Anyone who is sexually active and not currently planning to have children must make a decision about a suitable contraceptive method. Contraceptives provide control over potential pregnancies and offer the opportunity to actively shape family planning. (3) But which contraceptive method suits individual needs and expectations while providing sufficient safety? In what follows, we explain the advantages and disadvantages of all contraceptive methods.

The list of different contraceptive options is long. These are the methods available to prevent pregnancy (4):

What Contraceptive Methods Are Available?

Women* and men* have access to an ever-growing variety of contraceptives. Each method has its own advantages and disadvantages, different mechanisms of action, and varying effectiveness. At the end of this article, you will find an overview of the safety of each method.

Barrier Methods

Barrier or mechanical methods include:

• Male condom

• Female condom

• Diaphragm

• Cervical cap with spermicide

• Contraceptive sponge

The aim is to prevent the interaction of sperm and egg. Barrier methods achieve this by blocking the man’s* ejaculate (sperm). Diaphragms, cervical caps, and contraceptive sponges also prevent sperm from entering the uterus by covering the cervix. In addition, they use a spermicide, a gel that inhibits sperm, applied to the diaphragm or cervical cap to further reduce the chance of sperm reaching the uterus.

Note: The effectiveness of barrier methods depends on consistent and correct use. Most failures result from improper or inconsistent application.

Condoms

Condoms for men* and women* are easy to use and non-invasive, meaning they cause no injuries and do not remain in the body. They are for single use only and can be applied without much preparation. They also provide good protection against sexually transmitted infections and HIV. (5)

Diaphragm, Cervical Cap, Contraceptive Sponge

Hormonal Contraceptives

Hormonal contraceptives differ in the composition of the sex hormones used, the method of administration, and the duration of effectiveness. (7) The main mechanism of hormonal contraception is the suppression of ovulation by the hormones progestin or estrogen. (6)

Progestins inhibit ovulation by suppressing luteinizing hormone (LH) and reduce the thickening of cervical mucus, thereby hindering the transport of sperm. (6) Estrogens act in a similar way, depending on the dosage, by suppressing ovulation through inhibition of follicle-stimulating hormone (FSH) and LH. In addition, they alter the secretions and cellular structures of the endometrium (uterine lining) in the uterus.

The Pill for Women

Since its introduction in 1960, hormonal contraceptives in tablet form (oral contraceptives) have become one of the most popular methods of family planning worldwide. The “contraceptive pill” – often simply called “the pill” – usually contains the two sex hormones estrogen and progestin, which belong to the group of steroid hormones. (8)

This is particularly important because steroid hormones can enter the bloodstream through the digestive tract and do not have to be injected into tissue, as is the case with the pancreatic hormone insulin. No invention of the 20th century has so radically transformed social and cultural life as the pill. (9)

Pills that contain low doses of two hormones – a progestin and an estrogen – similar to the natural hormones progesterone and estrogen in a woman’s* body, are called combined oral contraceptives. The so-called “mini-pill,” which contains only progestin, tends to have fewer side effects than the usual combination preparations, but it must be taken at the same time every day to remain effective. (6)

The pill can relieve menstrual pain, premenstrual syndrome, signs of endometriosis (endometrial-like tissue outside the uterine cavity), abnormal uterine bleeding, and severe acne. Other advantages are that it is easy to take and controlled entirely by the woman*, that it can be discontinued at any time without assistance, and that it does not interfere with sexual activity.

However, it does not provide protection against sexually transmitted infections. The most common side effects are changes in the intensity, duration, and timing of periods, headaches, dizziness, nausea, breast tenderness, weight changes, and mood swings. More serious side effects, which are very rare, include blood clots in deep veins or in the lungs (deep vein thrombosis or pulmonary embolism) (5, 10).

Implants, Injections, IU

Long-acting and reversible contraceptives that need to be used less than once a month include implants, injections, and hormonal intrauterine devices (IUDs, also called intrauterine systems, IUS). They may contain a combination of progestin and estrogen, but can also be progestin-only. (5)

Hormonal implants are inserted subcutaneously (under the skin) in the upper arm and are effective for three to five years, depending on their composition. Injections are administered into the buttock or upper arm muscle of the woman*.

The most common side effects are disturbances of the regular menstrual cycle, with frequent and irregular bleeding. (7)

Contraceptive Patch, Vaginal Ring

Effective and reliable contraception can be achieved through the combined administration of estrogen and progestin using a contraceptive patch or a vaginal ring. The general mechanism of these methods is the same as that of oral contraceptives.

These methods offer the advantage that they do not need to be used daily, are relatively easy to apply, and can therefore achieve higher reliability.

The disadvantages of these methods are the lack of protection against sexually transmitted infections and HIV. In addition, the menstrual cycle may be altered.

The Pill for Men

While women* have many contraceptive options, men* are currently limited to condoms and vasectomy (surgical interruption of the vas deferens). As seventy percent of contraception worldwide is performed by women*, many men* wish for a more active role in family planning.

Condoms have relatively high failure rates, and vasectomy is only reversible with major surgery under general anesthesia. Research is therefore ongoing into new male contraceptives similar to female options, such as daily pills, long-acting injections, and implants. (11, 12)

Natural Contraceptive Methods

The principle of natural contraception or family planning is based on a woman’s* awareness of when the fertile phase of her menstrual cycle begins and ends. Conception is only possible during this period.

Symptom-based methods are used to gain information about the current probability of conception. This makes it possible either to avoid intercourse during the fertile phase or to rely on alternative contraceptive methods such as barrier methods. (13)

Calendar Method

This method involves tracking menstrual cycle days to identify fertile and infertile times. It assumes that ovulation occurs around day 14 (±2 days), that the egg survives about 24 hours, and that sperm can survive about five days. (6)

Symptothermal Method

This method is based on the biphasic course of body temperature: in the first half of the cycle, basal body temperature is slightly lower than in the second half, directly after ovulation. A sudden rise in temperature therefore indicates that ovulation has taken place. (5) The consistency of cervical mucus, the natural secretion of the cervix, also changes over the course of the female cycle, becoming clearer and whiter during fertile days.

The combination of natural family planning methods – measuring basal temperature and monitoring cervical secretions – increases the effectiveness of avoiding an unintended pregnancy. Mobile health applications that record symptom changes over the course of the month have proven useful. These apps help women* identify their maximum fertility window and thus provide valuable support both in preventing and in planning pregnancies. (14)

Natural contraceptive methods are practical alternatives for women* who do not wish to use other methods, particularly hormonal ones. (15) These approaches have no side effects and do not interfere with a woman’s* hormonal balance. Another advantage is that cycle monitoring allows women* to learn more about their bodies and fertile days, and it enables couples to follow their religious or cultural norms regarding contraception. (5)

However, the effectiveness of natural methods depends strongly on the behavior of both partners. In addition, irregular menstrual cycles as well as acute or chronic increases in body temperature can impair success. Furthermore, these methods do not provide protection against sexually transmitted infections or HIV.

Emergency Contraception

If unprotected sex occurs or contraception fails, emergency contraception – commonly called the “morning-after pill” – can be used. It prevents or delays the release of an egg from the ovaries.

Reported side effects include changes in bleeding, nausea, abdominal pain, fatigue, headaches, breast tenderness, dizziness, and vomiting. (5)

Surgical Contraception (Vasectomy, Sterilization)

Vasectomy and sterilization are permanent surgical methods for men* and women* who no longer wish to have children. In vasectomy, the vas deferens are sealed so that sperm do not enter the semen. Female sterilization involves blocking or cutting the fallopian tubes, preventing sperm from reaching the egg.

These methods are highly effective, but reversal is generally impossible or requires major surgery. (5)

Effectiveness of Contraceptive Methods

Effectiveness is often expressed by the Pearl Index, which indicates the number of unintended pregnancies per 100 women* per year. The lower the index, the safer the method.

• Condom (male): 2–12

• Condom (female): 5–25

• Diaphragm: 1–20

• Cervical cap: 6

• Hormonal IUD: 0.16

• Pill: 0.1–0.9

• Mini-pill: 0.5–3

• Injection: 0.3–0.88

• Vaginal ring: 0.4–0.65

• Patch: 0.72–0.9

• Copper IUD: 0.3–0.8

• Implant: 0–0.08

• Calendar method: 9

• Symptothermal method (if intercourse is avoided during fertile days): 0.4–1.8

• Female sterilization: 0.2–0.3

• Male sterilization: 0.1

• No contraception: 85 (16)

You might also be interested in these articles