How to find the best contraceptive for you

As of next month, millions of women will be saved a trip to their GP when pharmacists will be given the power to prescribe the contraceptive pill (both combined and mini) over the counter.

The move is part of the Government’s Pharmacy First plan, a drive to make access to everyday healthcare more convenient, and it’s been hailed one of the most revolutionary changes for women’s health since the pill first became available in 1961. Since then it’s become the most popular contraception in the UK, with figures showing there were almost seven million prescriptions for it between 2022 and 2023.

“The Family Planning Association welcomes this as an additional route for women to access the contraceptive pill,” says its Chief Health and Sex Education Officer, Adam Jepsen. “It offers choice and convenient access at a time when it can be hard to get an appointment with a GP or sexual health clinic. But the pill isn’t right for everyone. So, while this is a welcome initiative, it only covers the pill.”

Here’s everything you need to know about the pill and what else is out there…

The combined pill

How it works

It contains artificial progesterone and oestrogen, which prevent your ovaries from releasing an egg each month, along with thickening the mucus in the neck of the womb making it harder for sperm to reach an egg. It will also thin the womb’s lining meaning that if an egg is fertilised it won’t be able to implant itself. The combined pill is over 99 per cent effective if taken properly, which involves taking one pill every day for 21 days, having a seven-day break while you bleed (this isn’t strictly a period, but rather a “breakthrough bleed”), before starting again.

Pros and cons

“The pill is a long-standing, reliable form of contraception,” says GP Dr Jane Leonard. “However, there are so many newer options out there that don’t require patient input, in other words, you don’t have to remember to take them.” Dr Leonard says women should also consider a LARC [a Long-Acting Reversible Contraceptive, such a coil or jab – see below]. “There’s a tendency for GPs to just put women on the pill, but there are so many other options out there that might suit them better, with fewer side effects.”

In March, scientists from Oxford University found that taking the pill increases the risk of breast cancer by 25 per cent, after looking at the NHS records of 10,000 women. Common side effects also include headaches, skin problems, decreased sex drive, breast tenderness and low mood. Certain medicines can reduce its effectiveness (always check with your doctor), as can sickness and diarrhoea.

On the subject of midlife contraception, Dr Aziza Sesay, a GP specialising in women’s health, says deciding on the best form is complex as there are several factors to take into account and risks vary. “These depend on the individual, and their health and lifestyle. For instance, some pills may impact on blood pressure and cholesterol levels, and with age cardiovascular risks increase. Similarly the risk of blood clots can be higher in midlife women. We also need to consider the fact that older women may be on other medications, which may interact with the pill.”

Best suited for

It’s often prescribed for heavy periods, or those with endometriosis, because it can make bleeding lighter. It’s not suitable for over 35s (due to the heart and blood clot risks), smokers, or those who are overweight.

Progesterone-only pill

How it works

Known as the mini pill, or POP, as its name suggests it only contains progesterone and works by thickening the mucus in the cervix to stop sperm reaching an egg.

Pros and cons

Similar to the combined pill, it’s over 99 per cent effective if taken properly but less effective if you have sickness or diarrhoea. 

You need to take it continuously without a seven-day break. And you must take it at the same time, within a three-hour window, so it’s best for those who are organised or don’t travel regularly across time zones. It’s thought to cause fewer side effects than the combined pill, but these can include acne or breast tenderness.

Best suited for

It’s good for those who can’t take contraception containing oestrogen, the over 35s or those who smoke. “Both types of pill are also good for those who might just want to come off it suddenly if they don’t like the way it makes them feel,” says Dr Leonard. “Women in their forties may also choose a mini pill over the combined, because of the lower risk of blood clots.”

Mirena coil

How it works

This is an IUS (Intrauterine System), which is a small T-shape device that’s placed in your uterus by a nurse and releases the hormone progesterone to stop you getting pregnant.

Pros and cons

It’s a LARC, which means it lasts for up to five years, but it’s reversible and can be taken out at any time. It’s more than 99 per cent effective, you can become pregnant immediately after having it removed, and it can make your periods lighter. You don’t have to think about it or remember to do anything to ensure its effectiveness, and it’s not affected by sickness or medication.

However, it can be uncomfortable to put in and take out, it can cause acne, changes in mood, and there’s a small risk of infection when it’s first put in. And the Oxford breast cancer study included all forms of hormonal contraceptive, including the coil.  

Best suited for

Those who want low-maintenance contraception.

IUD (or copper) coil

How it works

Similar to the IUS, an IUD (Intrauterine Device) is made of plastic and copper and is known as the “copper coil”. It’s put in by a doctor or nurse and stops you getting pregnant for five to ten years by releasing copper, which alters the cervical mucus. 

The pros and cons

It’s over 99 per cent effective, and because it doesn’t release hormones there are no side effects like headaches or irritability. It can also stay in place up until menopause, or the age of 55, if it’s been put in after the age of 40. 

However, it can cause heavy periods in the first few months after insertion and there is a small risk of a pelvic infection after it’s first put in. 

Best suited to

Those who are sensitive to hormonal contraception, or midlife women. 

Implant

How does it work

The contraceptive implant – the most commonly used is the Nexplanon implant – is a small plastic rod that’s placed just under the skin in your upper arm using local anaesthetic. It slowly releases progestogen into your bloodstream, which prevents pregnancy, and lasts for three years.

Pros and cons

“They are convenient and once in place, there are usually no concerns about compliance,” says Dr Sesay. “Like other LARCs, it’s also long-lasting, reversible, and has the potential added benefit of improving period problems such as heavy bleeding or painful periods. They are also quite discreet so the woman has privacy in the choice of contraceptive she is using.” Fertility returns very quickly after removal, and it’s over 99 per cent effective.

However, some medicines make it less effective, and it can stop your periods altogether (which isn’t harmful, but something to consider). Side effects can include headaches, weight gain, breast tenderness and mood swings.

Best suited for

Low maintenance  

The contraceptive injection

How it works

Usually a brand like Depo-Provera, Sayana Press or Noristerat, a contraceptive jab works by releasing the hormone progesterone to stop ovulation, thicken the cervical mucus, which prevents sperm getting to an egg, and thins the lining of the womb. The Depo-Provera jab is the one most commonly given in the UK, and lasts for 12 weeks and 5 days. Sayana Press lasts for 13 weeks but this is a newer type and isn’t available yet at all clinics or GP surgeries. Noristerat lasts for 8 weeks.

Pros and cons

If used correctly, it’s over 99 per cent reliable. It isn’t affected by medicines or sickness. It’s also useful for women who can’t take oestrogen-containing contraception.

However, possible side effects can include weight gain, headaches, irregular bleeding, and it can take up to a year for your fertility to return to normal after the jab wears off. It doesn’t last as long as a coil or implant. 

Best suited for

Those who aren’t planning a pregnancy any time soon, or who might forget to take a daily pill.

Condoms

How it works

The trusty condom is made of stretchy latex and acts as a barrier for sperm. This prevents pregnancy of course, but also sexually transmitted diseases (STIs) which, it’s worth noting, are not prevented with any of the hormonal contraceptives listed above.

Pros and cons

Dr Leonard says that younger women are frequently turning away from hormonal contraception due to their side effects, but also the potential risk of cancer, and towards hormone-free methods like condoms. When used properly condoms are 98 per cent effective.

However, they leave a lot of room for human error, or snags and tears caused by fingernails or mishandling. They can also be something of a mood killer.

Best suited for

Couples in new relationships, where you don’t know each other’s sexual history or STI risk. They’re also good for women who are sensitive to or have suffered side effects to hormonal contraception.

Diaphragm

How it works

This is a circular dome made of thin, flexible silicone that’s inserted into the vagina to sit snugly around the cervix before sex. It acts as a barrier, stopping the sperm from getting into the womb. You can put it in any time before sex, and it can stay in place for up to six hours afterwards.

Pros and cons

Like a condom it’s hormone-free. When used properly with spermicide (a chemical gel that you cover the diaphragm with to stop sperm in its tracks) it’s around 92 to 96 per cent effective. As with condoms, stopping to put one in can also kill the mood.  

You can also catch an STI when using one, so if you’re unsure of your partner’s sexual history it’s recommended he wear a condom anyway. There’s a small risk of cystitis or being sensitive to the silicone or spermicide.

Natural methods

How they work

Natural family planning is where you observe certain signals during your menstrual cycle to work out when you’re most and least likely to get pregnant (this method can also be used in reverse, to get pregnant). Signs like body temperature, vaginal discharge, and the dates of your cycle can guide you. The NHS advises you to find a fertility awareness clinic in your area (speak to your GP for advice). There are also plenty of apps, but none that the NHS vouches for.

Pros and cons

“It’s entirely hormone-free without any symptoms,” says Dr Leonard. “And as before, there does seem to be a trend towards more natural contraception. However, there is a lot of room for it not to work and it can be time-consuming and fiddly to work out which days you’re fertile.” You’ll also have to abstain from sex on your fertile days (or use another form of contraception), and it doesn’t protect you from STIs.

Best suited for

Those who are diligent in their research and who know their partner’s sexual history.

For more details on contraception visit the Family Planning Association at www.fpa.org.uk.