Written by Dr. Specialist Stine Andreasen
Specialist in Gynecology and Obstetrics, PhD in Obstetrics in 2015 and more than 15 years of clinical practice in Obstetrics and Gynecology
There is no single contraception method that’s right for everyone. The best choice depends on your age, medical history, period symptoms, lifestyle, plans for future pregnancy and personal preferences. Contraception can also do more than prevent pregnancy: some methods reduce bleeding, ease period pain, improve acne, or help manage endometriosis and adenomyosis.
Key takeaways
- IUDs and the implant are among the most effective reversible methods because they don’t depend on daily use.
- Combined methods (pill, patch, ring) contain estrogen and aren’t suitable for everyone.
- Progestogen-only methods are an option for many women who should avoid estrogen, including while breastfeeding.
- The copper IUD is the only long-acting method that is completely hormone-free.
- Condoms are the only method here that protects against sexually transmitted infections.
- You can still get pregnant during perimenopause, and HRT is not contraception.
In this article
Contraception methods at a glance
Combined hormonal contraception
The progestogen-only pill
The hormonal IUD
The copper IUD
The contraceptive implant
The contraceptive injection
Condoms
Sterilization
Contraception at different stages of life
Frequently asked questions
Contraception methods at a glance
| Method | How often | Contains estrogen? | Effect on periods |
|---|---|---|---|
| Combined pill, patch, ring | Daily / weekly / monthly | Yes | More predictable, often lighter |
| Progestogen-only pill | Daily | No | Often irregular |
| Hormonal IUD | Lasts several years | No | Often lighter or absent |
| Copper IUD | Lasts several years | No (hormone-free) | May be heavier and more painful |
| Implant | Lasts several years | No | Unpredictable |
| Injection | Every 12–13 weeks | No | Often stops over time |
| Condoms | Each time | No (hormone-free) | No effect |
| Sterilization | Permanent | No | No direct effect |
Combined hormonal contraception: the pill, patch and vaginal ring
How does it work?
Combined methods contain two hormones, estrogen and a progestogen. They mainly prevent pregnancy by stopping ovulation, and they also change cervical mucus and the lining of the uterus. They come as a daily pill, a weekly skin patch, or a vaginal ring usually replaced on a monthly schedule.
Who is it for?
Combined contraception can suit you if you want reliable contraception along with predictable bleeding, or no bleeding at all. It can also help with painful or heavy periods, irregular cycles or acne.
For teenagers and young women, it can be a good option when period symptoms get in the way of school, sports or everyday life. Women with endometriosis may benefit from continuous use, where hormone-free breaks are shortened or skipped. This can stop periods and reduce endometriosis-related pain.
Benefits
More predictable bleeding
Less menstrual blood loss and period pain
The option to skip periods through continuous use
Relief of endometriosis-related period pain
Reduced risk of ovarian and endometrial cancer
Side effects and risks
Common side effects include nausea, breast tenderness, headaches, breakthrough bleeding and sometimes mood changes. These often improve within the first few months. Combined contraception slightly increases the risk of venous blood clots. It isn’t suitable for everyone, particularly women with certain clotting disorders, migraine with aura, uncontrolled high blood pressure or some cardiovascular conditions.
Can you take the combined pill after 35? Age alone doesn’t rule it out, but smoking becomes an especially important factor from 35, and individual cardiovascular risk factors should be assessed.
The progestogen-only pill (the mini-pill)
How does it work?
The mini-pill contains no estrogen. Depending on the type, it prevents pregnancy by thickening cervical mucus, stopping ovulation, or both. Unlike the combined pill, it is usually taken every day without a break.
Who is it for?
The mini-pill can suit you if you can’t or prefer not to use estrogen. This includes many women who are breastfeeding, women with migraine with aura, and women with certain cardiovascular risk factors. It can also be a good option for teenagers and for women approaching menopause. For women with endometriosis, mini-pills that reliably stop ovulation may help reduce period pain and other symptoms.
Benefits
Suitable for many women who should avoid estrogen
Can be used while breastfeeding
May reduce bleeding and period pain
Some types can stop periods
May improve endometriosis symptoms
Side effects and risks
Irregular bleeding is the most common side effect. Some women have frequent spotting, while others bleed very little or stop having periods altogether. Other possible effects include acne, breast tenderness, headaches and mood changes.
What if you take the mini-pill late? That depends on the type. Some have a short window for a missed pill, while others are more flexible.
The hormonal IUD (hormonal coil)
How does it work?
A hormonal IUD is a small T-shaped device placed inside the uterus. It releases a low dose of levonorgestrel, a progestogen that acts mainly locally. It thickens cervical mucus and thins the uterine lining. Many users continue to ovulate. Hormonal IUDs are among the most effective reversible methods and can last several years, depending on the device.
Who is it for?
Women who want long-term contraception without remembering a daily pill
Women with heavy periods or significant period pain, for whom it can be a good option
Women with adenomyosis, where a hormonal IUD, particularly a 52 mg levonorgestrel device, may substantially reduce bleeding and pain
Women with endometriosis, who may get less period and pelvic pain, although some need additional treatment
Teenagers and women who have never given birth. The right device and insertion approach should be discussed individually.
Women approaching menopause, as it gives effective contraception and bleeding control. Certain 52 mg devices can also protect the endometrium as part of HRT, according to product-specific recommendations. → [Read more: Progesterone in HRT]
Benefits
Highly effective, long-lasting contraception
Much less menstrual bleeding, and many users get very light periods or none at all
Less period pain
Helps manage adenomyosis and some endometriosis symptoms
Little day-to-day attention needed
Side effects and risks
Irregular bleeding and spotting are common in the first three to six months, and bleeding usually becomes lighter over time. Some women experience acne, headaches, breast tenderness or mood changes, although hormone levels in the rest of the body are generally lower than with many other hormonal methods.
Does getting an IUD hurt? Insertion can be uncomfortable or painful, especially if you haven’t given birth. Pain relief should always be discussed and offered. Rare complications include expulsion, perforation of the uterus, and infection linked to insertion.
The copper IUD (hormone-free coil)
How does it work?
The copper IUD is a hormone-free device placed in the uterus. Copper affects how sperm function and prevents fertilization. It gives highly effective, long-term contraception without affecting your natural hormonal cycle.
Who is it for?
The copper IUD can suit you if you prefer to avoid hormones or have medical reasons to, or if you want long-lasting contraception while keeping your natural cycle. It can be used by teenagers and women who have never given birth, taking personal preferences and insertion into account.
Can a copper IUD be used as emergency contraception? Yes. It is highly effective emergency contraception when inserted within the recommended time after unprotected sex.
Benefits
Completely hormone-free
Highly effective, long-term contraception
No daily medication
Fertility returns quickly after removal
Can be used as emergency contraception
Side effects and risks
Copper IUDs may increase menstrual bleeding and period pain, especially in the first months. They may therefore be less suitable if you already have heavy bleeding, severe period pain, adenomyosis or symptomatic endometriosis. The risks linked to insertion are similar to those for hormonal IUDs.
The contraceptive implant
How does it work?
The implant is a small, flexible rod placed under the skin of the upper arm. It releases a progestogen that mainly prevents pregnancy by stopping ovulation, and it lasts several years, depending on the product.
Who is it for?
The implant is particularly suitable for teenagers and young women who want highly effective contraception without daily pills. It’s also an option if you can’t use estrogen, or want a reversible method with a quick return of fertility. Some women with painful periods or endometriosis get relief because ovulation is suppressed.
Benefits
One of the most effective reversible methods
No daily medication
Estrogen-free
May reduce period pain
Fertility returns quickly after removal
Side effects and risks
Unpredictable bleeding is the most common reason people stop using the implant. Some women bleed for long periods or often, while others get very light periods or none. Other possible side effects include acne, headaches, breast tenderness and mood changes. The implant is highly effective as contraception, but it doesn’t give predictable bleeding.
The contraceptive injection
How does it work?
The injection contains a progestogen, most commonly depot medroxyprogesterone acetate (DMPA), which stops ovulation. It’s usually given every 12–13 weeks, depending on the product.
Who is it for?
The injection can suit you if you prefer not to take daily medication and can’t use estrogen. It may also help with significant period pain or endometriosis symptoms, as it often stops periods.
Benefits
Effective contraception without daily medication
Often reduces or stops bleeding over time
May relieve endometriosis-related pain
Estrogen-free
Side effects and risks
Irregular bleeding is common at first, and periods are more likely to stop with continued use. Other possible side effects include weight gain, headaches and mood changes.
Does the injection affect bone density? DMPA is associated with reduced bone mineral density during use. This is particularly relevant for long-term use in teenagers or women with other risk factors for osteoporosis.
Fertility may take longer to return after the last injection than with other reversible methods.
Condoms
How do they work?
Condoms are a physical barrier that stops sperm from entering the vagina. Unlike the other methods here, they also reduce the risk of sexually transmitted infections, including chlamydia, gonorrhea and HIV.
Who are they for?
Condoms are particularly important for teenagers, people with new or multiple partners, and anyone who wants protection against sexually transmitted infections. They can be combined with hormonal contraception or an IUD for extra protection.
Benefits
Protect against sexually transmitted infections
Hormone-free
Widely available
Used only when needed
Side effects and risks
With typical use, condoms are less effective at preventing pregnancy than long-acting methods like IUDs and implants. Breakage, slipping or inconsistent use reduces effectiveness. Some people experience irritation or a latex allergy, and latex-free condoms are available.
Sterilization (permanent contraception)
How does it work?
Sterilization is intended to be permanent. For women, it usually involves blocking or removing the fallopian tubes. For men, a vasectomy prevents sperm from entering the semen.
Who is it for?
Sterilization may suit individuals or couples who are certain they don’t want future pregnancies, such as those who have completed their families or want to avoid long-term contraception.
Benefits
Highly effective, permanent contraception
No ongoing need for contraception
Female sterilization doesn’t directly affect the ovaries’ hormone production
Vasectomy is generally less invasive than female sterilization
Side effects and risks
Sterilization should be considered permanent, as reversal isn’t always possible or successful. Female sterilization involves surgery with associated risks, while vasectomy is usually done under local anesthesia. Sterilization does not protect against sexually transmitted infections.
Contraception at different stages of life
Teenagers and young women
When choosing contraception as a young woman, think beyond pregnancy prevention: period symptoms, how easy the method is to use, and privacy all matter. Implants and IUDs are particularly effective because they don’t depend on daily use. If you have acne, irregular bleeding or painful periods, combined contraception, a hormonal IUD or some progestogen-only methods can also help with symptoms.
Is severe period pain normal? Not necessarily. Period pain that keeps you from school, social activities or everyday life shouldn’t automatically be considered normal. If it persists, it may need to be checked for conditions such as endometriosis.
Use condoms as well, since they are the only method that protects against sexually transmitted infections.
Women with endometriosis
Hormonal contraception is often an important part of managing endometriosis. The aim goes beyond preventing pregnancy: to reduce bleeding, dampen hormonal fluctuations where appropriate, and relieve pain. Continuous combined contraception, progestogen-based methods and the hormonal IUD are commonly used. A copper IUD may be less suitable if heavy or painful periods are already an issue.
Hormonal contraception can reduce symptoms, but it does not cure endometriosis.
After childbirth and while breastfeeding
Breastfeeding does not always prevent pregnancy, and ovulation may return before the first menstrual period after childbirth. Choosing appropriate contraception is therefore important, even if menstruation has not resumed. Progestogen-only methods, including the progestogen-only pill, hormonal intrauterine device (IUD), implant, and contraceptive injection, are generally considered safe during breastfeeding and do not usually affect milk production. Copper IUDs and condoms are also suitable options. Combined hormonal contraceptives containing estrogen are generally avoided during the first weeks after delivery because of the increased risk of blood clots and possible effects on milk supply. Exclusive or nearly exclusive breastfeeding can provide effective contraception through the lactational amenorrhea method, but only during the first six months after childbirth, provided menstruation has not returned and breastfeeding remains frequent, including at night.
Women approaching menopause
Can you get pregnant during perimenopause? Yes. Pregnancy is still possible even when your cycles become irregular, so you may need contraception well into your late reproductive years.
A hormonal IUD gives reliable contraception and can reduce heavy or unpredictable bleeding. For healthy women without contraindications, combined contraception may help regulate bleeding and ease some perimenopause symptoms. Progestogen-only methods may be a better choice if cardiovascular risk factors rule out estrogen.
Does HRT work as contraception? No. Menopausal hormone therapy does not prevent pregnancy.
New, unusually heavy or persistent abnormal bleeding should be checked by a doctor, rather than assumed to be hormonal changes.
When can I stop using contraception?
Although fertility declines significantly with age, pregnancy is still possible during perimenopause, even when menstrual periods become irregular or infrequent. Contraception is therefore recommended until menopause has been established or pregnancy is no longer considered a realistic possibility. Women who are not using hormonal contraception can generally stop contraception one year after their last natural menstrual period if they are aged 50 or older, or two years after their last period if they are younger than 50. For women using hormonal contraception, determining menopause can be more difficult because these methods may alter or completely stop menstrual bleeding. In most cases, contraception can safely be discontinued at age 55, when spontaneous pregnancy is exceptionally rare.
→ [Read more: HRT for menopause]
This article is general information and not a substitute for medical advice. Talk to your doctor about whether hormone therapy is right for you.
FAQ – Contraception
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IUDs and the implant are among the most effective reversible methods because they don’t depend on daily use. Sterilization is a highly effective permanent option.
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The copper IUD, condoms and sterilization are hormone-free.
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The hormonal IUD, the injection, some mini-pills and continuous use of combined contraception can lead to very light periods or none at all.
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Implants and IUDs are particularly effective because they don’t depend on daily use, but the best choice also depends on period symptoms and personal preferences.
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Continuous combined contraception, progestogen-based methods and the hormonal IUD are commonly used. They can reduce symptoms but don’t cure endometriosis.
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Progestogen-only methods such as the mini-pill can be used while breastfeeding. [Fagperson bør utvide svaret]
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Yes. Pregnancy is still possible even when periods become irregular.
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Only condoms reduce the risk of sexually transmitted infections.