Birth Control Methods: Choosing the Right Option

There is no single best contraceptive; there is only the method best suited to you. The choice depends on age, plans for pregnancy, breastfeeding, menstrual pattern, coexisting medical conditions and how consistently a method can realistically be used. The options below are compared by effectiveness, convenience and return to fertility.

Methods ranked by effectiveness

The figures below indicate how many women in 100 conceive during a year of typical use.

• Contraceptive implant: 0.1% — three years of protection; the most effective reversible method.
• Hormonal IUD: 0.1–0.4% — 5–8 years; also reduces menstrual bleeding.
• Copper IUD: 0.8% — 5–10 years; entirely hormone-free.
• Tubal ligation / vasectomy: 0.1–0.5% — permanent methods.
• Three-monthly injection: 4% — oestrogen-free, suitable while breastfeeding.
• Combined pill, vaginal ring, patch: 7% — depend on consistent use.
• Condoms: 13% — the only method that also protects against infection.
• Fertility awareness and withdrawal: 20–23% — unreliable.

Hormonal methods

Combined preparations contain oestrogen and a progestogen and suppress ovulation. They also improve irregular or painful periods, acne and hirsutism. Migraine with aura, uncontrolled hypertension, previous thrombosis, active breast cancer and smoking over the age of 35 are contraindications.

Progestogen-only pills, the implant and injections contain no oestrogen and are therefore preferred during breastfeeding and wherever oestrogen is unsuitable. Irregular spotting in the first months is the commonest side effect; it settles with time and many women stop bleeding altogether, which is harmless.

Intrauterine devices

An IUD is fitted in the clinic in a few minutes. The copper device contains no hormone but may increase menstrual flow and cramping. The hormonal device markedly reduces bleeding and is therefore also used to treat heavy menstrual bleeding, adenomyosis and fibroid-related bleeding. It is appropriate at any age, including for women who have not given birth.

Permanent methods

Tubal ligation and vasectomy should be regarded as irreversible; reversal surgery has limited success. They suit couples certain that their family is complete. Vasectomy is the simpler procedure, carries less risk and can be performed under local anaesthesia.

Emergency contraception

• Levonorgestrel: within 72 hours; the earlier it is taken, the more effective.
• Ulipristal acetate: licensed up to 120 hours, with higher effectiveness.
• Copper IUD: the most effective option when inserted within five days, and it provides continuing contraception thereafter.

Return to fertility

After stopping the pill, ring, patch, implant or IUD, ovulation usually resumes within one to three cycles. Only the three-monthly injection may delay conception by 6–12 months, so it is not advised for women planning pregnancy in the near future.

When to seek advice

• Before choosing a method, so that your medical history can be reviewed.
• If you develop severe headache, visual disturbance or calf pain and swelling while taking the pill.
• If irregular or breakthrough bleeding persists beyond three months.
• If you cannot feel the IUD threads, or you develop pelvic pain or fever.

Family planning in Adana

Op. Dr. Sadık Kükrer, MD provides contraceptive counselling, IUD insertion and removal, implant fitting and individualised family planning in Adana, Türkiye.