Methods by typical-use effectiveness
| Tier | Methods | Pregnancies per 100 in the first year (typical use) |
|---|---|---|
| Most effective | Implant, levonorgestrel IUD, copper IUD, sterilisation | Under 1 |
| Very effective | Injectable (DMPA), combined pill, patch, ring, progestin-only pill | 4 to 7 |
| Effective | Condoms (male 13, female 21), diaphragm, fertility awareness, withdrawal | 13 to 24 |
| No method | About 85 |
Long-acting reversible methods (LARC) are the most effective because they do not depend on daily use.
Medical eligibility (US MEC 2024 and WHO MEC)
- Category 1: no restriction. Category 2: advantages generally outweigh risks. Category 3: risks usually outweigh advantages; use only if other methods are unacceptable and with follow-up. Category 4: unacceptable risk.
- Oestrogen-containing methods are category 3 or 4 with: migraine with aura (4), smoking 15 or more a day over age 35 (4), hypertension 160/100 or more (4), a history of VTE (4), ischaemic heart disease or stroke (4), under 21 days postpartum (4), breast cancer (4), severe liver disease.
- Progestin-only methods and IUDs are category 1 or 2 in almost every condition, which is why they are the answer to most 'she cannot have oestrogen' questions.
- IUD-specific: current pelvic infection or puerperal sepsis (4 for insertion), unexplained bleeding (4 until evaluated), distorted cavity (4), cervical or endometrial cancer awaiting treatment (4 for insertion).
- The categories are looked up, not memorised: the lab holds a table of the ones a student meets.
Counselling
- Start with the patient: what matters to them (effectiveness, bleeding pattern, hormones or not, privacy, cost, return to fertility, protection from infection), then the medical eligibility, then the options that fit, most effective first.
- Explain bleeding patterns honestly: irregular bleeding with progestin-only methods, lighter or absent periods with the levonorgestrel IUD, heavier with the copper IUD.
- Quick start: most methods can begin the same day if pregnancy can be reasonably excluded, with a back-up method for 7 days (2 for the progestin-only pill).
- Condoms alongside for infection protection. Emergency contraception discussed as a matter of course.
- Reproductive coercion and consent: a method the patient can control privately (the injection, the IUD with trimmed threads) is sometimes the most important feature.
Emergency contraception
| Method | Window | Notes |
|---|---|---|
| Copper IUD | Up to 7 days after intercourse (5 in some guidance) | Most effective (over 99 percent); ongoing contraception |
| Ulipristal acetate 30 mg | Up to 120 hours | More effective than levonorgestrel, especially day 3 to 5 and with higher BMI; delay starting hormonal contraception for 5 days |
| Levonorgestrel 1.5 mg | Up to 72 hours (some effect to 96) | Over the counter; less effective with BMI over 30; can start hormonal contraception immediately |
Watch it done
USAID Maternal and Child Survival Program teaching film: sounding, loading, fundal placement, threads.
On the modelEndometriumCervixFallopian tubes