Contraception methods the NHS lists compared

Which contraception methods does the NHS list?

The NHS contraception guide groups the methods it lists in several ways. These are hormonal methods, copper coils, barrier methods, emergency contraception and permanent options. The hormonal methods are the combined pill, the progestogen-only pill (or mini pill), the patch, the vaginal ring, the implant, the injection and the IUS, which is a hormonal coil. The IUD, or copper coil, contains no hormones. The barrier methods are condoms, internal (female) condoms, the diaphragm and the cap. Female sterilisation and vasectomy are the permanent methods. The NHS also covers natural family planning. The NHS says contraception is free.

How do the pill, patch, ring and injection work?

The combined pill contains two hormones, progestogen and oestrogen. The patch and the vaginal ring release both of these hormones too. NHS 111 Wales says the combined pill works by stopping the ovaries from releasing an egg each month. The NHS describes the patch as stopping ovulation, thickening the mucus at the neck of the womb and thinning the lining of the womb. The NHS says the progestogen-only pill works by thickening the mucus at the neck of the womb, which blocks sperm. The contraceptive injection also thickens this mucus and thins the womb lining. NHS 111 Wales says fertility usually returns to previous levels about a month after the combined pill is stopped. The NHS says the injection lasts for 8 or 13 weeks, depending on which injection is used.

Which methods last the longest?

NICE calls the injection, IUD, IUS and implant long-acting reversible contraception. It says these methods, unlike the pill or condoms, do not need attention every day or each time someone has sex. The NHS says the copper coil lasts 5 or 10 years, depending on the type. NICE public information gave the implant as lasting 3 years, but more recent NHS material lists it as 5 years, so older figures can be out of date. The injection works for a much shorter time, in weeks rather than years. The NHS says fertility returns quickly after the implant or the copper coil is removed. After the contraceptive injection wears off, the NHS says it can take up to a year for fertility to return to normal. The NHS says the copper coil, the IUS and the implant are over 99% effective in typical use, compared with 94% for the injection and 91% for the pill, patch and ring.

How do barrier methods differ, and which protect against infections?

Barrier methods put a physical barrier between sperm and egg. Examples include condoms, internal condoms, caps and diaphragms. Condoms help prevent pregnancy and sexually transmitted infections, or STIs. The NHS describes both male condoms and internal (female) condoms as helping to prevent pregnancy and STIs. Of the methods on the NHS list, only condoms are described as protecting against STIs. NHS-linked sources say the pill, patch and ring do not protect against STIs. The NHS table gives typical-use effectiveness as 82% for male condoms and 79% for internal condoms, and lists it as unknown for diaphragms and caps.

What is emergency contraception?

Emergency contraception is used after sex to help prevent pregnancy. The NHS lists emergency pills and the copper IUD as the options. There are two main emergency pills in the UK, and each works within a set time after sex. NHS sexual health services give the limit as 3 days for the levonorgestrel pill and 5 days for the ulipristal pill. A copper IUD can also be fitted as emergency contraception, and one NHS source says this works within 5 days of sex. A trained nurse or doctor must fit the IUD. The same source says it can stay in place as ongoing contraception. The oral emergency pill is also available through the NHS Pharmacy Contraception Service in England, which is described below.

What are the permanent methods?

The NHS lists female sterilisation and vasectomy as permanent methods. It says sterilisation lasts forever, and reversal is not usually available on the NHS. An NHS-affiliated source describes a vasectomy as a small operation to cut or tie the tube that carries sperm from the testicles to the penis. NHS Wales says that in most parts of the UK a vasectomy is free from the NHS, although waiting lists can be several months depending on where someone lives. The NHS also notes that reversals are rarely funded by the NHS.

Where can someone get contraception for free?

Contraception is free on the NHS. It is available from sexual health clinics, some GP surgeries, some young people's services and most pharmacies. Sexual health clinics are also called family planning or contraception clinics. Under the NHS Pharmacy Contraception Service in England, a person does not need to be registered with a GP. The service covers the oral contraceptive pill, including starting it for the first time, and oral emergency contraception. People can refer themselves, or be signposted by a GP or sexual health clinic. A pharmacist or pharmacy technician offers a confidential consultation. Supplies through this route are free and exempt from prescription charges. The NHS website has a pharmacy search function. NHS inform Scotland and NHS 111 Wales publish their own contraception pages for those nations.