Contraception: how do you choose the method that fits you?

Hormonal contraceptives use synthetic hormones (estrogens, progestins, or both). They prevent ovulation, thicken the cervical mucus (which blocks sperm), or change the lining of the uterus.

The combined pill is still the best-known method in France, used by 36.5% of women on contraception in 2016 ^[1]. About 99.7% effective in theory, it drops to roughly 91% with typical use, mostly from missed pills ^[2]. The progestin-only pill, without estrogen, suits women with contraindications (thrombosis, migraines with aura, smoking after age 35) ^[3].

Other forms avoid the daily tablet:

• the patch (changed weekly) and the vaginal ring (worn for 3 weeks) ^[2]
• the injection of a progestin, every 3 months ^[2]
• the implant (a soft rod under the skin of the arm), over 99.9% effective for 3 years ^[4]

The copper IUD (the "coil") is a small T-shaped device placed in the uterus by a professional. Copper makes the environment hostile to sperm, without touching your hormones ^[5]. Over 99% effective, it lasts 5 to 10 years ^[5].

Contrary to a 1970s myth, it also suits women who've never had children: short models exist, and both the WHO and French health authorities recommend it for everyone ^{[5] [2]}.

The condom, external or internal, is the only method that also protects against sexually transmitted infections (STIs). Its typical contraceptive effectiveness is about 82% (external) and 79% (internal) ^[2]. The diaphragm, a silicone cup used with a spermicidal gel, is an on-demand hormone-free option ^[2].

The symptothermal method tracks your waking temperature and cervical mucus each day to spot fertile days ^[6]. Well learned, it reached 98% in the key study, but falls to around 88 to 92% with typical use ^[6]. It needs real training and regular cycles, not just an app.

A missed pill, a torn condom, unprotected sex: it can happen to anyone. Using it is nothing to be ashamed of. In France, 6.2% of women aged 15 to 49 have used it at least once within a year ^[7].

Three options exist:

• levonorgestrel, effective up to 72 hours, best within the first 24 ^[8]
• ulipristal acetate, active up to 120 hours (5 days) and more effective across that window ^[8]
• the copper IUD, placed within 5 days: the most effective option, over 99% ^[5]

These pills work by delaying or blocking ovulation. They don't end an already established pregnancy: the WHO and FIGO classify them as contraception, not abortion ^{[8] [9]}. The sooner they're taken, the better they work. In France, they're available without a prescription and fully covered.

No method is better in absolute terms, only the one that fits you. Long-acting methods (IUD, implant) are the most reliable, because they don't depend on a daily step ^[2]. Your own experience (bleeding, mood, libido) matters as much as the statistics and deserves to be discussed ^[3].

Estrogens aren't recommended with a history of thrombosis, migraines with aura, or smoking after age 35 ^{[2] [3]}. Two myths fall away: the pill doesn't cause significant weight gain (a Cochrane review of 49 trials) ^[15], and no "break" is useful, it even raises the risk of pregnancy ^{[12] [13]}. Fertility returns fast, within 1 to 3 cycles on average ^[16].

With endometriosis, which affects about 1 in 10 women (nearly 190 million women and girls) ^[11], some methods play a dual role. The continuous pill or dienogest slow the lesions and ease pain ^{[12] [14]}. Discuss this with a specialist, without sacrificing your contraceptive needs.