Contraception: options and overview
Contraception is used to help prevent pregnancy. There are lots of different options, and the 'best' one depends on your body, your health, your relationships, your periods, your preferences, and what feels manageable for you.
Contraception may be worth thinking about if sperm could get near a vagina or vulva. This includes penis-in-vagina sex, genital rubbing, or if semen gets onto fingers or sex toys that then go near the vagina.
Condoms are the only contraception method in this list that also helps protect against most sexually transmissable infections, also called STIs. For stronger protection against both pregnancy and STIs, many people use condoms plus another contraception method, such as the pill, implant or IUD.
You can talk to a nurse, doctor, school nurse or Sexual Wellbeing Aotearoa about contraception. Some hormonal contraception can also be used for period management. In Aotearoa New Zealand, contraception and sexual health visits are confidential, unless someone is worried that you or someone else is at serious risk of harm. Sexual Wellbeing Aotearoa appointments are currently free for New Zealand residents under 22 years old.
There are various contraception methods available to prevent pregnancy. Here's a brief overview of some common options we have in Aotearoa New Zealand.
Long-acting reversible contraception
Long-acting reversible contraception, or LARC, working for a long time once it is inserted. You do not need to remember it every day or every time you have sex. These methods are sometimes called 'fit and forget' contraception.
LARC methods are among the most effective options for preventing pregnancy. They are reversible, which means they can be removed if you want to stop using them or if you want to become pregnant.
Jadelle is an implant made of two small rods placed under the skin of the upper arm by a trained clinician.
It contains progestogen and can prevent pregnancy for up to 5 years. It mainly works by thickening cervical mucus so sperm cannot easily reach an egg. For most people, it also stops ovulation.
Jadelle is highly effective and long-lasting. It can be removed earlier if you want it taken out.
Possible side effects include irregular bleeding, spotting, lighter bleeding, longer bleeding, or no bleeding. Some people also notice headaches, acne, mood changes, breast tenderness or changes in libido.
Jadelle does not protect against STIs, so condoms are still useful for STI protection.
A copper IUD is a small device placed inside the uterus by a trained clinician. It does not contain hormones.
It can prevent pregnancy for 5 to 10 years, depending on the type. It can also be used as emergency contraception if inserted within 5 days of unprotected sex.
The copper IUD may be a good option for people who want long-acting contraception without hormones.
Possible side effects include heavier, longer or more painful periods, especially in the first few months.
The copper IUD does not protect against STIs.
A hormonal IUD is a small T-shaped device placed inside the uterus by a trained clinician. It slowly releases a small amount of progestogen.
Mirena can be used for contraception for up to 8 years. Jaydess can be used for contraception for up to 3 years.
Hormonal IUDs mainly work by thickening cervical mucus and thinning the lining of the uterus. Some people continue to ovulate while using them.
Hormonal IUDs can make periods lighter, shorter, less painful or stop altogether. Mirena can also be used to treat heavy menstrual bleeding and as part of endometrial protection for some people using menopausal hormone therapy, but the replacement timing may be different depending on why it is being used.
Possible side effects include irregular bleeding or spotting in the first few months. Some people may notice hormonal side effects such as acne, breast tenderness, headaches or mood changes, although many people have few side effects because the hormone mostly acts locally in the uterus.
Hormonal IUDs do not protect against STIs.
Pills
The combined oral contraceptive pill, often called “the pill”, contains two hormones: oestrogen and progestogen.
It is taken every day and mainly works by stopping ovulation. It also thickens cervical mucus and changes the lining of the uterus.
The combined pill can help with period pain, heavy bleeding, acne, premenstrual symptoms and cycle control. Some people take it in a way that reduces how often they bleed.
Possible side effects include nausea, headaches, breast tenderness, mood changes, spotting or changes to bleeding. These often settle after the first few months.
There are different types of combined pill. If one does not suit you, another type may be better.
The combined pill is safe for many people, but it is not right for everyone. A clinician will ask about migraines, blood pressure, smoking, medicines, personal or family history of blood clots, and other health conditions. This is because the combined pill slightly increases the risk of blood clots, stroke and heart attack, especially in people with certain risk factors.
The combined pill does not protect against STIs.
The progestogen-only pill, sometimes called the mini pill, contains progestogen only. It does not contain oestrogen.
It may be suitable for people who cannot take oestrogen, including some people with migraine with aura, some people who are breastfeeding, and some people with risk factors that make the combined pill unsuitable.
Different progestogen-only pills work slightly differently. Some mainly thicken cervical mucus. Some also stop ovulation. Some need to be taken within 3 hours of the same time each day, while others have a 12-hour window. A clinician or pharmacist can explain which type you have.
Possible side effects include irregular bleeding, spotting, lighter bleeding or no bleeding. Some people may notice headaches, breast tenderness, acne or mood changes.
The progestogen-only pill does not protect against STIs.
Injection
Depo-Provera is a progestogen injection. It is given every 13 weeks.
It prevents pregnancy by stopping ovulation and changing cervical mucus. It is useful for people who do not want to remember a pill every day.
Possible side effects include irregular bleeding, lighter bleeding or no bleeding. Some people notice weight change, mood changes, headaches, acne, reduced libido or delayed return of fertility after stopping. Periods and fertility can take several months to return after the last injection, although this varies.
Depo-Provera does not protect against STIs.
Condoms
Condoms help prevent pregnancy by stopping sperm from entering the vagina. They also help reduce the risk of STIs.
External condoms are worn over a penis. Internal condoms are worn inside the vagina or anus.
Condoms need to be used before any genital contact where sperm or sexual fluids could get near the vagina, vulva, anus or mouth. For pregnancy prevention, this means no penis or sexual fluids near the vulva or vagina until the condom is on.
Condoms are single-use only. Use a new condom every time.
Condoms work best when they are used correctly every time. They can be used with another contraception method, such as the pill, implant or IUD, for stronger pregnancy protection.
Tips:
- Check the expiry date
- Open the packet carefully
- Pinch the tip of an external condom before rolling it on
- Use water-based or silicone-based lubricant to reduce friction and reduce the chance of the condom breaking
- Do not use two condoms at once, as this can make them more likely to break
- Use a new condom if changing between anal, vaginal or oral sex.
Other options
Fertility awareness means tracking your menstrual cycle to work out when pregnancy is more or less likely. This might include tracking periods, cervical mucus, body temperature and other cycle signs.
This method requires education, daily tracking and a good understanding of your cycle. It can be difficult to use if your periods are irregular, if you have recently been pregnant, if you are breastfeeding, if you are close to menopause, or if your routine changes often.
Fertility awareness does not protect against STIs.
Lactational amenorrhoea method, or LAM, is using breastfeeding as contraception after giving birth.
LAM can only be relied on when all of these apply:
- the baby is less than 6 months old
- periods have not returned
- the baby is fully or nearly fully breastfed, day and night, without long gaps between feeds
- If any of these change, pregnancy can become possible again and another contraception method should be used.
LAM does not protect against STIs. It is a good idea to talk with your midwife, nurse or doctor about contraception after birth, especially before sex starts again.
Permanent contraception
Vasectomy is a procedure for people with sperm-producing testes. It stops sperm from being part of the semen.
Vasectomy is intended to be permanent. It is usually simpler, safer and cheaper than tubal ligation, but it does not work immediately. Another contraception method is needed until follow-up testing confirms there is no sperm in the semen.
Vasectomy does not protect against STIs.
Tubal ligation, sometimes called “having your tubes tied”, is a surgical procedure for people with fallopian tubes. The tubes are cut, tied, blocked or removed so sperm and egg cannot meet.
Tubal ligation is intended to be permanent and can be difficult or impossible to reverse. It is very effective but not 100% effective.
Tubal ligation does not protect against STIs.
Choosing what is right for you
There is no single best contraception method for everyone. A good method is one that suits your body, health, relationships, values, period pattern and daily life.
When choosing contraception, it can help to think about:
- How important is it that the method is very effective?
- Do I want something I do not have to remember every day?
- Do I want hormones or no hormones?
- Do I want lighter periods, fewer periods or no periods?
- Do I need STI protection?
- Do I want something I can stop quickly?
- Am I taking any medicines or supplements that could affect contraception?
- Do I want to become pregnant soon, later, or not at all?
You can talk with a doctor, nurse, pharmacist, school nurse, midwife or Sexual Wellbeing Aotearoa clinic. You deserve clear information, privacy, and support to choose the option that feels right for you.