Different types of contraception: The pros and cons

The types of contraception available are constantly evolving. Knowing the different methods, and what they can and can’t do, will help inform the choices you make when selecting the right contraceptive for you and your needs.

Because the most common reason for contraceptive use is to prevent pregnancy, we’ve included how effective each method can be when used correctly as birth control by describing the percentage of people who would avoid falling pregnant during a year of typical use. Bear in mind, some contraceptives are tricky to use correctly, but perfect use could improve their effectiveness even further.

The pill is the most popular contraception among Australians, and there are more than 30 different brands available.¹

There are 2 main types on the market:

1. the combined pill (which contains synthetic forms of oestrogen and progesterone)
2. the progesterone-only pill (also called the mini pill).

None of the contraceptive pills listed below protect against sexually transmitted infections (STIs).

• Pros: Controls the timing of periods. May help to manage pre-menstrual syndrome (PMS) and acne. May also reduce the symptoms of polycystic ovary syndrome and endometrial and ovarian cancer.
• Cons: Temporary side effects (nausea, sore breasts and spotting) in the first few months, weight gain, mood changes, loss of libido and a small risk of clotting, heart attack and stroke.
• 93% effective with typical use.²

• Pros: Safer and effective in those over 40, with less risk of blood clotting, heart attack and stroke. Doesn’t affect milk supply during breastfeeding.
• Cons: It must be taken at the same time daily (within 3 hours). Some people experience irregular periods or spotting.
• 93% effective with typical use.³

• Pros: Can be used to prevent pregnancy up to 5 days after unprotected sex. If it doesn’t work, it won’t harm the pregnancy and embryo.
• Cons: Only meant for emergency situations. Can affect the timing and severity of your next period, and cause side-effects like nausea and vomiting.
• 85% effective if taken within 72 hours of sex (the sooner you take it, the more effective it is).⁴

Dr Chelsie McMullin, Bupa Medical Advisor and GP, says there’s a new progestogen-only pill (SLINDA) which is working well for many people as a middle ground between the combined and mini pill.

“It uses a different progesterone, so you don't have to take it as strictly (within 3 hours) as the mini pill, so in this way its more aligned to the combined pill,” she says. “This may be a good option for people who get break-through bleeding with the low-dose mini pill but can’t tolerate the oestrogen in the combined pill.”

• Pros: Protect against STI’s, plus they’re drug-free and can be used at short notice.
• Cons: Can cause vaginal irritation or erection problems.
• Condoms are 82% effective with typical use and internal (female) condoms are 79% effective with typical use.⁵

• Pros: A drug-free contraception that can be used at short notice.
• Cons: Not as reliable as some other contraceptive methods, and can be difficult to insert. Insertion and removal may increase the risk of urinary tract infections.
• Typically 82% effective.⁶

If remembering to take a pill or buy condoms doesn’t work for you, long-acting reversible contraception might be best.

• Releases the same hormones as the contraceptive pill.
• Pros: Convenience, with less gastrointestinal side effects than the combined pill.
• Cons: It’s expensive, and not everyone is confident with insertion. A very low risk of clotting, heart attack and stroke. If it’s left in for more than 3 weeks, there’s a greater possibility of pregnancy.
• 93% effective with typical use.⁷

• A small implant that is inserted under the skin on your arm.
• Pros: Progestogen only. It’s inexpensive and long lasting.
• Cons: Periods may be irregular (especially in the first 3 months), some experience acne, breast tenderness, mood changes and weight gain.
• More than 99% effective.⁸

• A 12-week injection of a synthetic progesterone.
• Pros: It can be used by those who can’t take oestrogen. It’s also safe to use while breastfeeding and is useful in managing heavy periods or period pain, endometriosis and pelvic infection.
• Cons: It can take 18 months for fertility to return when you stop. It alters period patterns, can cause weight gain, moodiness, decreased sex drive, headaches and acne. Ongoing use is linked to osteoporosis.
• 99% effective.⁹

• A device that your doctor inserts into the uterus.
• Pros: It reduces or results in no period at all. It helps to manage periods through to menopause, may ease endometriosis symptoms, lasts for 5 years, and is easily removed.
• Cons: Some people experience irregular spotting and bleeding, and may experience progestogen-related side effects including bloating, sore breasts, weight gain and acne. Insertion may be uncomfortable.
• More than 99% effective.¹⁰

• Pros: It’s a non-hormonal contraceptive that lasts for 5 to 10 years and is easily removed. It can also be used as an emergency contraceptive if inserted within 5 days of intercourse.
• Cons: Some people experience heavier and/or painful bleeding. Spotting is also common, and insertion can be uncomfortable.
• More than 99% effective.¹¹

• Pros: A drug-free method of contraception.
• Cons: Increased risk of pregnancy. It requires education, your temperature must be accurate, and you may need to use another form of contraception while you are fertile.
• Typically 76% effective.¹²

Another form of ‘birth control’ commonly spoken about is the ‘withdrawal method’, where the penis is removed before ejaculation. While it can be around 80% effective, it’s still a very high-risk method and not recommended by experts as a reliable form of contraception.¹³

If you don’t want children, or have had all the children you want, permanent contraception via a surgical procedure may be right for you. For men and those assigned male at birth, this is a known as a vasectomy. For women and people assigned female at birth, it’s known as a tubal ligation.

A vasectomy is a lower risk and lower cost surgery than a tubal ligation.

While it may be possible to reverse both procedures, Dr McMullin says it’s important to make the decision assuming it can't be because the failure rates of reversal are high.

• Pros: A minor, low risk procedure with a quick recovery. It's permanent contraception.
• Cons: People may experience swelling, bruising and mild discomfort for a few days. Reversal is expensive and has a high failure rate.
• More than 99% effective.¹⁴

• Pros: Permanent and effective contraception.
• Cons: There is a risk of anaesthetic complications and surgical complications (like damage to nearby organs, infection or bleeding).
• 99% effective.¹⁵

Speak to your GP or healthcare provider about the best contraceptive options for your individual needs.