Contraception methods compared

When you choose contraception, you weigh up how well it prevents pregnancy along with safety, side effects, cost and access. It also matters how easily you can stop a method or have it taken out. The choice is yours.

What typical and perfect use mean

Perfect use means using a method correctly every time. Typical use includes things like forgetting a pill, a condom coming off, or not changing a vaginal ring on time. Check the column heading before you compare numbers, because the two measures describe different things.

The NHS bases its figures on pregnancies in the first year of use. For example, it says that if 100 women choose the implant, less than 1 woman will have an unplanned pregnancy in that year. These figures describe groups of people. They can’t promise what will happen to you.

The NHS comparison

The table uses NHS figures and wording, including where a figure is only an estimate. The hormones column shows what each method contains. Apart from condoms, none of these methods protects against STIs.

Method	Hormones	Typical use	Perfect use
Implant	Progestogen	Over 99%	Over 99%
Hormonal coil (IUS)	Progestogen	Over 99%	Over 99%
Copper coil (IUD)	None	Over 99%	Over 99%
Injection	Progestogen	94%	Over 99%
Combined pill	Oestrogen and progestogen	91%	Over 99%
Progestogen-only pill	Progestogen	91%	Over 99%
Patch	Oestrogen and progestogen	91%	Over 99%
Vaginal ring	Oestrogen and progestogen	91%	Over 99%
External condom	None	82%	98%
Internal condom	None	79%	95%
Fertility awareness / natural family planning	None	76%	91 to 99% (estimate)
Diaphragm or cap	None	Unknown	92 to 96% (estimate)

External latex condoms help protect against HIV and other STIs. CDC says natural or lambskin condoms may not protect against STIs, and internal condoms might help prevent them. You can use a condom alongside another method of contraception.

US figures and other options

CDC uses typical-use failure rates. These count pregnancies that happen, not pregnancies prevented. Its figures include 7% for either type of pill, the patch and the ring, and 4% for the injection. They are different from the NHS figures above. The extra methods below contain no added hormones. CDC doesn’t give a matching perfect-use figure for them here.

Additional method	CDC typical-use failure rate
Sponge with spermicide	17%
Spermicide / vaginal pH regulators	21%
Tubal surgery (sterilisation)	0.5%
Vasectomy	0.15%

Sterilisation and vasectomy are permanent. After a vasectomy, you need another method until a clinician confirms there is no sperm left.

Using breastfeeding as contraception is called lactational amenorrhoea (LAM). It only works for a while. CDC says all of these must apply: no periods since the birth, fully or nearly fully breastfeeding, and less than 6 months since the birth. If any of these stops being true, you need another method.

The NHS rules for breastfeeding are more detailed. It says to breastfeed at least every 4 hours during the day and at least every 6 hours at night. It says the method won’t work if your periods come back or you give formula milk or solid food. Ask a midwife to teach you the method.

Withdrawal means pulling the penis out before ejaculation (before semen comes out). The NHS doesn’t recommend it as a reliable way to avoid pregnancy. Fertility awareness needs to be taught by a trained practitioner. A period prediction on a calendar is not the same as learning the method.

Emergency contraception is for sex without contraception, or when a method fails, such as a broken condom. Options include the copper IUD and emergency pills. It isn’t meant for regular use. Ask a pharmacist or contraception service soon about what suits you.

The table below covers short-term and emergency options. It also includes withdrawal, which the sources give no effectiveness figure for.

Method	Hormones or approach	What the sources say
Breastfeeding contraception (LAM)	No added hormones	NHS: 98% when instructions are not followed exactly, and more than 99% with correct use. These figures refer to the first 6 months after birth and the NHS feeding rules.
Withdrawal	No added hormones	NHS does not recommend it as an effective way to avoid pregnancy.
Emergency pill	Medicine taken after sex	An emergency option, not a regular method of contraception.
Copper IUD for emergency contraception	No hormones	Can be used after unprotected sex. It can also give ongoing contraception.

Getting advice that fits your priorities

If side effects are a problem, book an appointment with your GP or sexual health clinic in the UK, or your doctor or contraceptive service in the US and elsewhere. Another method may suit you better.

Tell the clinician what matters to you. You might want to avoid a procedure or hormones, talk about bleeding, or pick a method that’s easy to stop. Ask what is available near you and what follow-up involves.