Choosing contraception: how to pick the right method for you

I am the Prescriptsy editorial team, and contraception is one of the consultations I genuinely enjoy, partly because it involves choice rather than disease, and partly because a good ten minute conversation can shape a patient's next five years.

The UK offers one of the widest publicly funded menus of contraception in Europe, all free on the NHS, and yet most women I see are not using the method that suits them best.

Usually that is because nobody explained the full menu.

This guide walks through every option available in the UK in 2026, with honest comments about what each method is actually like to use, so that you can walk into your GP or sexual health clinic appointment knowing what you want to ask for.

How I frame the choice in clinic

I start with three questions. How important is it that this pregnancy does not happen. How comfortable are you with daily routines. And what would you like your periods to do. The answers already narrow the menu. A woman who says she cannot tolerate another unplanned pregnancy and forgets pills regularly is pointed towards long-acting reversible contraception. A woman who wants monthly bleeds and predictability is pointed towards a combined method. A breastfeeding mother gets progestogen-only options. Everyone should know, before they leave the room, that the NHS overview of contraception sets all of this out clearly in writing.

The combined oral contraceptive pill

The combined pill contains an oestrogen and a progestogen.

It is taken daily for 21 days followed by a seven day break, or continuously without a break in the newer tailored regimens.

Typical use efficacy is around 91 per cent, perfect use over 99 per cent.

The three most commonly prescribed UK brands are:

• Microgynon 30, a levonorgestrel combined pill that has been the NHS workhorse for decades. Reliable, cheap, well tolerated by most.
• Rigevidon, essentially the same hormone profile as Microgynon 30 at a different price point.
• Yasmin, which contains drospirenone and tends to cause less fluid retention and less acne in patients who struggle with those issues on levonorgestrel pills.

Who should not use the combined pill

The absolute contraindications are important. Migraine with aura, known thrombophilia, past venous thromboembolism, current breast cancer, uncontrolled hypertension, smokers aged over 35, and the first six weeks postpartum are all reasons to avoid combined hormones. The Faculty of Sexual and Reproductive Healthcare UKMEC criteria guide the nuance, and the BNF at bnf.nice.org.uk summarises prescribing safely.

What combined pills do to periods

Periods on the combined pill are usually lighter, shorter and more predictable. Period pain often improves. Acne improves on drospirenone and oestrogen-dominant formulations.

Premenstrual symptoms can ease, though occasionally worsen.

Tailored continuous use, taking three packs back to back and then a four day break, is an entirely reasonable NHS option that fewer women are offered than should be.

The progestogen-only pill (mini-pill)

Progestogen-only pills contain a single hormone, usually desogestrel in the UK. The most commonly prescribed is Cerazette. It is a useful option for breastfeeding mothers, women over 35 who smoke, women with migraine, and women who cannot take oestrogen for any reason.

Efficacy with desogestrel pills is similar to the combined pill, around 91 per cent typical use.

The main drawback is bleeding patterns: around one in five women get frequent spotting, one in five get amenorrhoea, and the rest sit somewhere in between.

I tell patients to give it three months before judging.

The contraceptive patch

Evra patches deliver a combined hormone dose through the skin. You apply a new patch every week for three weeks then have a patch-free week. The efficacy is similar to the combined pill, and in patients who struggle to remember a daily tablet the weekly cadence is much more forgiving.

Practical points I cover:

• Rotate application sites between buttock, upper outer arm, abdomen and upper back to reduce skin irritation.
• Efficacy is lower in women over 90 kg. Consider an alternative if you are above that threshold.
• Patch can be worn in the shower, bath and pool. Check the edges after heavy exercise.

The vaginal ring

NuvaRing is a soft plastic ring inserted for three weeks then removed for a one week break.

Hormone delivery is very stable, breakthrough bleeding rates are low, and many women prefer not having to remember anything daily.

It is less commonly offered in NHS clinics than it should be, partly because clinician familiarity varies.

If you like the concept of a combined hormone method but hate tablets, ask for it by name.

The contraceptive injection (Depo-Provera)

An intramuscular injection every thirteen weeks, containing medroxyprogesterone. Efficacy with perfect timing is over 99 per cent.

Roughly half of women are amenorrhoeic by a year, which many like and some do not. Weight gain of two to three kilograms is common.

Bone mineral density can decrease with prolonged use, so we review after two years.

Long-acting reversible contraception (LARC)

This is the category that I wish every patient considered seriously, because typical use efficacy is over 99 per cent and forgetting is not possible. It comprises:

The hormonal intrauterine system (IUS)

Mirena and Levosert deliver small amounts of levonorgestrel locally into the uterus. Periods usually become much lighter or stop altogether.

Fitted for five to eight years depending on device. This is my first suggestion for women with heavy periods or fibroids who also want contraception.

The copper intrauterine device (IUD)

A non-hormonal option. Contraception is achieved by copper toxicity to sperm. Periods may become heavier and more painful, which is the main drawback.

Efficacy is excellent and fitting lasts five to ten years. Useful for women who cannot or do not want to use hormones.

The implant (Nexplanon)

A matchstick-sized rod fitted under the skin of the inner upper arm, lasting three years. Efficacy is the highest of any reversible method. Bleeding patterns are unpredictable and this is the main reason for early removal.

More information on the LARC category is on patient.info which my patients find a reliable companion read.

Progestogen-only pills compared

If the combined pill is not for you, progestogen-only options include:

• Cerazette (desogestrel), the most popular UK mini-pill. 12 hour missed-pill window.
• Mercilon is technically a combined pill with a lower oestrogen dose, often chosen for women who wanted the combined pill but had headaches or breast tenderness on standard doses.

Emergency contraception

Two oral options are available free from pharmacies, sexual health clinics and most GP practices:

• Levonorgestrel 1.5 mg within 72 hours. Efficacy drops after 24 hours.
• Ulipristal acetate 30 mg within 120 hours. More effective later in the window.

The copper coil, fitted up to five days after unprotected sex or five days after the earliest estimated ovulation, is the most effective emergency contraceptive and has the advantage of becoming ongoing contraception.

Side effects I am asked about most

Weight gain

The only method with robust evidence of weight gain is the Depo-Provera injection. The combined pill, mini-pill, patch, ring, implant and IUS do not cause weight gain at population level.

Mood

Some women notice low mood on hormonal contraception. The data is mixed, and the effect is real for some individuals.

If you notice it, switch rather than push through. A levonorgestrel pill may suit where a drospirenone one does not, or vice versa.

Libido

Rare but real. I counsel patients that if libido drops noticeably, it is worth trying a different formulation or method.

Clots

Absolute risk on combined hormones is roughly five to twelve per 10,000 women per year, compared with two per 10,000 in non-users and 29 per 10,000 in pregnancy. Pregnancy remains riskier than the pill, which patients often do not realise.

Choosing by life stage

• Teens and early twenties: combined pill, implant or IUS. LARC is superb and should not be withheld on the basis of age alone.
• Breastfeeding: progestogen-only pill, implant or IUS.
• Mid-thirties onward: review cardiovascular risk. Non-smokers without migraine with aura can continue combined hormones until 50. Everyone else moves to progestogen-only or LARC.
• Perimenopause: Mirena is an excellent option, providing contraception plus endometrial protection if HRT is started.

What to ask your GP

1. Which methods would suit my medical history.
2. What bleeding pattern can I expect.
3. Can I try tailored (continuous) use of the combined pill.
4. Am I a candidate for LARC, and where is the nearest fitting clinic.
5. If this method does not suit me, what is the plan B.

If you feel rushed in the consultation, book a double appointment. Contraception is not a two minute prescription renewal. Our clinic pages on contraception and women's health provide further reading to prepare.

A final word on consent and agency

The right contraception is the one you will actually use, feel comfortable with, and be able to stop if it does not suit.

No method is permanent except sterilisation. Switch without embarrassment. Ask questions.

Every good GP I know would much rather spend fifteen minutes matching you to the right method than see you back six months later for an unplanned pregnancy that a different prescription would have prevented.

the Prescriptsy editorial team

Missed pills and what to do

This is the question that fills my Monday morning surgery. The rules differ by pill type.

Combined pill (Microgynon, Rigevidon, Yasmin, Mercilon)

A missed pill is one that is more than 24 hours late.

One missed pill: take it as soon as you remember, even if it means two in one day, and carry on. No extra contraception needed.

Two or more missed pills: take the most recent missed pill now, use condoms or abstain for seven days, and consider emergency contraception if you had unprotected sex in the last week.

If the missed pills are in week one, emergency contraception is particularly important. If in week three, skip the pill-free break and start the next pack straight after.

Progestogen-only pill

For desogestrel mini-pills (Cerazette), the window is 12 hours. Levonorgestrel mini-pills have a three-hour window. Outside the window, take the pill as soon as you remember and use condoms for 48 hours. Emergency contraception if unprotected intercourse in the last few days.

Switching methods without losing cover

The golden rule: no gap. Start the new method the day after the old one finishes, or overlap for seven days. Specific switches that catch people out:

• Combined pill to mini-pill: start the mini-pill the day after the last active combined pill. No break.
• Mini-pill to combined pill: start on day one of next period, or any time with condoms for seven days.
• Pill to implant or IUS: fit during the pill course, keep taking pill for seven days after fitting.
• Depo-Provera to anything: start the new method before the next injection would have been due.

A note on interactions

Enzyme-inducing medicines (certain anti-epileptics, rifampicin, some HIV therapies, St John's Wort) can reduce combined pill, mini-pill and implant efficacy. The Mirena, copper IUD and Depo-Provera are unaffected and are safer options in these patients. Broad-spectrum antibiotics (amoxicillin, doxycycline) do not reduce pill efficacy, an old myth I still have to undo weekly.

Post-partum planning

The NHS standard is to discuss contraception before discharge, again at the six-week check and again at the baby's eight-week immunisations.

Non-hormonal and progestogen-only methods are safe from day 21. Combined methods are generally delayed to six weeks if not breastfeeding and to six months if breastfeeding.

LARC fitted within 48 hours or at the six-week check has the highest continuation rate.