What we'll cover
⚡In a nutshell
- Contraception is a very personal choice and it's important you feel empowered to make the right choice based on your body and circumstances.
- There are 13 types of contraception methods (and counting) in this guide. All of which have different pros and cons to consider - none of which are completely risk or side-effect free.
- A good way to start your research is by considering the effectiveness, convenience, side effects and hormone aspects to each contraception method.
Condoms and the Pill are typically the first two types of contraceptives we learn about when we're awkwardly sitting in a sex ed class as a teen.
It's crazy to think the Pill has actually been available in Australia since 1961. But not to all women. At the time, it was only available to married women and slapped with a 27.5% luxury tax! Not cool.
Now, fast forward to the 21st century, 70% of Aussie women use contraceptives AND we have the freedom of choice.
But with 13 different options (and counting) on our contraceptive menu, decision fatigue can consume us.
A word of warning: We won't lie, this is a big ass guide. But it's comprehensive and you can skip to the contraception options you want some more details on.
🤔 Spoilt for choice
Choice is definitely a great thing when it comes to the personal decision of choosing a contraceptive.
But it does beg the question, how do we choose which one is right for us?
The truth is: this is a decision that will take some time to consider, as it really depends on what you’re after. Each of them work in different ways, some require surgery and they can have different effects on your body.
Let's have a top-level look at each of them and take a deeper dive later.
- Male condom: Looks like a giant deflated water balloon that is glided onto the shaft of the penis. It acts a barrier and prevents the sperm from reaching the egg.
- Female condom: Alright so I had never heard of this one, but it's very similar to the male condom functionality. It's a plastic looking pouch that has two soft rings on either end; one to insert and act as a barrier and the second is to cover the vulva. You insert it like a tampon, but its like an inverted male condom.
- Diaphragm: A small silicone cup that is used with a contraceptive gel - spermicide. Apart from the fact it makes your vagina sound like it's growing weeds, it's there to either completely block or slow down the sperm's ability to swim to the egg.
- Combined Pill (AKA The Pill): Looks true to its name. It's made up of a hormone combo of estrogen and progesterone to stop your body from ovulating and thickening the cervical mucus so no sperm wants to trudge through it.
- Mini Pill: Similar to the Combined pill, only that it has no estrogen and relies solely on progesterone to thicken the cervical mucus.
- Vaginal Ring: A soft plastic ring that has long-lasting wear (up to 21 days) inside your vagina. It releases estrogen and progesterone to suppress ovulation and thicken cervical mucus.
- Shot: Known as Depo-Provera or Depo-Ralovera, it's a contraceptive injection that works similarly to the pill. It releases progestin into your body to prevent ovulation and thicken the cervical mucus.
- Implant (or Implanon): A small, flexible rod made of medical-grade material that is inserted under the skin of your upper arm. It releases a steady amount of progestogen into the bloodstream to prevent ovulation and cause changes to the cervical mucus.
- Hormonal IUD: A T-shaped device that is inserted into your cervix by a doctor. You might have heard this called a Mirena - which is the main hormonal IUD brand in Australia. They release a type of progesterone hormone (known as levonorgestrel) which prevents ovulation and thickens the cervical mucus.
- Copper IUD: Similar in looks to the Hormonal IUD, but without the hormones. Instead of using hormones to prevent ovulation, it releases copper ions into your cervix. These little copper ions work by thickening the cervical mucus and making it hard for the sperm to swim through to the egg.
- Tubal Ligation: For the women, this is a permanent contraceptive option where a surgeon will cut, clip or remove the fallopian tubes. This blocks the egg from ever moving to the uterus. Without that reproductive foundation, no baby.
- Vasectomy: For the men, this is a permanent contraceptive option where the tubes are tied. It means sperm can't travel from the testicles to the penis, so no sperm will be present in his semen when he ejaculates.
- Fertility Awareness Method (FAM): Basically, this method works by monitoring when your ovulation occurs, checking in on your cervical mucus and measuring your basal body temperature so you know when to avoid sex on the days when your fertility is running hot. That's right, no hormones, devices, rubber application or tubes to cut but it's one of the least effective methods of contraception (average ~75% effective).
And no - the pull-out and pray method is not on the list. 🙅♀️
👩⚕️ Choosing what’s right for us
There's actually no contraceptive method that is completely risk-free. So, all you really can do is weigh up the pros and cons.
Here's a few things you can consider:
Effectiveness: This one’s a biggie. How effective is the contraception at actually preventing pregnancy? We go into more detail about this in the next section.
Convenience: How easy is it for me to use the contraception method consistently and correctly? For example, if you aren't taking the Pill like clockwork every day, this can impact its effectiveness. So, you might find that using an IUD is the easiest - just set and forget (for a few years!).
Hormonal: Are there hormones involved in the contraception you choose? Hormones already control so much of our mood, energy and body. Maybe you don’t want extra hormones rocking your body.
Side Effects: What side effects are expected? If you’re using hormonal contraception methods, chances are that the hormonal cocktail will hit you with some side effects. It’s just a question of what side effects you’re willing to risk or put up with.
So, where do you start? Ask yourself what you value when it comes to effectiveness, convenience, hormones and side effects. From there, it’s about exploring the contraceptive options that align closest to what you need.
Let's get into the finer details 👇
🍌 Male Condom
A condom has done its job when it collects the sperm, stopping the swimmers from meeting the egg. We've got a lot to be thankful for when it comes to the humble condom.
PRO: It doesn't need to pump our bodies with hormones and it can protect us from STIs.
CON: The downside though is they can pop like a balloon, leaving you completely susceptible to falling pregnant. And, let's face it the admin of putting them on disrupts the steamy foreplay.
🥛 Female Condom
Also known as the femidom (condom for females). It’s just as good as a male version, but not as commonly used. To use it, you need to insert one of the rings into the vagina (to act as the barrier) and the second is attached to the outside of your vagina to cover your vulva. You insert it like a tampon but it funcitons like an inverted male condom.
PRO: No hormones involved; which means no side effects. Plus, no interruptions! You can insert it up to 8 hours before sex. Considering we wear tampons for that long, it seems doable. That way when the opportunity arises, you can keep all the steam and spontaneity burning. Another tick is that it prevents against STIs as well.
CON: Just like a male condom, they can break or slip off. It can also get a little tricky for the penis to find its flight path and stay in its lane, if you get what I mean. Problem is, they didn't really teach us the application of a female condom in sex ed, did they? Kinda makes you wonder what fruit would have been used instead of a banana.
Made from soft silicone, shaped like a small cup; the diaphragm is like a vagina shield. Combined with a contraceptive gel (spermicide), it works by preventing the sperm from entering the uterus and fertilising the egg. Caya is the Diaphragm brand sold in Australia.
PRO: They are reusable for up to two years. You'll just need to keep buying the spermicide. They don't impact the steamy flow of sex, as they can be inserted up to 2 hours before. And, they don't pump your body with hormones; so no side effects.
CON: They aren't the easiest of things to put up there correctly, so you'd need to learn that; and possibly have back-up protection until you feel like you've nailed it. But even with confidence, you could still misplace it.
Spermicide is the non-negotiable partner to using the diaphragm and even its name can sound like you're pumping your vagina with pesticides that you use in your garden to kill weeds. In saying that, the spermicide can actually disrupt your vaginal microbiome (the organisms that keep your vagina healthy and happy).
👅 Combined oral pill
The most popular option in Australia; the pill is taken orally every day. It contains a hormone mix of estrogen and progesterone (aka combined) that work together to stop ovulation, thicken the cervical mucus and prevent sperm from swimming through.
PRO: No devices are inserted into your body and no surgery is required. It can help regulate your periods, make them lighter and also make your symptoms - like period cramps- less severe.
CON: It can be easy to forget taking the pill, which can reduce the effectiveness of it. There are also a bunch side effects and it really depends on the brand you use. The most common side effects include spotting, nausea, breast tenderness, headaches, weight gain, mood changes and decreased libido.
The cost of the pill could be a pro or a con, but that's subjective. There are ranges that are relatively inexpensive around $15 per three months to up to $80 per three month. It depends on the pill brand you buy and which one is recommended to you by your Doctor. Which one you choose is entirely dependent on your body, your hormones and your susceptibility to symptoms.
💊 Mini pill
The mini pill is very similar to the combined pill. The main difference is that it only has progestogen and no estrogen. It works by thickening the mucus in the cervix which stops the sperm from reaching the egg.
You still take it every day, but you need to be even more hardcore with the timing and consistency of this. The reason for this is because the mini pill has a lower dose of hormones than the combined pill. Because it’s a lower dose of hormones than the combined pill, you need to take it around the same time every day. If you take it more than 3 hours late, it can be less effective.
PRO: The mini pill can be a better option for women who can't have estrogen due to certain health conditions, just recently gave birth, are breastfeeding or are trying to avoid the side effects of the combined pill.
CON: You're not totally in the clear from side effects. Some women taking the mini pill can still experience side effects such as headaches, mood changes, sore breasts, acne and irregular bleeding.
💍 Vaginal Ring
The Vaginal Ring (AKA NuvaRing) is a soft plastic ring that’s inserted into the vagina like a tampon on the first day of your cycle, after your period.
You'll keep it in there for the next 3 weeks so that it can release estrogen and progestrone into; the hormone combo that stops ovulation and thickens cervical mucus.
After 3 weeks, you take the ring out and your body will have a withdrawal bleed (your period).
You'll need a script from your Doctor before you make a trip to the pharmacy. Typically, you can get up to 4 vaginal rings at a time.
PRO: You can insert and forget for 21 days, rather than having to remember taking a pill every single day. Also, some women have used the vaginal ring to skip periods, reduce menstrual cramps and improve acne.
CON: It can be a bit more spenny than other types of contraception at $30 per ring. It can also cause side effects including increased discharge, nausea, tender breasts, headaches, bloating and mood changes.
Also known as the "jab" for lack of a better word. It's more medically known by their brand names “Depo-Provera” or “Depo-Ralovera." As it's described, a form of synethic progestin is injected into your body every 12 weeks by your Doctor.
This injectable birth control solution works by preventing your body from ovulating an egg and thickening the cervical mucus, making it a hostile environment for sperm.
PRO: The pregnancy-preventing effects last a longer time compared to other contraception methods. One injection in either your butt (🍑) or upper arm lasts you for three months.
CON: There's the admin of booking in to visit a doctor to get the injection every 3 months. If you miss an appointment, the injection can be given up to 2 weeks late but any longer than that - you should use condoms until the injection has had time to get into your system and do its thing.
Another potential downside to injections is that it's pumping hormones into your body. This means side effects. Your periods may become unpredictable, it can cause weight gain, moodiness, headaches, acne and bone thinning if use for a long time.
If you’re thinking about having kids in the next few years, probs a good idea to stay away from this contraception method.
Let me tell you why.
Even though the pregnancy-preventing effects of the injection wears off eventually, there's no guarantee on how long it will actually take to do that. It's different for everyone.
Injections require pretty strong doses of hormones to be effective, so your body will be like 'wtf' when you stop them. Ovulation won't kick back into gear until the effects of the injected hormones wear off.
On average, it takes around 6 months to get back to normal ovulation, but has been known to take up to 18 months for some women.
Oh and if you hate needles...you've probably already skipped this as an option. But if you haven't, then we'd like to warn you that this kind of contraception is probs your worst nightmare.
The Implant (aka the Implanon) is a small, flexible rod made of medical-grade material that is inserted under the skin of your upper arm. It releases a steady amount of progestogen into the bloodstream to prevent ovulation and cause changes to the cervical mucus so the sperm swimmers can't make it to the egg.
This contraception option does require surgery and you'll need to see a Doctor to have it prescribed and inserted.
PRO: Long-lasting - 3 years in fact! After a few months, some women notice lighter (or no) periods at all and less menstrual cramps.
CON: You may experience side effects including headaches, mood swings, sore breasts and acne.
🦂 Hormonal IUD
The IUD (Intrauterine Device) is a T-shaped device that gets inserted into your cervix by a doctor. In Australia the main brand available is called the Mirena - so you might have heard of that before.
They are designed to be long-lasting and make a comfortable home in your cervix for years. While they're living in there, they make themselves useful by releasing a type of progesterone hormone (known as levonorgestrel). Again, what this does is prevent ovulation and thickens the cervix mucus to make it difficult for the sperm to swim through.
If this is something you’re considering, you’ll need to get a doctor to prescribe and insert it for you.
PRO: They’re 99% effective.- great odds! Studies have even shown that the IUD is comparable to female sterilisation. The biggest advantage is that they can last in your body for up to ~3-5 years (depending on the brand), and you can reverse its pregnancy preventing effects by getting a doctor to remove it when you’re ready.
Unlike oral contraceptive pills which release hormones into your bloodstream, the IUD is a localised hormone release - just in your uterus. This tends to result in less hormonal side effects than the contraceptive pill.
CON: It’s still a type of hormonal contraception so it still comes with listed side effects and risks. Most commonly, you may experience spotting in the first few months, longer and heavier periods or missed periods. Other possible side effects include irregular periods, cramping, backaches, cramping, nausea, ovarian cysts and mood changes.
There are also some more severe side effects.
While rare (like 1 in 1000 type rare), there is the risk that the IUD will dislodge and perforate your uterus and cause infection and severe bleeding.
Also rare, but if the IUD insertion procedure introduces bacteria into the uterus, there is a chance that you may get Pelvic Inflammatory Disease (PID).
What we recommend is that you seek out an experienced doctor and someone you really trust to insert your IUD.
⛏️ Copper IUD
The Copper IUD is similar to the hormonal IUD, but it doesn’t use hormones to work. It’s a T-shaped device that is inserted into your cervix by a doctor.
Again, these are long-lasting and make a home in your cervix for years. But the biggest difference is instead of releasing hormones - it releases copper ions into your cervix.
Copper makes your uterus a hostile environment for sperm by thickening the cervical mucus that sperm will struggle to navigate through to your egg.
Without repeating ourselves, the pros and cons for the Copper IUD are very similar to the Hormonal IUD. Scroll back up if you want the longer version👆🏽
PRO: Long-lasting, reversible and non-hormonal (so, less side effects).
CON: You can still experience side effects with the most common including menstrual cramps, spotting between periods and heavier and longer periods.
There’s also a (very) small risk that the IUD will dislodge and perforate your uterus.
🧬 Tubal Ligation
You’re probably more familiar with the phrase “getting your tubes tied." Now this is another permanent contraceptive option for women. You'll need surgery where a surgeon will clip, cut or remove the fallopian tubes to ensure the egg can't move into the uterus to be fertilised.
PRO: It's 99% effective, making it one of the most effective contraceptive methods. If you've made your mind up that you either don't want to birth a child or you've finished creating a family, then this could be a suitable and convenient option for you solely based on the fact that you never have to deal with contraception again.
CON: A shorter-lived con would be that after the operation, you can expect to feel some abdominal pain, cramps and nausea for a few days.
And, if you do actually change your mind (which can happen) then you've already made a permanent decision so that would have to be something you're prepared to live with.
However, tubal ligation can sometimes be reversed. If you’ve gotten your tubes completely removed, this can’t be reversed. However, if they have been cut, the surgeon can rejoin the cut tubes using small stitches, but there are very low success rates with this.
There are other possible risks that come with tubal ligation, including damage to nearby organs, infections, haemorrhages and infections in the wounds of the fallopian tubes.
In saying that, tubal litigation might not be right for you. Especially if you're relatively young. Even if you say you don't want kids now, circumstances can change. You just never know!
If you’re looking for a long-term method that’s set and forget, and not something permanent, it’s worth looking at the long-acting reversible contraceptives like the IUD.
A vasectomy is a permanent type of contraception where surgery is performed on the male to stop the sperm travelling through the tubes from the testicles (where the sperm are made) to the penis (and then to ejaculation).
It takes around three months from the time of the procedure for a vasectomy to begin working (i.e., for no sperm to be present in ejaculation). So make sure you take that into consideration before you get too comfy!
PRO: It’s 99% effective, another one of the most effective contraceptive methods. If you are sure you don't want his sperm for any more baby-making, then it could be a convenient solution so you can both forget about contraception!
CON: He might experience some post-surgery pain, bruising, lumps, infections and scarring.
Similar to the tubal litigation procedure, the indefinite nature of it means you shouldn't take this decision lightly and need to consider it carefully.
If you’re looking for a long-term method that’s set and forget, and not something permanent, it’s worth looking at the long-acting reversible contraceptives such as the IUD.
🌳 Fertility Awareness Method
This is a method that doesn't require any surgery, implants, cutting tubes or hormones. It simply relies on you monitoring when your ovulation occurs, checking in on your cervical mucus and measuring your basal body temperature.
I guess you kinda become the product of your own science experiment.👩🏻🔬
The reason why you'd do this is to figure out which days you need to avoid having sex. Basically, the days where your fertility is ready to rumble. Or, you can always just use this to cue the condoms if you don't want to abstain from sex.
The logic of this method relies on the fact that you can't get pregnant every day of the month. It considers your fertile window and the days you are most likely to get pregnant (usually 5 days before ovulation and the day of).
PRO: There’s no hormones to consume, devices to insert, rubber to apply or tubes to cut. It’s au naturale.
CON: As you could imagine, the biggest con compared to the other contraception types is its effectiveness - sitting at ~75%. That’s because ovulation is highly variable woman to woman.
There's also a bunch of factors that impact your ovulation and your ability to track it such as travel, illnesses and stress.
So, it’s not typically suitable for people with irregular cycles as it makes it much harder to predict when you’re likely to ovulate.
It requires commitment to daily monitoring of the changes in your basal body temperature (BBT) and cervical mucus. And, it requires the discipline to not have sex during your fertile window, which actually happens to be when your libido is running hot! However you could always wear a condom.
🤖 Information Overload, Halp
If you read this guide top to toe, then not only are you a legend but you've also probably got a pretty sore head.
Considering everything you've just read, here's what we recommend you do to move forward with a decision:
- When you're feeling overwhelmed: just remind yourself that choice is a good thing. And hopefully you've learn't about some other options that you didn't even know was available, so that's always a bonus too!
- Try narrow the list down to your top 3 options and separate out the pros and cons.
- Use this list to discuss with your doctor as they will be able to personalize the discussion more to your current situation.
It will feel empowering once you making the right decision for yourself.
Dr. Vamsee Thalluri