form of contraception that protect you against STIs, there are 15 methods to choose from for preventing an unwanted pregnancy.

Whether they’re hormonal, non-hormonal, long-acting, irreversible or emergency, they’re all free on the NHS if you live in the UK.

Non-hormonal forms of contraception, such as condoms or copper coil (IUD), mainly work by preventing sperm from fertilising an egg and don’t change the natural hormonal functions and levels in your body.

Hormonal contraception, such as the pill or IUS, interacts with your natural hormonal fluctuations and mainly works by preventing ovulation or by making the endometrium inhospitable. 

No contraceptive method is perfect and risk-free – but wouldn’t that be neat. Finding the right one for you depends on lifestyle factors, age, current health and medical history, and how effective a method of contraception is depends largely on whether or not it’s taken correctly (“typical use”). 

Ultimately, choosing the best form of contraception for you is a matter of weighing out the pros and cons, so we put together a handy guide to help you navigate your options. And in case you were wondering, no, the pull-out method is not on the list… 

Non-hormonal contraception

Condoms

Condoms are a barrier form of contraception that stop sperm meeting an egg, and they are the only method that protects you from STIs (including HIV).

External condoms (AKA male condoms) are one of the most popular – who hasn’t awkwardly practiced on a banana, eh? – but internal condoms (AKA female condoms) are also a choice of barrier method, albeit a less popular one. 

With perfect use, external condoms are 98% effective, but with typical use, they’re 82% effective. This means that if five of your friends are using condoms, one of them will be pregnant within a year. 

With perfect use, internal condoms are 95% effective, but with typical use they’re 79% effective – so 21 in 100 women will get pregnant in a year using internal condoms. 

Pros of condoms

• External condoms are widely available. They’re inexpensive and can be bought in supermarkets, pharmacies and in vending machines
• Both external and internal condoms are available for free in sexual health clinics, family planning clinics and at the GP
• You only need to use them while having sex
• Unlike external condoms, internal condoms can be inserted up to 8 hours before intercourse
• They protect against STIs as well as pregnancy

Cons of condoms

• They can slip off or break, and oil-based lubricants can make them porous, therefore ineffective
• Internal condoms are harder to find and can be quite expensive compared to external condoms
• When using an internal condom, you need to make sure the penis enters the condom properly, which can be tricky
• They do not protect you from contracting genital warts, which are caused by HPV

Intrauterine device (IUD)

The IUD, or copper coil, is a small plastic and copper device that sits inside your uterus and has two strings that stick out of your cervix.

It works by releasing small doses of copper that alter your cervical mucus and makes it more difficult for sperm to survive in your uterus. It can also stop a fertilised egg from implanting in the uterus. 

It is a method of long-acting reversible contraception (LARC), also known as “fit and forget”, and is 99% effective. Although it’s one of the safest and most effective forms of contraception, it’s probably the most misunderstood. 

Pros of the IUD

• Once inserted, it lasts five to ten years depending on the brand
• It takes less than 15 minutes to insert and can be done at any point of the menstrual cycle, provided that there is no chance of you being pregnant
• It works as soon as it’s inserted, and can be removed at any point by a nurse or doctor without disrupting your fertility
• It’s not affected by other medication
• It’s safe to use while breastfeeding

Cons of the IUD

• Insertion can be uncomfortable or painful, and has to be done by a specially trained nurse or doctor
• Some spotting is common for the first few months
• It may make your periods longer and heavier in the first six months
• There is a small chance (one in 20) that your body will expel the IUD in the first 3 months
• There is a very small chance (one in 1000) that the IUD will dislodge and perforate your uterus. This is extremely uncommon and is typically due to an inexperienced clinician not inserting it properly or abnormal anatomy

Cervical caps and diaphragms 

Diaphragms are dome-shaped cups barrier methods made of thin, soft latex or silicone and have a flexible rim. Cervical caps are slightly smaller and made of silicone. Caps and diaphragms aren’t very popular, and they’re a bit of a throwback contraceptive method. 

They’re inserted in the vagina and sit at the base of your cervix, preventing sperm from entering the uterus and fertilising an egg. With typical use, they’re 71-88% effective. 

Pros of cervical cap and diaphragm

• You only need to use them when you have sex
• They can be inserted before intercourse and can be worn for up to six hours after
• They have no serious health risks or side effects

Cons of cervical cap and diaphragm

• Caps and diaphragms should be used with spermicide, which can disrupt your vaginal microbiome. If they are inserted more than three hours before intercourse, more spermicide needs to be used
• You will need to see a doctor or nurse the first time to make sure it fits correctly, as their shape and size can vary
• If you lose more than 3kg (7lbs) or have a baby, you might have to fitted with a new cap or diaphragm
• It can take time to learn how to use it properly
• Some women develop cystitis when they use a diaphragm or cap
• Even though they are a barrier method, they don’t protect you from STIs

Fertility awareness methods (FAM)

Also known as “natural family planning”, fertility awareness methods (FAM) involve tracking your cycle to identify when you’re within the fertile window (ie. ovulating) so you can either plan or avoid a pregnancy.

It requires keeping daily records, but can be relatively effective (76%). This means around 24 in 100 women will get pregnant in a year when using FAM.

In order for FAM to be effective, you need to record your basal body temperature (BBT) at the same time every morning before getting out of bed, and before drinking or eating anything.

It also involves monitoring your cervical mucus to identify when you are ovulating, and tracking the length of your cycle. 

Pros of fertility awareness methods

• FAM has no physical or mental side effects
• It doesn’t require relying on synthetic hormones or any devices
• It’s accepted by all faiths and cultures
• It can help you understand your cycle better

Cons of fertility awareness methods

• It will take a few cycles to get the hang of, and learn how to predict your fertile days properly
• It is not suitable for people with irregular periods
• You have to keep daily records
• Illness, alcohol, stress, travel and certain medications can interfere with your BBT and therefore compromise records
• During your fertile days you need to avoid intercourse, or use a barrier method of contraception to prevent pregnancy

Hormonal contraception

Combined oral contraceptive pill (COCP)

Typically referred to as “the pill”, the combined oral contraceptive pill (COCP) is the most common form of contraception – and arguably the most contentious.

It’s made of two synthetic versions of progestogen and oestrogen, the female hormones produced naturally by the body. 

The combined oral contraceptive pill works by preventing ovulation, meaning that your ovaries don’t release an egg. It also thickens your cervical mucus, making it harder for sperm to reach the egg, and thins the uterine lining, preventing a fertilised egg from implanting. The COCP is 99% effective with typical use. 

Types of contraceptive pill

There are two different types of COCPs: monophasic pills and phasic pills. Monophasic pills are the most commonly used, and they contain the same dose of hormones.

You usually take them every day for 21 days, then have a 7 day break before starting a new pack. Phasic pills contain two or three sections of pills that contain different amounts of hormones, and it’s really important that you take them in the right order. 

There is no reason why you can’t take COCPs back to back, and the seven day break is mostly intended to allow women to have a withdrawal bleed. During the break, the drop in hormones triggers your endometrium to shed, but since you don’t ovulate on the pill, it’s not the same as your period.

There’s no health benefit to having a withdrawal bleed every month, and it’s not medically necessary. The seven day break is mostly intended to allow women to know they are not pregnant, and many women feel more comfortable bleeding every month. 

Skipping the seven day break causes no harm, it simply means you don’t bleed. However, skipping the break for multiple cycles in a row makes unexpected spotting more likely – your endometrium has a shelf life and your body automatically resets it every few months. Basically, your body pulls a Marie Kondo on your womb. Whether or not you have withdrawal bleeds, and how heavy they are depends on your body and the brand of pill you are taking. 

Pros of the pill

• It can make periods lighter, more regular and less painful
• It may also help alleviate PMS symptoms
• Certain brands of COCPs can help with cystic acne
• Studies have found that it reduces the risk of ovarian, uterine and colorectal cancer
• It doesn’t affect your fertility once you stop using it
• Despite the common misconception, the pill does not cause weight gain
• It helps with problems associated with polycystic ovarian syndrome (PCOS)

Cons of the pill

• Side effects such as headaches, nausea, mood changes, and breast tenderness are common in the first few months
• It can increase your risk of breast and cervical cancer
• Although there is no definitive link between the pill and depression, overwhelming anecdotal proof suggests otherwise (more research is needed)
• It increases your risk of deep vein thrombosis (DVT), but this is very rare
• Missing a pill, vomiting or severe diarrhoea after taking the pill can make it less effective
• It may not be suitable if you’re a smoker and are over 35 years old, have a family history of breast cancer, have cardiac problems or are very overweight
• Medications to treat HIV, epilepsy and TB, as well as St. John’s Wort can make the pill less effective

Progestogen-only pill (POP)

The progestogen-only pill (POP), or mini pill, mainly works by thickening your cervical mucus, which prevents sperm from reaching an egg, and thinning the lining uterine lining, so it’s less likely for a fertilised egg to implant. The POP is 91% effective with typical use. 

Some POPs also prevent your ovaries from releasing an egg (ovulation), which means you don’t get a period. The POP is also taken every day at the same time, but, unlike the COCP, there is no seven day break. 

Pros of the mini pill

• It doesn’t contain oestrogen, so it’s useful for women who cannot take oestrogen (such as breastfeeding women)
• It’s safe for smokers over 35
• It can help with PMS symptoms and painful or heavy periods

Cons of the mini pill

• You need to take the pill within three hours of your usual time every day. 
• It may cause temporary side effects in the first few months, such as headaches, breast tenderness, weight change and spots
• Your periods may become irregular or stop altogether. Spotting in between periods is also common with the POP
• Missing a pill, vomiting or severe diarrhoea after taking the pill can make it less effective
• Medications to treat HIV, epilepsy and TB, as well as St. John’s Wort can make the pill less effective

Intrauterine system (IUS) 

An IUS is a small T-shaped plastic device that’s inserted into your uterus and releases progestogen (the synthetic version of progesterone), and has two strings that stick out of your cervix. It’s 99% effective, and comes in different sizes which release different amounts of progestogen. It's sometimes referred to as the 'hormonal coil'.

Much like an IUD, it is a LARC method. Two brands are available in the UK: Mirena, which lasts five years, and Jaydess, which lasts three years.

The IUS thickens your cervical mucus, making it harder for sperm to reach the egg, and thins the uterine lining, preventing a fertilised egg from implanting. 

Pros of the hormonal coil

• Once inserted, it lasts three to five years depending on the brand
• It makes your periods lighter and less painful, and may make them stop altogether
• It doesn’t contain oestrogen
• It’s a good option for women who won’t remember to take the pill every day
• It takes less than 15 minutes to insert and can be done at any point of the menstrual cycle, provided that there is no chance of you being pregnant
• It works as soon as it’s inserted, and can be removed at any point by a nurse or doctor without disrupting your fertility
• It isn’t affected by any other medicines

Cons of the hormonal coil

• You may experience unpredictable spotting during the first few months
• Insertion can be uncomfortable or painful, and has to be done by a specially trained nurse or doctor. Some spotting is common for the first few weeks
• There is a small chance (one in 20) that your body will expel the IUS in the first three months
• There is a very small chance (one in 1000) that the IUD will dislodge and perforate your uterus. This is extremely uncommon and is typically due to an inexperienced clinician not inserting it properly

Contraceptive implant

The implant is a small plastic rod, about 4cm in length, that is inserted under the skin of the upper arm. It contains the progestogen, which stops ovulation and thickens the cervical mucus, preventing sperm from reaching an egg. The contraceptive implant is a LARC method that lasts three years and is 99% effective. 

Pros of the implant

• It doesn’t contain oestrogen, so it’s useful for women who cannot take oestrogen
• Insertion is quick and only requires local anaesthetic

Cons of the implant

• Insertion may cause bruising, swelling and tenderness in your arm.
• Infections after insertion are rare, but can happen
• Although rare, removing the implant can be painful or tricky if excessive scarring is present
• It may cause temporary side effects in the first few months, such as headaches, breast tenderness, weight change and spots
• In the first year your period may become irregular, lighter or heavier. It may also stop altogether
• Medications to treat HIV, epilepsy and TB, as well as St John’s Wort can make the implant less effective

Contraceptive injection

The contraceptive injection is an injectable form of progestogen, which prevents your ovaries from releasing an egg (ovulation).

It’s a LARC method and for either eight, 12 or 13 weeks, depending on the type. The types of injection available in the UK are Savana Press, DepoProvera and Noristerat. The contraceptive injection is 94% effective with typical use. 

Pros of the contraceptive injection

• Periods may become lighter, or stop altogether
• It may help with PMS symptoms
• It isn’t affected by any other medications
• It doesn’t contain oestrogen, so it’s useful for women who cannot take oestrogen
• The Sayana Press injection can be self-administered without the presence of a nurse or doctor
• It’s a good option for women who won’t remember to take the pill every day but don’t want an IUD/IUS

Cons of the contraceptive injection

• Some women experience weight gain with the contraceptive injection
• Breakthrough bleeding and occasional spotting is common
• The DepoProvera and Noristerat injections need to administered in-clinic by a doctor or nurse. Noristerat has to be administered every eight weeks, but is not commonly used in the UK
• It can cause side effects such as headaches, mood swings and breast tenderness. If side effects occur, they will last for 12 weeks until the injection leaves your system
• It can take a while for your fertility to return to normal once you stop taking the injections
• It can reduce bone mineral density and cause your bones to thin. This usually recovers once you stop taking the injections

Contraceptive patch

The contraceptive patch is a slightly lesser-known form of contraception. It’s a small square (5cm x 5cm) plastic patch that sticks to the skin (like a plaster) and releases oestrogen and progestogen. 

It works by preventing ovulation, meaning that your ovaries don’t release an egg. It also thickens your cervical mucus, making it harder for sperm to reach the egg, and thins the uterine lining, preventing a fertilised egg from implanting. 

It’s 91% effective with typical use, and has to be applied weekly for three weeks in a row, followed by a seven day break. Just as with the pill, the seven day break is optional. 

Pros of the contraceptive patch

• Unlike the pill, it is not affected by vomiting and diarrhoea
• It can make periods lighter, more regular and less painful
• It may also help alleviate PMS symptoms
• It may help with cystic acne
• Studies have found that it reduces the risk of ovarian, uterine and colorectal cancer
• It doesn’t affect your fertility once you stop using it
• It does not cause weight gain
• It helps with problems associated with polycystic ovarian syndrome (PCOS)

Cons of the contraceptive patch

• It may cause skin reactions where you apply it
• It can fall off without you noticing
• Side effects such as headaches, nausea, mood changes, and breast tenderness are common in the first few months
• It may not be suitable if you’re a smoker and are over 35 years old, have a family history of breast cancer, have cardiac problems
• It can increase your risk of breast and cervical cancer
• It increases your risk of deep vein thrombosis (DVT), but this is very rare
• Medications to treat HIV, epilepsy and TB, as well as St John’s Wort can make the patch less effective

Vaginal ring

The contraceptive ring (NuvaRing) is a flexible, plastic ring that is placed inside the vagina and releases oestrogen and progestogen. It’s 91% effective with typical use. 

It works by preventing ovulation, meaning that your ovaries don’t release an egg. It also thickens your cervical mucus, making it harder for sperm to reach the egg, and thins the uterine lining, preventing a fertilised egg from implanting. It is inserted and worn for three weeks, followed by a seven day break. 

Pros of the vaginal ring

• You don’t have to think about it every day
• It’s easy to insert and remove and you can do it yourself
• It can make periods lighter, more regular and less painful
• It may also help alleviate PMS symptoms
• Studies have found that it reduces the risk of ovarian, uterine and colorectal cancer
• It doesn’t affect your fertility once you stop using it
• It helps with problems associated with polycystic ovarian syndrome (PCOS)

Cons of the vaginal ring

• It may fall out during intercourse or strenuous bowel movements, but this is rare
• Side effects such as headaches, nausea, mood changes, and breast tenderness are common in the first few months
• It can increase your risk of breast and cervical cancer 
• It increases your risk of deep vein thrombosis (DVT), but this is very rare
• It may not be suitable if you’re a smoker and are over 35 years old, have a family history of breast cancer, have cardiac problems, or are very overweight

Permanent contraception (sterilisation)

Sterilisation is a permanent form of contraception, and can be both male and female.

Male sterilisation (vasectomy) involves cutting or sealing the vas deferens, which stops sperm travelling from the testicles to the penis. Although vasectomy is technically reversible, the procedure is complicated and dramatically reduces the chances of pregnancy. 

Female sterilisation (tubal occlusion) is commonly referred to as “getting your tubes tied”, and involves cutting or blocking the fallopian tubes, which stops an egg travelling from the ovary to the uterus.

You will still ovulate and have regular periods, the egg is simply absorbed by your body rather than being shed. Unlike vasectomies, tubal occlusion is irreversible. 

Pros of sterilisation

• Once you’ve had the procedure, you never have to take contraception ever again. It’s the best option for people who don’t want children
• Vasectomy doesn’t require a surgical procedure, and only requires local anaesthetic
• Only about one in 2000 vasectomies fail
• People who have had their tubes tied can still conceive through IVF, where an egg is extracted and fertilised in vitro, then reintroduced in the uterus. It’s complicated and costly, but possible. 

Cons of sterilisation

• Tubal occlusion requires an invasive surgical procedure
• Failure rates for tubal occlusion are slightly higher compared to vasectomy, and about one in 200 fail
• You need to take contraception for 12 weeks following a vasectomy, until semen tests can confirm that the sterilisation was successful
• You will still need to use a barrier method of contraception (condoms) to protect against STIs

Emergency contraception

Emergency contraception should only be used if you’ve had unprotected sex, or your usual method of contraception has failed. It is not a routine method of contraception, and although it is very effective, it is not as effective as taking regular methods of contraception. 

Emergency contraception comes in three forms: emergency IUD, and two types of “morning after pills.”  

Emergency IUD

The IUD is the most effective form of emergency contraception, and less than 1% of women who have the emergency IUD fitted get pregnant.

It can be fitted up to five days after having unprotected sex, and doesn’t rely on hormones. The copper present in the IUD is toxic to an egg, and prevents it from implanting.

The emergency IUD is the only form of emergency contraception that works even after ovulation. 

Ulipristal acetate pill (UPA)

Sold under the brand name ellaOne, this is a pill containing ulipristal acetate (UPA). UPA stops progesterone from functioning normally, either delaying or stopping the release of an egg (ovulation). 

It can be taken up to five days after unprotected sex, but the sooner you take it the more effective it is. If you feel sick three hours after taking ellaOne, you may need to take another dose or have an emergency IUD fitted.

Most women can take ellaOne, but if you used hormonal contraception the week before taking ellaOne, it may make it less effective. 

Levonorgestrel pill 

Sold under the brand name Levonelle, this emergency contraceptive pill contains levonorgestrel, a synthetic version of progesterone that prevents ovulation. 

It needs to be taken within three days of unprotected sex. If you feel sick two hours after taking Levonelle, you may need to take another dose or have an emergency IUD fitted. Levonelle doesn’t interfere with your usual method of contraception.

Most women can take Levonelle, but if you’re taking certain medications or have a BMI higher than 26, you may need a higher dose of levonorgestrel. 

There are no serious side effects attached to ellaOne and Levonelle, but some women may experience headaches or nausea shortly after taking the pill. 

TL;DR

• Contraception comes in non-hormonal, hormonal, emergency and permanent forms. These methods are: condoms (external and internal), caps and diaphragms, IUD, FAM, combined pill, progesterone-only pill, IUS, implant, patch, injection, vaginal ring, sterilisation (male and female), and the morning after pill (ulipristal acetate pill and levonorgestrel pill).
• Non-hormonal forms of contraception work by preventing sperm from reaching an egg, or by inhibiting implantation.
• Hormonal forms of contraception work by preventing ovulation, thickening cervical mucus, or making the endometrium inhospitable.
• The efficacy of a contraceptive methods highly depends on how accurately it's used.
• Whether or not a contraceptive method is right for you depends on your age, health, medical history, weight and lifestyle.
• No method of contraception is 100% risk or side effect-free. Finding the right type for you is a matter of weighing the pros and cons.