Contraception

Introduction

Photo of a couple in the park
PantherMedia / Benis Arapovic

Various forms of contraception are available for people who don’t want to get pregnant. Condoms and birth control pills are the most commonly used contraceptives.

But there are many other forms of contraception, including coils, the vaginal ring and the contraceptive skin patch. Each of these has its own pros and cons. For example, hormonal contraceptives are very reliable, but also have various side effects. Condoms are the only contraceptives that also offer protection from sexually transmitted diseases (STDs).

A woman’s choice of contraception will mainly depend on how reliable it is, how easy it is to use, and how well tolerated it is. Her personal preferences and needs will play an important role in the decision too.

Fertilization and pregnancy

Women can get pregnant around the time a mature egg cell has left their ovary. The moment the egg cell leaves the ovary is called ovulation. The egg cell moves along the fallopian tube and into the womb. If sperm cells manage to get through the cervix and womb, and into the fallopian tube, the egg cell may become fertilized. If a sperm cell meets the egg cell, they join together. Women become pregnant if the fertilized egg cell becomes embedded (implanted) in the lining of the womb.

Girls can become pregnant as soon as they start ovulating – in other words, when they start getting periods. Boys can already have fertile sperm cells as soon as they start ejaculating.

Different contraceptives prevent fertilization or implantation in different ways: Some, such as condoms or diaphragms, prevent sperm cells from getting into the womb through the cervix. These are collectively known as "barrier methods." The coil prevents fertilized egg cells from becoming embedded in the womb. Most hormonal contraceptives influence the monthly cycle and prevent ovulation.

Hormonal contraception

Many of the various hormonal contraceptives contain a combination of that prevent ovulation, thereby preventing egg cells from being fertilized. All hormonal contraceptives have to be prescribed by a doctor. The most commonly used hormonal contraceptives are:

  • Birth control pills ("the pill"): These pills contain estrogen and progestin, and are taken on 21 or 22 days per cycle. The woman then has a period in the week when she doesn't take the pill. Some women use a "mini pill" instead, for example because they don't tolerate the combined pill well. Mini pills only contain progestin, not estrogen.
  • The contraceptive skin patch: Contraceptive skin patches are placed on the body, where they release a combination of estrogen and progestin. The patch is changed once a week in the first three weeks of the menstrual cycle. No patch is worn during the fourth week.
  • Vaginal ring: Vaginal rings also contain a combination of that enter the bloodstream through the wall of the vagina. They are inserted deep into the vagina and taken out again after 21 days, using a finger. The woman then has a period in the week that follows. Women usually can't feel the vaginal ring inside them.
  • Hormone-releasing contraceptive coils (IUDs or IUSs): Hormone-releasing coils contain a hormone called levonorgestrel. They are inserted into the womb by a doctor or nurse. The hormone is continuously released by the coil and absorbed by the lining of the womb. This prevents the implantation of any fertilized eggs. The coil has a contraceptive effect as soon as it is in place, and can stay in the womb for up to five years.

Other, less common, hormonal contraceptives include the three-month injection and the hormonal birth control implant.  In both cases, you can't simply stop using them. The three-month injection contains a high dose of and often causes side effects. These two forms of contraception are usually only recommended for women who cannot tolerate other contraceptives or can't use them regularly.

When used properly, hormonal contraceptives are very reliable. They can also relieve period pain and reduce menstrual bleeding.

The disadvantages of include possible side effects such as sore breasts, headaches and nausea. There is also a risk of blood clots developing (thrombosis). According to research, hormonal contraceptives are not likely to lead to weight gain.

Non-hormonal contraception

Non-hormonal contraceptives have fewer or no side effects, but are considered to be less reliable than hormonal contraceptives. In many cases, though, the reliability of a contraceptive will mainly depend on whether it is used properly. Commonly used non-hormonal contraceptives include:

  • Condoms for men: Condoms not only prevent unwanted pregnancies – they also prevent the spread of sexually transmitted infections or diseases such as HPV, HIV, hepatitis C, gonorrhea and syphilis. They offer reliable protection if used properly. The most common mistakes include using the wrong size, damaging the condom when taking it out of the packet, and pulling it on rather than rolling it down the penis. Condoms shouldn't be used together with greasy or oily substances such as lubricants. Doing so could weaken and damage them.
  • Female condoms: These "internal" condoms are covered with a lubricant before use and placed inside the vagina. When used properly, they are as reliable as normal condoms are. A lot of women find it difficult to use them.
  • Copper coils or the copper "chain": These contraceptives are inserted into the womb by a doctor or nurse. Copper makes it harder for the egg to be fertilized and become embedded in the lining of the womb: It changes the mucus in the cervix and womb, and also reduces the mobility of the sperm. Both the coil and the "chain" (a frameless copper IUD) are considered to be reliable forms of contraception, and can remain in the womb for about five years. The possible side effects include heavier periods and pelvic infections.
  • Diaphragms: These soft silicone cups with a flexible outer ring are inserted into the vagina to completely cover the cervix (the opening of the womb). A gel containing a sperm-killing agent (a spermicide) is applied to the diaphragm beforehand. The diaphragm is inserted into the vagina before having sex, and must be left in place for at least six hours afterwards. Like other forms of contraception, diaphragms are only reliable if they are used properly. The gynecologist will determine the correct size of diaphragm.
  • Chemical contraceptives like creams, gels or suppositories are put inside the vagina before having sex. The woman's body heat makes them runnier, and a thick, sticky barrier forms in front of the opening of the womb, stopping sperm cells from entering. A lot of chemical contraceptives also contain sperm-killing agents (spermicides). Because chemical contraceptives are quite unreliable, they should only be used together with other forms of contraception.
  • Natural birth control methods: These methods are used to determine when a woman is fertile based on her body temperature in the morning, as well as on her vaginal discharge. They aren't very reliable, and require a lot of effort and discipline. Other forms of contraception, such as condoms, must be used on the days when she is fertile.

You can get more information about the different kinds of contraceptives from your doctor or women’s health center.

Beckermann MJ, Perl FM (Ed). Frauen-Heilkunde und Geburtshilfe. Basel: Schwabe; 2004.

Bundeszentrale für gesundheitliche Aufklärung (BzgA). Sichergehn. Für sie und ihn. Cologne, 2016.

Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM). Rote-Hand-Brief zu kombinierten hormonalen Kontrazeptiva, einschließlich Informationsmaterialien: Risiko von venösen Thromboembolien. February 03, 2014.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Print page

Updated on June 29, 2017
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.