Contraception methods compared

Choosing contraception means weighing up how well it prevents pregnancy alongside safety, side effects, cost and access. How easily you can stop a method or have it removed matters too. The choice is yours.

What typical and perfect use mean

Perfect use means using a method correctly all the time. Typical use includes things such as forgetting a pill, a condom coming off or a vaginal ring not being replaced on time. Check the column heading before comparing numbers: the two measures describe different things.

The NHS explains its figures using pregnancy during the first year of use. For example, it says that if 100 women choose the implant, less than 1 woman will have an unintended pregnancy within that year. These estimates describe groups of users; they cannot promise what will happen to you.

The NHS comparison

The table uses NHS figures and wording, including where an estimate is uncertain. The hormones column shows what each method contains. None of these methods except condoms provides STI protection.

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 provide STI protection, while internal condoms might help prevent STIs. A condom can be used alongside another contraceptive method.

US figures and other options

CDC uses typical-use failure rates, meaning pregnancies rather than pregnancies prevented. Its figures include 7% for either pill, the patch and the ring, and 4% for the injection. They differ from the NHS estimates above. The following additional methods have no added hormones; CDC does not supply a matching perfect-use column 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 methods. After vasectomy, another method is needed until a clinician confirms that sperm are no longer present.

Breastfeeding contraception, called lactational amenorrhoea, is temporary. CDC requires all of these conditions: no periods since birth, fully or nearly fully breastfeeding, and less than 6 months since birth. If any condition no longer applies, another method is needed.

The NHS breastfeeding criteria are more specific: it says to breastfeed at least every 4 hours during the day and at least every 6 hours during the night. It says the method will not work if periods return or you give formula milk or solid food. Ask a midwife to teach you the method.

Withdrawal means pulling the penis out before ejaculation. The NHS does not recommend it as an effective way to avoid pregnancy. Fertility awareness needs teaching from 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 a method failure, such as a broken condom. Options include the copper IUD and emergency pills. It is not a regular contraceptive method; ask a pharmacist or contraceptive service promptly about what is suitable.

The table below covers temporary methods and emergency options, along with withdrawal, for which the sources give no effectiveness figure.

Method	Hormones or approach	What the sources say
Breastfeeding contraception (LAM)	No added hormones	NHS: 98% when instructions are not followed exactly; more than 99% with correct use. These figures refer to the first 6 months after birth and the NHS feeding criteria.
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 contraceptive method.
Copper IUD for emergency contraception	No hormones	Can be used after unprotected sex; can also provide ongoing contraception.

Getting advice that fits your priorities

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

Tell the clinician what matters to you. You might want to avoid a procedure or hormones, discuss bleeding, or choose a method that is easy to stop. Ask what is available locally and what follow-up involves.