Contraception – help me choose

There are a lot of contraceptive methods that can be used to stop you getting pregnant. Each type works differently and has its pros and cons. Some methods work better at preventing pregnancy than others.

When deciding on the best contraception for you, think about things such as how important it is for you not to get pregnant, whether you want any children in the future, your general health, whether you smoke, whether you take any medicines and your personal preferences.

Here are some things you may want to talk about with your healthcare provider:

What are the different contraception options?

Hormone-based contraception Non-hormone based contraception
  • These have a small amount of synthetic (human-made) oestrogen and/or progestogen hormones.
  • These hormones make changes to your body’s natural hormones to prevent pregnancy, usually by stopping ovulation.
  • Examples include:
    • progestogen-only pill (the mini-pill)
    • combined oral contraceptive pill (the pill)
    • injection (Depo Provera)
    • implant (the rods)
    • intra-uterine devices (IUDs) that contain progestogen such as Mirena® or Jaydess®.
  • These contraception methods don’t contain hormones:
    • condoms (over your penis or into your vagina)
    • copper IUD
    • fertility awareness
    • tubal ligation
    • vasectomy.

How effective are the different methods?

Not all contraceptive methods are equally reliable. How effective they are depends on how well they are used. These are the chances of getting pregnant with the following methods:

Reliability  Chances of getting pregnant
Most reliable
  • Implant: Less than 1 in 100
  • IUD: Less than 1 in 100
Medium level of reliability
Least reliable

Do I have to remember every day or every time I have sex?

Don’t have to remember every day  Have to remember every day or at the time of sex
  • Depo Provera injection – renewed every 12–13 weeks
  • Contraceptive implant – lasts 4–5 years, depending on your weight
  • Intrauterine device (IUD) – lasts up to 10 years, depending on the type.
  • Combined pill (oestrogen and progestogen)
  • Progestogen-only pill (mini pill)
Have to remember every time you have sex:
  • Condoms

I do/don't want to get pregnant in the future

I don’t want to get pregnant in the future I do want to get pregnant in the future
  • If you want a permanent (non-reversible) contraceptive option, the options are tubal ligation for people with a uterus or vasectomy for people with a penis.
  • Note: You must use another method of contraception for the first 3 months after a vasectomy.
  • Many people who don’t want to get pregnant in the future also choose a LARC method. Many of these contraceptives are nearly as effective as tubal ligation or vasectomy for preventing pregnancy, and are long lasting.
  • Choose a contraceptive option that is NOT tubal ligation or vasectomy.
  • Other options are easily reversible, which means that when you stop the contraception, your ability to get pregnant returns.
  •  Your fertility may take longer to return to normal after stopping the Depo Provera injection. 

I smoke

Smokers can use most types of contraception. But if you’re a smoker and over 35 years old, the combined pill might not be suitable for you.

I have concerns about my weight

Your weight won’t affect most types of contraception, but if you are very overweight, then the combined pill might not be suitable for you.
Most contraception won’t make you put on weight, but the Depo Provera injection has been linked to a small amount of weight gain if used for 2 years or more.

I have epilepsy

  • If you have epilepsy, your choice of contraception requires special consideration.
  • Some anti-epilepsy medicines can make some types of contraception less effective.
  • Also, antiepileptic medicine may risk harm to your baby, especially during the first trimester (first 12 weeks of pregnancy), when you may not realise you are pregnant.
  • Read more about epilepsy and contraception

I can’t use hormonal contraceptives

  • Some contraceptives work by using hormones that are similar to the hormones women produce naturally. These hormones are oestrogen and progestogen.
  • Contraceptives that contain these hormones aren’t suitable for some women, such as those who have medical conditions like breast cancer.
  • Contraceptive methods that don’t use hormones are the copper IUD and condoms.

I can't use contraceptives that contain oestrogen

Contraceptives that contain oestrogen are not suitable for women who:

  • are over 35 and who smoke
  • are very overweight
  • take certain medicines
  • have certain medical conditions, such as problems with blood circulation or migraines with aura.

If you can’t use contraceptives that contain oestrogen, there are other options, including:

  • intrauterine device (IUD)
  • contraceptive implant
  • contraceptive injection
  • progestogen-only pill.

I am taking medicines with known risks of birth defects, such as isotretinoin

  • If you are taking medicines that are known to cause birth defects, such as isotretinoin (Oratane), you must use reliable contraception for at least 1 month before you start, the whole time you are taking it and at least 1 month after you finish taking it.
  • This usually means using 2 methods of contraception, ie, condoms plus a pill, implant, injection or IUD.
  • Fertility awareness or condoms alone are NOT recommended.
  • Talk to your doctor about the best options for you.

I am breastfeeding

  • If you’re using a hormonal method of contraception, a small amount of hormone enters your breast milk but no research has shown that this harms your baby.
  • Breastfeeding can be used as a contraceptive method, but there are things you need to do for it to be effective. Read more about breastfeeding and contraception.

I want to have fewer periods

  • You may want to have fewer periods, either for convenience or health reasons such as endometriosis, breast tenderness, bloating or mood swings.
  • The following contraception enables you to have fewer periods:
    • The combined pill – if you continue taking active hormones, you won’t have withdrawal bleeding.
    • IUDs – over time, all hormonal IUDs make periods lighter, and may make them less painful, shorter or come less often.
    • Depo Provera – after 1 year of Depo Provera injections, 50–75% of women report having no periods. The longer you use Depo Provera, the more likely your periods will stop.

References

  1. Contraception: which option for which patient? BPAC, NZ, 2019
  2. Things to consider when choosing contraception NHS Inform, UK, 2020

Reviewed by

Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP, Wellington Last reviewed: 19 Apr 2021