Choosing the right contraception is one of the most personal decisions you will make about your health. Whether you are spacing pregnancies, finished building your family, or not ready to start one yet, effective birth control is essential for taking control of your reproductive health.

With over 30 years of experience counseling women on contraception, my aim is to help you understand all your options so you can choose what best fits your lifestyle, health, and future goals.

Why Family Planning Matters

Personal Benefits

• Choose when and if to have children
• Space pregnancies for optimal health
• Complete education and career goals
• Achieve financial stability
• Maintain relationship quality
• Preserve your health between pregnancies

Health Benefits

• Reduce maternal mortality
• Prevent unintended pregnancies
• Allow adequate recovery time between pregnancies
• Manage health conditions before pregnancy
• Reduce MTP rates

Family Benefits

• Plan family size
• Provide better time and resources for each child
• Improve children’s health outcomes
• Strengthen parental relationships

Understanding Contraceptive Effectiveness

Perfect Use vs Typical Use

• Perfect use: How effective a method is when used exactly as directed every single time
• Typical use: How effective it is in real life, where missed pills, delays, or mistakes can occur

Methods that require daily or frequent action (like pills) often have a bigger gap between perfect and typical use. Methods that you can “set and forget” (like IUDs and implants) tend to maintain high effectiveness in typical use.

Below, effectiveness figures refer to typical use unless otherwise mentioned.

Barrier Methods

1. Male Condoms

Effectiveness: About 87 percent with typical use

How it works
A latex or polyurethane sheath is rolled over the erect penis before intercourse to prevent sperm from entering the vagina.

Pros

• Easily available without prescription
• Inexpensive
• Protects against sexually transmitted infections (STIs) and HIV
• Hormone-free
• Minimal side effects (except in latex allergy)

Cons

• Must be used correctly every time
• Can break or slip
• Some men may feel reduced sensation
• Requires stopping to put it on

Best for
New relationships, when STI protection is needed, or when a hormone-free method is preferred.

2. Diaphragm with Spermicide

Effectiveness: About 83 percent with typical use

How it works
A silicone dome is inserted into the vagina to cover the cervix, used with spermicide to immobilize or kill sperm.

Pros

• Can be inserted up to 2 hours before intercourse
• Reusable
• No hormones
• Controlled by the woman

Cons

• Requires fitting by a doctor
• Must be left in place for at least 6 hours after intercourse
• Increased risk of urinary tract infection
• Does not protect against STIs

Hormonal Methods

1. Combined Oral Contraceptive Pills (The Pill)

Effectiveness: Around 93 percent typical use, up to 99 percent with perfect use

How it works
Contains estrogen and progestin. Prevents ovulation and thickens cervical mucus. Taken once daily.

Pros

• Highly effective when taken correctly
• Regulates periods
• Reduces menstrual cramps and premenstrual symptoms
• Lighter periods
• Can improve acne
• Reduces risk of ovarian and endometrial cancers
• Fertility returns quickly after stopping

Cons

• Must remember to take it every day
• May cause nausea initially
• Possible mood changes or breast tenderness
• Not suitable for smokers over 35
• Does not protect against STIs
• Slight increase in blood clot risk (rare)

Who should avoid combined pills

• Smokers over age 35
• Women with history of blood clots
• Certain heart conditions
• Migraine with aura
• History of breast cancer

2. Progestin-Only Pill (Mini-Pill)

Effectiveness: About 93 percent typical use

How it works
Contains only progestin. Thickens cervical mucus and sometimes suppresses ovulation. Must be taken at the same time every day.

Pros

• Safe during breastfeeding
• Suitable for women who cannot take estrogen
• Fewer estrogen-related side effects
• Can be used by smokers

Cons

• Very time-sensitive; must be taken at the same time daily
• Irregular bleeding is common
• Less forgiving of missed pills

Best for
Breastfeeding women and those with contraindications to estrogen.

3. Contraceptive Injection (Depo-Provera)

Effectiveness: About 96 percent typical use

How it works
A progestin injection is given every 3 months, preventing ovulation and thickening cervical mucus.

Pros

• Very effective
• Private and discreet
• Only needs attention 4 times a year
• Reduces menstrual cramps
• Many women eventually stop having periods

Cons

• Requires clinic visit every 3 months
• Can cause weight gain in some women
• Irregular bleeding initially
• Delay in return of fertility (can take up to 18 months)
• Can temporarily reduce bone density (reversible after stopping)

Best for
Women who want long-term but reversible contraception without daily pills or a permanent method.

Long-Acting Reversible Contraception (LARC)

1. Copper IUD (Non-Hormonal)

Effectiveness: About 99.2 percent

How it works
A small T-shaped copper device is inserted into the uterus. Copper creates an environment toxic to sperm, preventing fertilization.

Pros

• One of the most effective reversible methods
• Lasts 10 to 12 years
• Hormone-free
• Fertility returns immediately after removal
• No need to remember anything daily
• Can be used as emergency contraception if inserted within 5 days of unprotected sex

Cons

• Heavier, longer, or more painful periods initially
• Insertion can be uncomfortable
• Small risk of expulsion
• Does not protect against STIs
• Very rare risk of perforation of the uterus during insertion

Best for
Women wanting highly effective, long-term, hormone-free contraception.

2. Hormonal IUD (Mirena, Skyla, Kyleena, etc.)

Effectiveness: About 99.8 percent

How it works
A T-shaped device placed in the uterus releases a low dose of progestin locally.

Pros

• Among the most effective reversible methods
• Lasts 3 to 7 years depending on the type
• Periods usually become lighter; some women stop having periods
• Reduces menstrual cramps
• Hormone mostly stays local with lower systemic levels
• Fertility returns quickly after removal
• No daily action required

Cons

• Irregular bleeding in the first 3 to 6 months
• Insertion discomfort
• Small risk of expulsion
• May rarely cause acne or mood changes
• Does not protect against STIs

Best for
Women seeking long-term, highly effective contraception and lighter periods.

3. Contraceptive Implant (Nexplanon)

Effectiveness: About 99.9 percent

How it works
A small, matchstick-sized rod is inserted under the skin of the upper arm, releasing progestin continuously.

Pros

• One of the most effective methods available
• Lasts up to 3 years
• Reversible with rapid return of fertility
• No user error (once inserted, nothing to remember)
• Some women have lighter or no periods

Cons

• Requires minor procedure for insertion and removal
• May cause irregular bleeding
• Can be felt under the skin
• Possible side effects: weight gain, headaches, mood changes
• Does not protect against STIs

Best for
Women who want the most effective temporary method and minimal maintenance.

Permanent Methods

1. Female Sterilization (Tubal Ligation)

Effectiveness: Around 99.5 percent

How it works
Fallopian tubes are blocked or removed surgically, preventing sperm from reaching the egg.

Pros

• Permanent
• Very effective
• No ongoing cost or maintenance
• Hormone-free
• Does not affect sex drive

Cons

• Requires surgery and anesthesia
• Usually irreversible
• Surgical risks such as infection or bleeding
• Higher upfront cost
• Does not protect against STIs

Best for
Women who are certain they do not want more children.

2. Male Sterilization (Vasectomy)

Effectiveness: About 99.85 percent

How it works
The tubes (vas deferens) that carry sperm are cut or sealed.

Pros

• More effective than female sterilization
• Simpler procedure than tubal ligation
• Done under local anesthesia
• Lower cost
• Quick recovery
• No hormones

Cons

• Generally permanent
• Not immediately effective (sperm remain for about 3 months)
• Small risk of complications
• Requires partner willingness

Best for
Couples who are certain they do not want (more) children.

Emergency Contraception

1. Emergency Contraceptive Pills

Levonorgestrel (Plan B type)

• Take within 72 hours of unprotected intercourse
• More effective the sooner it is taken
• Available over the counter in many places
• About 85 percent effective in preventing pregnancy

Ulipristal Acetate (Ella)

• Can be taken up to 120 hours (5 days) after unprotected sex
• More effective than levonorgestrel in the later part of this window
• Requires prescription
• Around 85 percent effective

2. Copper IUD

• Most effective method for emergency contraception (around 99 percent)
• Can be inserted up to 5 days after unprotected sex
• Provides long-term contraception once inserted

Natural Methods

1. Fertility Awareness Methods (FAM)

Effectiveness: Around 76 to 88 percent typical use

How it works
Track cycle length, basal body temperature, and cervical mucus to identify fertile days and avoid intercourse or use barriers during that time.

Pros

• No hormones or devices
• No cost
• Acceptable for many religions and cultures
• Improves understanding of your body
• Can also be used to help achieve pregnancy

Cons

• Requires dedication and daily tracking
• Requires abstinence or barriers on fertile days
• Less suitable for irregular cycles
• Higher user error
• No STI protection

Best for
Highly motivated couples with regular cycles willing to avoid sex during fertile periods.

2. Withdrawal (Pull-Out Method)

Effectiveness: About 78 percent typical use

How it works
The penis is withdrawn from the vagina before ejaculation.

Pros

• No cost
• Always available
• No hormonal side effects

Cons

• Requires high self-control and timing
• Pre-ejaculate may contain sperm
• High failure rate
• No protection from STIs

This method is generally not recommended as a primary form of contraception because of its high failure rate.

Choosing the Right Method

Ask yourself these questions:

1. How effective does it need to be

• Definitely do not want pregnancy: IUD, implant, sterilization
• Want very effective but temporary: LARC, injection, pills (if you are regular)
• Accept some risk of pregnancy: Condoms, diaphragm, FAM

2. Do you prefer hormonal or non-hormonal methods

• Prefer hormonal: Pills, injection, hormonal IUD, implant
• Want hormone-free: Copper IUD, condoms, diaphragm, FAM, sterilization

3. How often are you willing to think about contraception

• Do not want to think about it regularly: IUD, implant, sterilization
• Comfortable with periodic attention: Injection every 3 months
• Can remember daily: Pills
• Prefer using something only during intercourse: Condoms, diaphragm

4. Do you have any health conditions

• Blood clot history: Avoid estrogen-containing methods
• Heavy periods: Hormonal IUD, combined pills
• Migraine with aura: Avoid estrogen
• Breastfeeding: Progestin-only pill, IUD, implant

5. Do you need protection against STIs

• New partner or multiple partners: Condoms are essential, preferably combined with another method for better pregnancy prevention
• Monogamous relationship with both partners tested: Any effective pregnancy prevention method is acceptable

6. What is your budget

• Higher upfront but low long-term cost: IUD, implant, sterilization
• Lower upfront but ongoing monthly cost: Pills, condoms
• Check for government or family planning clinic programs for free or low-cost options.

Addressing Common Concerns

Will birth control make me gain weight
Most methods do not cause significant weight gain. The injectable contraceptive (Depo-Provera) may lead to weight gain in some women. Pills, IUDs, and implants generally are not associated with major weight gain beyond normal variation.

Will I be able to get pregnant after stopping
Yes. All methods except sterilization are reversible. Fertility usually returns quickly after stopping pills, removing IUDs or implants. After Depo-Provera, it may take up to 18 months for fertility to fully return.

Will hormones change my mood
Some women experience mood changes on hormonal contraception, while others do not. If you notice significant mood changes, we can review your method and switch if needed.

Does birth control cause cancer
Combined oral contraceptive pills actually reduce the risk of ovarian and endometrial cancers. There may be a very slight increase in breast cancer risk while taking them, which returns to normal after stopping.

Will an IUD hurt to insert
Insertion can cause discomfort similar to strong menstrual cramps, but it lasts only a few minutes. Pain relief and local anesthesia can be used. Most women feel the brief discomfort is worth the long-term benefit.

Is it safe to skip periods with birth control
Yes. Using hormonal contraception continuously to skip periods is medically safe for most women. There is no medical requirement for a monthly bleed when on hormonal contraception.

My Personalized Approach

When you come for contraceptive counseling, I will:

• Review your full medical history
• Discuss your reproductive plans and goals
• Explain all suitable options in detail
• Address your doubts and concerns
• Help you select a method that fits your body and your life
• Provide the contraception or refer you for procedures
• Follow up to make sure you are comfortable and satisfied with your choice

The best contraceptive method is the one you can use correctly and consistently.

Special Populations

Teenagers

• Long-acting reversible methods (IUD, implant) are highly effective and recommended for preventing teen pregnancies
• Confidential counseling is important
• Pills may be used if the teenager is responsible and consistent

Postpartum Women

• Many methods can be started soon after delivery
• Method choice may differ if you are breastfeeding
• Lactational amenorrhea method (LAM) is only reliable under strict conditions and for a limited time

Perimenopausal Women

• Contraception is still needed until menopause is confirmed
• Hormonal methods can help manage perimenopausal symptoms
• Non-hormonal IUD can also be a good choice

Women with PCOS

• Combined pills can help regulate cycles and reduce symptoms such as acne and excess hair
• Hormonal IUD can reduce heavy or irregular bleeding

Women with Endometriosis

• Hormonal methods, especially continuous use, often reduce pain
• Hormonal IUD is very effective in managing heavy, painful periods

Switching Methods

If you are not happy with your current method, you can always change it.
We can discuss:

• What you dislike about your current method
• What matters most to you in a new method
• Alternative options
• How to safely transition from one method to another

Final Thoughts

Choosing contraception is a personal decision that should respect your health, lifestyle, values, and future plans. There is no single “best” method for everyone, only the best method for you at a particular stage of your life.

Do not feel embarrassed to talk about contraception. As a gynecologist, this is a routine and important part of my practice, and I have counseled thousands of women over the years. Your reproductive health and family planning goals matter and deserve proper attention.

Whether you are 18 or 48, planning your first baby or avoiding a fifth, we will work together to find a contraceptive solution that suits you.

Schedule Your Contraceptive Counseling

If you are ready to discuss your contraception options, you can book a consultation.

Call: 9811078323
WhatsApp: Available for messages and appointment booking
Timings: Monday to Saturday, 10 am to 7 pm
Clinic: S-77, Greater Kailash Part 2, South Delhi

Take control of your reproductive health. You deserve contraception that truly works for you.

Dr. Deepa Dureja
MD (Obstetrics and Gynaecology)
30+ Years Experience in Family Planning and Contraceptive Counseling