What contraception is best for me?

Combined contraceptive pills, the most commonly prescribed pill, contain two versions of naturally occurring female hormones - oestrogen and progesterone. There are also different versions of these synthetic hormones, which surround generational pill changes over the years, and some affect women in different ways.

Each month, levels of oestrogen and progesterone rise and fall naturally which impacts how and when the female body prepares for pregnancy. Ovulation occurs, for example, and the uterus lining thickens to create a safe environment to receive a fertilised egg.

So, how do combined pills work? When you take combined contraceptive pills, natural levels of these hormones are altered. In doing so, the way in which the body prepares for pregnancy changes. Eggs don’t get released, vaginal mucus thickens which makes it difficult for sperm to pass through the cervix and the uterus lining remains thin - meaning in the (now very unlikely) event an egg does get fertilised, it will have a tricky time implanting itself in the uterus where it would normally grow.

Typically, you take the combined pill for 21 days followed by a seven day break, although it is possible to take the combined pill without any breaks. Sometimes, you won’t take any pills during your break, or some pill packets will contain inactive pills that are included to help you maintain a routine. Certain other combined contraceptive pills are taken for 24 days, followed by only four days of taking placebo pills.

Combined pills are over 99% effective when used perfectly. (Perfectly meaning you never forget to take a pill and always take them at the time you’re supposed to.)

Common side effects associated with the combined pill can include feeling sick, stomach ache, putting on weight, headaches, depressive moods or mood swings and sore or painful breasts. However, because certain combined pill brands contain different versions of female hormones, depending on their generation, switching pills can sometimes help reduce certain side effects.

Pros and cons of the combined pill

Advantages of the combined pill:

• You’re in control, you can start and stop using the method whenever it suits you
• Won’t interrupt sex in the same way a condom might
• Can make periods more regular, lighter or less painful
• Reduces the risk of certain types of cancer, including of the womb and ovaries
• Can reduce premenstrual symptoms
• Can reduce acne
• May reduce the chance of pelvic inflammatory disease
• May reduce the risk of ovarian cysts and fibroids

Disadvantages of the combined pill:

• May cause side effects that clear up over time, including headaches, feeling sick, tender breasts and mood swings.
• May increase blood pressure for some women
• Doesn’t protect against STIs
• Spotting is common for the first few months of using the pill
• Has been linked with a small but increased risk of blood clots and breast cancer.

Mini pills offer birth control without oestrogen, they’re also known as progestogen-only pills (POP). These might be more suitable for women who experience oestrogenic side effects when using the combined pill. They’re also a safer choice for women who shouldn’t take the combined pill due to their age, smoking habits or medical conditions.

Traditional mini pills prevent pregnancy by thickening cervical mucus, which stops sperm from reaching an egg. Mini pills which contain desogestrel as their active ingredient can also prevent ovulation from occurring.

Like combined pills, mini pills are over 99% effective when taken perfectly. When taken typically their effectiveness drops to around 91%. This means approximately nine out of every 100 women who use the mini pill will become pregnant.

You take the mini pill every day without breaks in between packs. If you’re over the age of 35 and smoke, it’s safe for you to use the mini pill.

Common side effects associated with the progestogen-only pill include feeling sick, headaches, loss of libido, tender breasts, breast enlargement, mood swings, dizziness, fatigue, bleeding between periods and skipped periods.

Pros and cons of the mini pill

Advantages of the mini pill:

• Doesn’t interrupt sex the same way a condom might
• Can be taken postnatally and also when breastfeeding
• Safe to use if you cannot take the oestrogen hormone
• You can use it at any age
• Safer for smokers than the combined pill
• Can make periods less frequent, lighter or even stop

Disadvantages of the mini pill:

• Your periods may change and become irregular
• Doesn’t protect against sexually transmitted infections
• You need to remember to take it daily and at a similar time each day (though this is dependent on the brand)
• Certain medications can reduce mini pill effectiveness

The contraceptive patch, or the transdermal contraceptive patch, is applied to the skin and releases hormones directly into the bloodstream. (It works similarly to a nicotine patch.)

It’s a small, sticky patch that can be applied to any area of the skin - providing it’s clean, dry and not too hairy. It contains and releases two synthetic versions of female hormones called oestrogen and progesterone. When these are absorbed into the bloodstream, they affect how the body prepares for pregnancy.

The main contraceptive patch used here in the UK is known as Evra. It works by releasing hormones which prevent ovulation from occurring each month. However, the patch also causes mucus found in the vagina to thicken, this can block sperm from travelling through the cervix. Lastly, the uterus lining will remain thin - meaning fertilised eggs cannot implant themselves and grow.

You apply a patch and leave it on for seven days. On the eighth day, apply a new one. Do this for three weeks and then spend the fourth week ‘patch-free.’ (You’re still fully protected in the fourth week.)

The most common side effects of the contraceptive patch include headaches, nausea, tender breasts and mood changes, however less than 1 in 10 women experience these. These are more likely to occur when you first start using the patch and usually subside over time.

Pros and cons of the patch

Advantages of the contraceptive patch:

• Easy application and won’t interrupt sex the same way a condom might
• You don’t have to think about it every day. You change your patch once a week for three consecutive weeks and then spend a week without one
• The hormones are absorbed directly into the bloodstream so sickness and vomiting don’t impact how the patch works
• Can make periods lighter or less painful
• May help to lessen premenstrual symptoms
• May reduce the risk of certain cancers including those of the womb or ovaries.

Disadvantages of the contraceptive patch:

• Might be visible depending on where you apply it
• May cause the skin to become irritated or itchy, if you’re sensitive to adhesives
• Won’t protect against sexually transmitted infections
• Can cause spotting and bleeding in between periods, especially when you first start using it
• Certain medications make the patch less effective
• You need to change the patch weekly. If you’re prone to forgetfulness, the implant or an IUD might be a better method of contraception for you.

The contraceptive ring is a small, soft plastic device which is inserted into the vagina. Unlike the contraceptive cap, it doesn’t need to cover the entrance of the womb to work. It contains two synthetic versions of oestrogen and progesterone, which affect how the body prepares for pregnancy.

The ring works similarly to combined pills and the contraceptive patch. The hormones released by the ring stops ovulation, thickens vaginal mucus, which blocks sperm from passing through the cervix, and changes the environment in the uterus so that fertilised eggs cannot implant themselves.

The contraceptive ring is inserted once a month, which can be optimal for women who struggle to swallow tablets or forget when to take them. When used perfectly, the contraceptive ring is over 99% effective.

Common side effects associated with the ring include vaginal discharge, breast tenderness or headaches. These are more likely to occur when you first start using the contraceptive ring.

Pros and cons of the ring

Advantages of the contraceptive ring:

• Doesn’t interrupt sex the same way a condom might
• Easy to insert and remove
• It’s an ‘invisible’ method, no one can see a patch or find a packet of pills, only you know you’re using it
• Shouldn’t feel uncomfortable when you have sex
• You insert it for a month at a time, meaning you don’t have to think about using it all the time
• If you’re sick or vomit, this won’t impact how the contraceptive ring works or its effectiveness
• Can help to reduce premenstrual symptoms
• Periods can become lighter and less painful

Disadvantages of the contraceptive ring:

• You need to feel comfortable putting your fingers inside your vagina to get the ring in place and to remove it
• When you first start using the contraceptive ring, spotting or bleeding in between periods can occur
• It doesn’t protect against sexually transmitted infections
• You need to change it monthly, which may not be beneficial if remembering to do this is difficult
• Certain medications make the ring less effective

The contraceptive injection is a method of birth control which intravenously releases hormones directly into the bloodstream. Depo-Provera, the main contraceptive injection used in the UK,
can provide protection for up to 13 weeks at a time. Other brands provide protection for eight weeks.

Contraceptive injections contain the hormone progesterone, and work in a similar way to the desogestrel mini pill. Ovulation doesn’t occur, vaginal mucus thickens which blocks sperm from passing through the cervix and the environment within the uterus becomes unsustainable for fertilised eggs to implant themselves and subsequently grow.

It’s usually injected into the buttocks, but you can also have them in the upper arm. You can also have them in the abdomen if you’re using Sayana Press, which is an injection you can use yourself. When used and administered correctly, the contraceptive injection is over 99% effective at preventing pregnancy.

Common side effects associated with the contraceptive injection include weight gain, mood changes, headaches or migraines, tender breasts and irregular periods.

Pros and cons of the injection

Advantages of the contraceptive injection:

• Protection lasts for up to 13 weeks weeks at a time
• Doesn’t interrupt sex the same way a condom might
• Beneficial if you cannot take oestrogen-based contraceptives
• You don’t have to think about using the injection daily, weekly or even monthly
• Safe to use while you breastfeed
• Medication won’t affect how the contraceptive injection works
• May make periods less heavy or painful, and can help to reduce premenstrual symptoms.

Disadvantages of the contraceptive injection include:

• Will not protect you again sexually transmitted infections
• May take up to a year before your periods and fertility to return to normal
• Some women say that their appetite increases while using the contraceptive injection
• You might experience side effects such as headaches, acne, hair loss, low libido or mood changes.
• Side effects may take a while to settle, once the medication has been injected it can’t be removed as it's designed to stay in your system for several weeks