Contraception without confusion: Finding the best option for you

Navigating the world of contraception: What to consider before making your choice

Condoms and the pill are typically the first 2 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 [1].

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 use the menu on the left to skip to the contraception options you want more details on.

The 13 types of contraception methods

Variety of choice is definitely a great thing when it comes to the personal decision of picking a contraceptive method. 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 these options works in different ways, some require surgery, and they can all 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 and it acts as a barrier and prevents the sperm from reaching the egg [2].
• Female condom: Similar to the male condom, it's a plastic-looking pouch that has 2 soft rings on either end; one to insert and act as a barrier and the second to cover the vulva. You insert it like a tampon, but it's like an inverted male condom.
• Diaphragm: A small silicone cup that is used with a contraceptive gel called spermicide. Apart from the fact that it makes your vagina sound like it's growing weeds, it's there to either block or slow down the sperm's ability to swim to the egg.
• Combined pill (AKA the pill): The combined pill is made up of a hormone combo of oestrogen and progestin (a man-made form of progesterone) to stop your body from releasing an egg each month and thicken the cervical mucus so no sperm wants to trudge through it.
• Mini pill: Similar to the combined pill, only it has no oestrogen and relies solely on progestin 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 oestrogen 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, thicken the cervical mucus, and thin the lining of your womb, making implantation more difficult.
• 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 progestin into the bloodstream to pause 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 or Kyleena, which are the main hormonal IUD brands in Australia. It releases a type of progestin hormone, known as levonorgestrel, which again, prevents ovulation, thickens the cervical mucus, and makes it harder for implantation to occur.
• Copper IUD: Similar in looks to the Hormonal IUD, but instead of using hormones to prevent ovulation, it releases copper ions into your cervix. These ions work by thickening the cervical mucus and making it hard for the sperm to swim through to the egg.
• Tubal ligation: For 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, there's no baby.
• Vasectomy: For 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 applications or tubes to cut but it's one of the least effective methods of contraception.

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 are 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 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, especially man-made ones.

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 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 male latex condom.

Pros:

• It doesn't need to pump our bodies with hormones.
• It can protect us from STIs.

Cons:

• It can pop like a balloon, leaving you completely susceptible to falling pregnant.
• The admin of putting it on can disrupt 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 [3]. You insert it like a tampon but it functions like an inverted male condom.

Pros:

• There are no hormones involved; which means no side effects.
• You can insert it up to 8 hours before sex which, considering we wear tampons for that long, seems doable. That way when the opportunity arises, you can keep all the steam and spontaneity burning.
• It prevents STIs as well.

Cons:

• Just like a male condom, it can break or slip off.
• It can get a little tricky for the penis to find its flight path and stay in its lane, if you get what we mean. The 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.

Diaphragm

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 [4]. Caya is the diaphragm brand sold in Australia.

Pros:

• They are reusable for up to 2 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.
• They don't contain hormones; so no side effects.

Cons:

• 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, the non-negotiable partner to using the diaphragm, can disrupt your vaginal microbiome (the organisms that keep your vagina healthy and happy).

Combined oral contraceptive pill

The most popular option in Australia; the oral contraceptive pill is taken daily. It contains a hormone mix of oestrogen and progestin (aka combined) that work together to stop ovulation, thicken the cervical mucus, and prevent sperm from swimming through [5].  

Pros:

• 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.

Cons:

• It can be easy to forget to take the pill, which can reduce its effectiveness.
• Depending on the brand you choose, there are some potential side effects, which can include spotting, nausea, breast tenderness, headaches, mood changes, and decreased libido.

With Kin's contraceptive pill subscription, you can get the pill delivered straight to your door without the hassle of having to head to the doctor's office or the pharmacy.

Undergo a digital consult and an Aussie practitioner will create a prescription plan just for you. It couldn't get any easier than that!

Mini pill

The mini pill is very similar to the combined pill. The main difference is that it only has progestin and no oestrogen. 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 that the mini pill has a lower dose of hormones than the combined pill, which means 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.

Pros:

• The mini pill can be a better option for women who can't have oestrogen due to certain health conditions, just recently gave birth, are breastfeeding or are trying to avoid the side effects of the combined pill.

Cons:

• Some women taking the mini pill can still experience symptoms such as headaches, mood changes, sore breasts, and irregular bleeding.

Vaginal Ring

The Vaginal Ring is a soft plastic ring that’s inserted into the vagina like a tampon on the first day of your cycle, after your period [6].

You'll keep it in there for the next 3 weeks so that it can release oestrogen and progestin; 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 and typically, you can get up to 4 vaginal rings at a time.

Pros:

• You can insert and forget for 21 days, rather than having to remember to take a pill every single day.
• Some women have used the vaginal ring to skip periods, reduce menstrual cramps, and improve acne.

Cons:

• It can be a bit more spenny than other types of contraception at $30 per ring.
• It can cause side effects including increased discharge, nausea, tender breasts, headaches, bloating, and mood changes.

Shot

Also known as the "jab" for lack of a better word. It's more medically known by its brand name “Depo-Provera” or “Depo-Ralovera." As it's described, a form of synthetic 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 [7].

Pros:

• The pregnancy-preventing effects last a long time compared to other contraception methods. One injection in either your butt or upper arm lasts you for 3 months.

Cons:

• 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.
• It pumps hormones into your body, which means side effects. Your periods may become unpredictable, and it can cause weight gain, moodiness, headaches, acne, and bone thinning if used for a long time.
• 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 probably your worst nightmare.  
• If you're thinking about having kids in the next few years, it's probably a good idea to stay away from this contraception method. Even though the pregnancy-preventing effects of the injection wear 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 it has been known to take up to 18 months for some women.

Implant

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 progestin into the bloodstream to prevent ovulation and cause changes to the cervical mucus so the sperm swimmers can't make it to the egg [8].

The contraceptive implant does require surgery and you'll need to see a doctor to have it prescribed and inserted.

Pros:

• It's long-lasting — 3 years, in fact!
• After a few months, some women notice lighter (or no) periods at all and fewer menstrual cramps.

Cons:

• 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.

IUDs are designed to be long-lasting and make a comfortable home in your cervix for years. While they're living there, they make themselves useful by releasing a type of progestin hormone, known as levonorgestrel. Again, what this does is prevent ovulation and thicken 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.

Pros:

• It's 99% effective and studies have even shown that the IUD is comparable to female sterilisation [9].
• It can last in your body for up to 3-5 years (depending on the brand).
• 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 fewer hormonal side effects.

Cons:

• 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 cramping, backaches, nausea, ovarian cysts, and mood changes.
• While rare (like 1 in 1000 type rare), there is the risk that the IUD will dislodge and perforate your uterus, causing 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. It’s a T-shaped device that is inserted into your cervix by a doctor and makes a home in it 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 of the copper IUD are very similar to the hormonal IUD. Scroll back up if you want the longer version.

Pros:

• Long-lasting, reversible, and non-hormonal.

Cons:

• 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 [10].  

Pros:

• It's 99% effective, making it one of the most effective contraceptive methods
• If you've made up your mind 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.

Cons:

• After the operation, you can expect to feel some abdominal pain, cramps, and nausea for a few days.
• There's a risk of damage to nearby organs, hemorrhages, and infections in the wounds of the fallopian tubes.
• If you 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. We should mention that if your tubes have been cut (rather than removed), the surgeon can rejoin them using small stitches, but there are very low success rates with this. Having said that, this contraceptive method 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. 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.

Vasectomy

A vasectomy is a permanent type of contraception where surgery is performed on the male to stop the sperm from travelling through the tubes from the testicles (where the sperm are made) to the penis (and then to ejaculation) [11].

It takes around 3 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.

Pros:

• 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.

Cons:

• He might experience some post-surgery pain, bruising, lumps, infections, and scarring.
• While it's considered a permanent type of contraception, men can get the surgery reversed, but if you are relying on the fact that you can technically change your mind down the track, just know that it still comes with risks.
• In a vasectomy reversal, your doctor needs to rejoin the tubes back together so that the sperm can reach the flow of semen again and be ejaculated.
• There is the risk that even with the reversal, the sperm still isn't able to flow through. And without sperm, there's no fertilised egg and no chance of a natural pregnancy. So it's not a decision to take lightly, even with the possibility of reversal.

Fertility Awareness Method

This is a method that simply relies on you monitoring when your ovulation occurs, checking in on your cervical mucus, and measuring your basal body temperature.

The reason why you'd do this is to figure out which days you need to avoid having sex (at least, unprotected sex). Basically, the days when 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 altogether.

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).

Pros:

• There are no hormones to consume, devices to insert, rubber to apply or tubes to cut. It’s au naturel.

Cons:

• As you can imagine, the biggest con compared to the other contraception types is its effectiveness, sitting at around 75%. That’s because ovulation is highly variable from person to person.
• There are 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 a commitment to daily monitoring of the changes in your basal body temperature (BBT) and cervical mucus.
• It requires the discipline to not have sex during your fertile window, which actually happens to be when your libido is running hot. (although you could always wear a condom).

Help, information overload!

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, remind yourself that choice is a good thing. And hopefully, you've learnt about some other options that you didn't even know were available, which is always a bonus too.
• Try to 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 personalise the discussion more to your current situation.

It will feel empowering once you make the right decision for yourself.