What is the best contraceptive?

It all depends on your needs:

  • Are you still planning to have a baby and if yes, when?
  • Would you like to use something short-term – a few months to a year or long-term?
  • Do you have any medical problems such as diabetes, high blood pressure, immunodeficiency, epilepsy, heart disease, depression, anxiety etc.?
  • Do you take chronic medications?
  • Have you used contraceptives before and have you had any side effects?
  • How are your periods, are they regular, light or heavy, painful?
  • Do you suffer from migraines?
  • Do you have bad pre-menstrual syndrome (PMS)?
  • Do you suffer from acne and excess hair growth?
  • Do you smoke? – Stop now!
  • How old are you?

We all look different and have different hormonal sets so there is no one size fit all in contraception

For some women, their first contraceptive choice will work perfectly with minimal or no side effects and others need to go through a few different contraceptives before they find the right one.

We are fortunate to have so many choices nowadays…

IUDs or Contraceptive Loops

Click here to download Dr Novikova’s Information Sheet on IUDs

Mirena IUD (hormonal intrauterine device)

If you have heavy painful periods and you are not planning to have a baby any time soon I would say the Mirena IUD (intrauterine device) is your best option. It’s a small loop inserted into your uterus by a gynaecologist or a skilled GP in the office (or under anaesthesia if you wish so). It will last you for 5 years. You are likely to stop having periods altogether in a few months after having Mirena IUD inserted. Mirena IUD contains a small amount of levonorgestrel (progesterone type of hormone).

Only a very small amount is absorbed into circulation so systemic side-effects are very uncommon. It is a very safe and effective contraceptive and has the advantage of controlling period pain, decreasing blood loss during periods. Women with endometriosis and fibroids find Mirena effective in managing their condition. The procedure to insert it is not painful but may be uncomfortable. The main side-effect in about 10% of women is irregular bleeding or spotting. Click here to download more information on the Mirena IUD.

Kyleena IUD (hormonal intrauterine device)

Another choice of hormonal IUD is the Kyleena, which is a smaller Mirena that contains a lesser amount of progesterone (levonorgestrel). Click here to download the patient brochure on the Kyleena IUD.

Copper T

If you do not like to have any hormones in your body, your periods are not heavy or painful then Copper T  is your only choice. It is also inserted into the uterus, but your periods will be unchanged or slightly heavier. It also lasts for 5 to 8 years. Click here to download more information on the Copper T 

Pearls, Intrauterine balls

It is a copper loop, that that is less painful to insert than the Copper T and thanks to its structure it sheets into the shape of the uterus when inserted. Click here to download more information on Pearls or IUB Balls

All loops can be easily removed by a doctor. If you prefer taking tablets, there is a huge choice and you can get advice during your consultation on what you shall try. Take your pill at night to avoid nausea. Be careful and use protection if you fall sick and have diarrhoea or vomiting or you forget to take the pill or you use antibiotics as the efficacy of the pill may be altered.


There is another long-acting progesterone-only device available, which is Implanon. It’s a small rod, which is inserted into the arm. It’s a super easy procedure. It lasts 3 years. The most common issue is irregular bleeding.

Vaginal Ring (NuvaRing)

A vaginal ring (NuvaRing) is also convenient contraception. It’s a plastic ring that you insert into your vagina yourself (just like a tampon) and it stays there for 3 weeks. You remove the ring for 1 week and have your period and insert a new one a week later for another 3 weeks. The ring contains hormones like pill oestrogen and progesterone but is safer in terms of systemic effects on the body because hormones are absorbed in the vagina and they do not have to go through the liver and their levels in the blood are smaller than from the pill.

Evra Patch

Evra Patch is another option – it’s a patch you have to apply weekly for 3 weeks with also a week free interval when you get your period.

All hormonal contraceptives such as pills, rings, patches are likely to make periods less painful and less heavy.

Other Methods

Condoms, female condoms, calendar methods are all methods used by women, but they are not as effective as the above-mentioned methods of contraception.

If you want permanent contraception (such as tubal ligation or tying/cutting the tubes or Essure procedure to block the tubes) keep in mind that it’s irreversible. If you decide you would like to have a baby in the future your options will be IVF. Reversal of tubal ligation has a very poor success rate. Tubal ligation has also a failure rate of about 1 in 300.

If you are using a contraceptive now, it works for you, you have no side-effects and you are able to take it as prescribed without forgetting to keep using it.

If you have side-effects from your contraceptive, consult the gynaecologist to find a better choice for you.

Your lifestyle, diet, exercise, and sleep play the most substantial role in your weight. Taking hormonal contraceptives may influence fluid retention or your appetite, but so do hormonal changes during your menstrual cycle or pregnancy. Some of us eat more, retain more fluid, feel bloated in a week preceding our period due to high levels of progesterone. Some pills can have similar effects on some, but not all women.

However, if you live a healthy lifestyle, exercise daily, sleep well, and eat healthy these changes are likely to be mild and not relevant for your weight. Copper T is a non-hormonal contraceptive and will have no influence whatsoever on your weight, but if you suffer from bad period pain and very heavy periods it is not a good choice for you.

The use of pill increases the risk of clots four times, but the pregnancy increases this risk 20 times! However, this risk is very small, in non-users of pill it’s about 1 to 2 in10,000, in pill users 4 in 10,000 and in pregnancy, it is 20 in 10,000. The oestrogen component of the pill (ethynyl oestradiol) is responsible for the increased risk of clots. Different types of progestins are used in pills and they have different impacts on clotting.

The newer generation of oestrogen (oestradiol valerate and 17-beta oestradiol) have no or only minimal effect on clotting. Talk to your doctor about what pill to choose if you are worried about this complication or rather choose IUD or implant as they do not increase such risk.

A recently published large study, which compared 23,000 women using contraceptive pills since 1968 and 1969 to non-users of the contraceptive pills, found no difference in the incidence of any type of cancer, colon / rectal cancer, breast cancer. Cancer risk increased with age and smoking in both users and non-users of pills.

Current or recent users (less than 5 years) were at increased risk of cancer in general, breast cancer, cervical cancer, but this increased risk was not found in users of the pill for more than 5 years. This study also confirmed the decreased risk of uterine cancer and ovarian cancer in short and long term users of the pill, and the protective effect lasted for more than 35 years.