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There is no ideal contraception, only the one that suits your situation at a given moment. A method that is highly effective on paper but forgotten once a week becomes less reliable than a simple, well-tolerated one.
Understanding the two effectiveness figures
Every method has two rates: perfect use (instructions followed exactly) and typical use (missed doses, delays, mistakes). The second is what matters day to day.
| Method | Typical use | Worth knowing |
|---|---|---|
| Implant | > 99 % | 3 years, nothing to manage |
| IUD, copper or hormonal | > 99 % | 5 to 10 years depending on model |
| Combined or progestogen-only pill | ≈ 93 % | Entirely dependent on regularity |
| Patch, vaginal ring | ≈ 93 % | One action a week or a month |
| Three-monthly injection | ≈ 96 % | Return of fertility can be slow |
| Male condom | ≈ 87 % | Only protection against STIs |
| Fertility awareness | 76–88 % | Demanding, poorly suited to irregular cycles |
The main families
Long-acting methods: IUD and implant
These are the most effective precisely because they do not depend on you once fitted. The copper IUD contains no hormones and lasts up to 10 years; it can make periods heavier. The hormonal IUD does the opposite, lightening periods and sometimes stopping them. The implant, placed under the skin of the arm, lasts 3 years and can make bleeding irregular.
Contrary to a persistent belief, an IUD can be fitted in a woman who has never had a child.
Regular hormonal methods
The combined pill (oestrogen + progestogen) regularises cycles and often reduces period pain and acne. The progestogen-only pill suits those for whom oestrogen is contraindicated, notably while breastfeeding, but demands stricter timing.
Barrier methods
Condoms are less effective as pure contraception, but they are the only way to protect against sexually transmitted infections. They combine well with another method.
When the combined pill is not advised
- Smoking after 35;
- Migraine with aura (visual disturbance before the headache);
- Uncontrolled high blood pressure;
- Previous clot in a vein or lung, or a known clotting disorder;
- Past breast cancer;
- The first weeks after giving birth.
In all these cases alternatives exist — progestogen-only, copper IUD, implant. A contraindication to one method is never a contraindication to all.
Missed pill: the 12-hour rule
For most combined pills, being less than 12 hours late does not compromise effectiveness: take the missed tablet immediately and carry on. Beyond 12 hours, or with several missed pills, use condoms for 7 days and check your pill's leaflet, since rules differ between products — progestogen-only pills have a much shorter margin.
Emergency contraception
Taken after unprotected sex or a contraceptive accident. Levonorgestrel works up to 72 hours, ulipristal up to 120 hours, and a copper IUD fitted within 5 days remains the most effective emergency method. In all cases effectiveness falls with time: sooner is better. It does not replace regular contraception and does not end an established pregnancy.
Discussing it without travelling
Choosing, switching or managing a side effect is well suited to teleconsultation; only fitting an IUD or implant requires an in-person appointment. You can see a gynaecologist by video or browse available practitioners.
