Contraception methods: effectiveness, benefits and practical advice
In brief
The most effective methods of contraception in real life are those that do not depend on you every day: the coil (intrauterine device, IUD) and the implant, with a failure rate of less than 1% per year. The pill, patch and ring are very effective when used perfectly, but their real-life failure rate is about 9% in the first year because of missed doses. Condoms are the only method that also protects against sexually transmitted infections.
How do I choose the right contraception?
There is no ideal contraception for everyone, but there is a method suited to each stage of life. The choice takes into account:
- your health and medical history (smoking, migraine, blood clots, high blood pressure, breast cancer);
- your preferences: daily or not, having periods or not, hormonal or non-hormonal;
- your plans for pregnancy in the short or long term;
- whether you need protection against STIs.
The French College of Gynaecologists and Obstetricians (CNGOF) recommends giving every woman information on all methods and their real-life effectiveness, then letting her choose. Your gynaecologist then checks for any reasons a method is unsuitable. For specific situations, see also contraception after pregnancy and the gynaecological surgery page for permanent contraception.
How effective is each contraceptive method in real life?
"Theoretical" effectiveness (perfect use) differs from "real-life" effectiveness (with the missed doses and mistakes of everyday life). Pregnancy rates during the first year of typical use, according to the data used by the HAS (French National Authority for Health):
| Method | Real-life failure in the first year | What it depends on |
|---|---|---|
| Implant, hormonal IUD, copper IUD | Less than 1% (0.05%, 0.2% and 0.8% respectively) | Nothing day to day |
| Pill, patch, ring | About 9% | Taking it regularly |
| Male condom | About 15% | Using it every time, from the start |
| Withdrawal | About 22% | Self-control; sperm can be present before ejaculation |
Fertility awareness methods (temperature, mucus, calendar: about 25%), the diaphragm and spermicides also have high failure rates. They are not suitable if a pregnancy would be unwelcome or medically inadvisable.
Combined pill or progestogen-only pill: which is right for me?
The combined pill
It contains an oestrogen and a progestogen. It stops ovulation, thins the lining of the womb and thickens cervical mucus. It is taken for 21 days followed by a 7-day break, or continuously with inactive tablets depending on the brand. It increases the risk of venous blood clots (deep vein thrombosis, pulmonary embolism) and, more rarely, arterial clots.
It is not suitable in particular if you have had a blood clot or embolism, migraine with aura, uncontrolled high blood pressure, if you smoke and are over 35, or have certain heart, blood vessel or liver diseases, or breast cancer.
The progestogen-only pill (mini-pill)
It contains no oestrogen and is taken continuously, with no break. It can be used when oestrogen is unsuitable, for example while breastfeeding. Irregular bleeding is its main drawback.
What should I do if I miss a pill?
- Combined pill, less than 12 hours late: take the missed pill and carry on as normal.
- More than 12 hours late: take the last missed pill, continue the pack and use condoms for 7 days. If you had sex in the previous 5 days, take emergency contraception, available free and without prescription from pharmacies in France, whatever your age.
- Progestogen-only pill: the window is 12 hours for desogestrel and 3 hours for levonorgestrel; for other progestogen-only pills, check the leaflet.
If in doubt, ask your pharmacist.
Which contraception does not need to be taken every day?
- Copper IUD: hormone-free, effective for several years depending on the model. Periods may become heavier or more painful.
- Levonorgestrel hormonal IUD: it often makes periods lighter, or stops them. Depending on the model, it lasts 3 to 8 years. See our page on the IUD (coil).
- Implant: a small flexible rod (about 4 cm) placed under the skin of the arm under local anaesthetic. It releases a progestogen (etonogestrel) for 3 years. Bleeding often becomes irregular or stops.
- Patch: one patch a week for 3 weeks, then a patch-free week. Apply it to the abdomen, buttocks, upper arm or upper back, never on the breasts.
- Vaginal ring: a soft ring you insert yourself into the vagina for 3 weeks, then remove for one week.
The patch and ring contain oestrogen: they have the same restrictions and the same risk of blood clots as the combined pill.
Do condoms protect against STIs?
Yes. The male condom (latex, or polyurethane if you have an allergy) and the internal condom, also called the female condom, are the only methods that protect against both pregnancy and sexually transmitted infections, including HIV. The internal condom can be put in several hours before sex.
Their effectiveness as contraception depends on correct use every time you have sex. With a new partner, double protection (condom plus effective contraception) is advised until both partners have been tested. In France, condoms are free in pharmacies for people under 26.
What about natural methods or permanent contraception?
Natural and barrier methods
Counting fertile days (the calendar or rhythm method), temperature charting, checking cervical mucus and withdrawal need great discipline and regular cycles. Their real-life effectiveness is much lower than that of hormonal methods or the IUD. The diaphragm and cervical cap, used with a spermicide, must be correctly placed before each time you have sex and left in for a few hours afterwards. Cycle-tracking apps do not turn these methods into reliable contraception.
They may suit a couple for whom an unplanned pregnancy would be acceptable. If not, it is better to choose a more reliable method, or to add condoms during the fertile window.
Permanent contraception
When you have completed your family, tubal ligation for women or vasectomy for men is available to any adult. In France, there is a legal 4-month reflection period first. These procedures should be considered irreversible. A long-acting reversible method, such as the IUD or implant, offers similar effectiveness without a permanent commitment.
By age
- Teenagers: all methods are possible; the CNGOF encourages offering long-acting methods (implant, IUD), which are more effective than the pill at an age when missed pills are common.
- Over 40: contraception is still needed until the menopause is confirmed. Cardiovascular risks are reassessed and oestrogen-free methods are often preferred.
What check-ups are needed, and is contraception reimbursed in France?
- Before prescribing: questions about your personal and family history and smoking, blood pressure and weight checks, and an examination if needed. A blood test (blood sugar, cholesterol) is prescribed depending on your situation, in the months after starting combined hormonal contraception.
- Follow-up: a check-up is advised a few months after starting, then regularly, at the same time as cervical cancer screening.
- Reimbursement: in France, for people under 26, contraception, consultations and related tests are covered in full. For others, some pills, the implant and IUDs are partly reimbursed by the Assurance maladie; other pills, the patch and the ring are not.
Never stop hormonal contraception on your own if you have a symptom: see a doctor first, and use other protection in the meantime.
When should I seek urgent help while on hormonal contraception?
These signs may point to a blood clot or a stroke and need immediate medical attention:
- pain, swelling or warmth in a calf;
- sudden breathlessness, chest pain, coughing up blood;
- unusual, severe headaches, problems with vision or speech, weakness in an arm or leg.
In these situations, call 15 or 112 in France, or your local emergency number. Also see a doctor quickly if you have pelvic pain with fever while using an IUD, or if your period is late.
Frequently asked questions
Does the pill cause weight gain?
Most women notice no significant change in weight on the pill. If you do, talk to your gynaecologist: another method can be considered.
Can you have an IUD fitted if you have never had a baby?
Yes. The CNGOF states that an IUD can be offered to women who have never given birth, including teenagers.
Should you take breaks from the pill?
No. Breaks bring no benefit and increase the risk of an unplanned pregnancy. You can keep taking the pill as long as it suits you and there is no medical reason to stop.
Does fertility come back quickly after stopping contraception?
Yes. For the pill, patch, ring, implant and IUDs, fertility usually returns from the first cycle after stopping or removal.
What methods of contraception are hormone-free?
The copper coil, male and internal (female) condoms, the diaphragm or cap with spermicide, fertility awareness methods and permanent contraception. Their effectiveness varies widely: only the copper coil has a real-life failure rate below 1% per year (0.8%), compared with about 15% for male condoms and 25% for fertility awareness methods.
References
- Chabbert-Buffet N, et al. Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF). Journal of Gynecology Obstetrics and Human Reproduction, 2019. doi:10.1016/j.jogoh.2019.04.009 — PMID 31051299
- HAS. Efficacité des méthodes contraceptives [Effectiveness of contraceptive methods]. Memo sheet. has-sante.fr
- Vidal F, et al. Contraception intra-utérine : recommandations pour la pratique clinique du CNGOF [Intrauterine contraception: CNGOF guidelines]. Gynécologie Obstétrique Fertilité & Sénologie, 2018. doi:10.1016/j.gofs.2018.10.004 — PMID 30429071
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
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