Contraception: a complete guide to the pill, the IUD, the implant and every other method

01How do I choose the best contraception for me?

The best contraception is the method that is safe for your health, fits your life and that you will use consistently. There is no single “best” method for every woman: the choice depends on your age, health, plans for future pregnancy, breastfeeding, smoking, migraine, blood-clot risk and personal preferences.

Contraception (or family planning) is the deliberate use of a method to prevent pregnancy. The World Health Organization (WHO) groups methods by effectiveness:

• Highly effective and long-acting: the implant, the IUD (copper or hormonal) and sterilisation.
• Effective when used correctly: the pill, the injection, the patch and the vaginal ring.
• Less effective: condoms, natural methods and withdrawal (coitus interruptus).

What do “typical use” and “perfect use” mean? Perfect use means the method is always used exactly right; typical use includes the forgotten pills and mistakes of everyday life. The gap is large for methods that depend on you and almost zero for long-acting methods. According to the WHO Family Planning Global Handbook (2022), pregnancies per 100 women in the first year (typical use / perfect use) are approximately:

• Implant: 0.1 / 0.1
• Hormonal IUD: 0.7 / 0.5
• Copper IUD: 0.8 / 0.6
• Female sterilisation: 0.5 / 0.5
• Progestogen-only injection: 4 / 0.2
• Combined pill, mini-pill, patch and ring: 7 / 0.3
• Male condom: 13 / 2
• Withdrawal: 20 / 4
• No method: about 85 pregnancies per 100 women per year

In real life, this means that about 7 in 100 women using the pill become pregnant within a year, compared with fewer than 1 in 100 with the implant or IUD. That is why the American College of Obstetricians and Gynecologists (ACOG) recommends long-acting reversible contraception (LARC: the IUD and the implant) as first-line options, including for young women and adolescents, because they do not depend on daily memory.

Questions that help you choose:

1. How important is it for you to avoid pregnancy completely right now?
2. When do you think you might want to become pregnant: in a few months, a few years, or never?
3. Can you take a pill every day at around the same time?
4. Do you smoke, have migraine with aura, high blood pressure or a history of blood clots?
5. Are you breastfeeding?
6. Do you also need protection from sexually transmitted infections (STIs)?
7. How do you feel about changes to your periods (lighter, irregular or absent)?

In Albania, according to the Institute of Public Health (ISHP), contraceptive methods have been offered free in public health services since 1996, yet withdrawal has long been the most widely used method (Demographic and Health Survey 2008–09). A good consultation helps you move from an unreliable method to one that truly suits you.

02The combined pill, patch and ring: how do they work and what are the side effects?

The combined pill, the patch (a sticker on the skin) and the vaginal ring contain two hormones, an oestrogen and a progestogen. They work mainly by stopping ovulation (the release of an egg from the ovary) and by thickening cervical mucus so sperm cannot pass easily.

How they are used:

• Pill: taken every day, following the regimen your doctor explains.
• Patch: stuck on the skin and changed every week.
• Vaginal ring: inserted by you into the vagina and kept in place for about three weeks.

Effectiveness: according to the WHO, about 7 pregnancies per 100 women per year with typical use and 0.3 with perfect use. The patch and ring have the advantage that you do not need to remember them every day.

Benefits:

• Periods are usually more regular, lighter and less painful.
• Acne improves in many women.
• Lower risk of endometrial and ovarian cancer, lasting for years after stopping (WHO).
• Can be stopped at any time, and fertility returns quickly.

Limitations:

• Must be used correctly; missed doses reduce effectiveness.
• No protection against sexually transmitted infections.
• Not for everyone: some health conditions make oestrogen unsuitable (see the oestrogen section).
• Some medicines, such as certain anti-epileptics and rifampicin, can reduce their effect.

Common side effects, especially in the first 3 months: spotting between periods, nausea, breast tenderness, headaches and mood changes. They usually settle on their own. If they persist, your doctor can suggest a different type.

The rare but serious risk: blood clots (venous thrombosis). According to the European Medicines Agency (EMA), about 2 in 10,000 women not using hormonal contraception develop a blood clot each year, compared with about 5–12 in 10,000 users, depending on the type of progestogen. The risk is higher during pregnancy and after childbirth than with the pill. Seek urgent help if you have pain or swelling in one leg, chest pain, breathlessness, a sudden severe headache or problems with your vision.

03The mini-pill, implant and injection: oestrogen-free methods

Progestogen-only methods contain no oestrogen, so they are a safe option for many women who cannot use the combined pill: women who are breastfeeding, smokers over 35, women with migraine with aura or with a higher risk of blood clots.

The mini-pill (progestogen-only pill):

• Taken every day without a break; some types require strict timing.
• Effectiveness: 7 per 100 with typical use and 0.3 with perfect use (WHO); about 1 per 100 during breastfeeding.
• Most common side effect: irregular periods or spotting.

The contraceptive implant:

• A small, flexible rod placed under the skin of the upper arm with local anaesthetic, in a few minutes.
• Protects for 3 to 5 years, depending on the type.
• The most effective reversible method: 0.1 pregnancies per 100 women per year (WHO).
• Can be removed whenever you wish, and fertility returns quickly.
• Side effects: changes to periods (irregular, less frequent or absent), sometimes headaches or acne.

The contraceptive injection:

• Given every 1 to 3 months, depending on the type.
• Effectiveness: 4 per 100 with typical use and 0.2 with perfect use (WHO), mainly depending on getting each injection on time.
• After stopping, fertility returns on average about 4 months later than with other methods (WHO), so it is not ideal if you plan a pregnancy soon.
• In some women it is associated with weight gain (on average 1–2 kg a year, according to the WHO) and with absent periods.

Irregular or absent periods on these methods are not dangerous: blood does not “build up” inside the body. This is one of the most common questions in the consultation.

The availability of different types may vary in Albania. The doctor explains what is available and arranges the method that suits you.

04Copper and hormonal IUD (coil): how safe is it and does insertion hurt?

The IUD (intrauterine device, also called the coil or spiral) is a small T-shaped device that a gynaecologist places inside the uterus. It is one of the most effective methods: fewer than 1 pregnancy per 100 women per year, with both typical and perfect use (WHO).

The two main types:

• Copper IUD: hormone-free. Copper makes sperm unable to fertilise an egg. It protects for many years (up to 10 years or more, depending on the type) and can also be used as emergency contraception.
• Hormonal IUD: releases small amounts of progestogen inside the uterus. It protects for 3 to 8 years, depending on the type. It often makes periods lighter and is also used to treat heavy menstrual bleeding.

Does IUD insertion hurt? Most women feel period-like cramps for a few minutes. The procedure usually takes a few minutes: a gynaecological examination, measuring the uterus, then insertion. The doctor discusses ways to make it more comfortable. Cramps can last a few hours or days.

How safe is the IUD?

• Expulsion (the IUD coming out): happens in about 1 in 20 women, most often in the first months (NHS).
• Perforation of the uterus: rare, up to about 2 in 1,000 insertions (FSRH).
• Infection: a small risk, mainly in the first 3 weeks after insertion. If there is a risk of STIs, testing may be recommended.
• If pregnancy occurs (very rarely), it is more likely to be outside the uterus (ectopic), so you should be seen straight away.

Side effects: with the copper IUD, periods may be heavier and more painful in the first months. With the hormonal IUD, spotting is common at first, after which periods usually become lighter or stop.

Who can use it? Including women who have never given birth and adolescents; under WHO criteria, age alone is not a reason to refuse it. A check-up is usually recommended 3–6 weeks after insertion. At Klinika Gjata, ultrasound can confirm the position of the IUD when needed. The IUD can be removed at any time and fertility returns quickly.

05Do condoms protect against pregnancy and sexually transmitted infections?

Yes. Condoms are the only contraceptive method that protects against both pregnancy and sexually transmitted infections, including HIV (WHO).

Effectiveness according to the WHO:

• Male condom: 13 pregnancies per 100 women per year with typical use, 2 with perfect use.
• Female condom: 21 with typical use, 5 with perfect use.

Dual protection means using condoms together with another method (for example the IUD, the implant or the pill). This is especially recommended with a new partner or when you are unsure of your partner’s status.

Practical tips:

• Check the expiry date and the packaging.
• Put it on before any genital contact, not halfway through sex.
• With latex condoms, use a water- or silicone-based lubricant; oils damage latex.
• Never use two condoms at the same time.
• If you are allergic to latex, latex-free condoms are available.

If a condom breaks or slips off: consider emergency contraception within 5 days and talk to your doctor about STI testing.

06The morning-after pill (emergency contraception): how long does it work?

Emergency contraception can prevent pregnancy if used within 5 days (120 hours) of unprotected sex; the sooner, the more effective it is (WHO).

The WHO lists these options:

• Copper IUD: the most effective method, over 99%, if inserted within 5 days. It can then stay in as long-term contraception.
• Ulipristal acetate pill: within 120 hours; it is more effective than other pills between 72 and 120 hours.
• Levonorgestrel pill: most effective the sooner it is taken, ideally within 72 hours, with effectiveness falling over time.

Emergency pills can prevent more than 95% of pregnancies when taken within 5 days (WHO). They work mainly by delaying or preventing ovulation.

Key facts:

• Emergency contraception does not cause an abortion and does not harm an established pregnancy.
• It does not affect future fertility.
• There are no absolute medical contraindications to emergency pills and no age limit.
• In women with a body mass index (BMI) over 30, the pills are less effective but remain safe; the copper IUD may be the better choice.
• If you vomit within 2 hours of taking it, contact your doctor or pharmacist about another dose.
• Side effects (nausea, headache, irregular bleeding, tiredness) are usually mild and short-lived.

When is it needed? After sex without protection, when a condom breaks, after missed pills, when an injection is late, or after sexual assault.

What next? Emergency contraception is not a regular method: frequent use disrupts the cycle and is less effective than regular methods. If your period is more than 7 days late, take a pregnancy test. Ask your doctor when to start a regular method, because after ulipristal, starting a hormonal method straight away can reduce its effect.

07Natural methods, withdrawal and permanent methods: how reliable are they?

Natural methods (fertility awareness-based methods) rely on identifying the fertile days of the cycle and avoiding unprotected sex on those days. They include the calendar method, basal body temperature, observing cervical mucus and the symptothermal method (a combination of these).

How effective are they? According to the CDC, typical use results in 2 to 23 pregnancies per 100 women per year, depending on the method and on discipline. They work best when:

• Your cycle is regular.
• You have had proper instruction and keep daily records.
• Both partners agree on days without sex or with a condom.

They are less reliable after childbirth, during breastfeeding, in perimenopause and when cycles are irregular.

Withdrawal (coitus interruptus): 20 pregnancies per 100 women per year with typical use (WHO). According to demographic data it is the most common method in Albania, but it is among the least reliable and does not protect against STIs.

The lactational amenorrhoea method (LAM): breastfeeding protects against pregnancy only when all three conditions are met: the baby is under 6 months old, is fed only or almost only on breast milk, day and night, and your periods have not returned. Effectiveness is then about 2 per 100 with typical use (WHO).

Permanent methods:

• Female sterilisation (tubal ligation): 0.5 pregnancies per 100 women per year.
• Vasectomy (for men): about 0.15 per 100; it is not effective immediately, but after about 3 months.

These methods should be considered irreversible. The decision is made after full counselling. It is worth knowing that the implant and the IUD are just as effective but reversible. The doctor advises you and refers you if you choose a permanent method.

08Does the pill cause weight gain, infertility or cancer? Myths and facts

Many women give up modern contraception because of fears that the evidence does not support. Here is what studies and international organisations say.

Myth: “The pill makes you put on weight.” Fact: Cochrane systematic reviews have found no large effect of the combined pill on weight. Some women feel bloated in the first months because of fluid retention. The injection is the method most often linked to weight gain in some women.

Myth: “The pill makes you infertile.” Fact: according to the WHO, modern contraceptive methods do not cause infertility. Fertility returns quickly after stopping the pill, patch, ring, implant and IUD. Only after the injection can the return take a few months longer. The main factor that reduces fertility is age, not contraception.

Myth: “You need a break from the pill every few years.” Fact: there is no medical reason for breaks; they increase the risk of an unplanned pregnancy.

Myth: “The pill causes cancer.” Fact: the combined pill lowers the risk of endometrial and ovarian cancer, and this protection lasts for years after stopping (WHO). There is a small increase in breast cancer risk during use, which fades after stopping, and a small increase in cervical cancer after long-term use; the main cause of the latter is HPV, which is why regular screening (smear/HPV test) matters.

Myth: “The IUD causes abortion.” Fact: the IUD works mainly by preventing fertilisation (WHO). It does not end an established pregnancy.

Myth: “The IUD is only for women who have had children.” Fact: according to the WHO, women who have never given birth can use it too.

Myth: “The morning-after pill is an abortion.” Fact: it does not cause abortion; it works by delaying ovulation.

Myth: “You can’t get pregnant while breastfeeding.” Fact: breastfeeding only protects if the LAM conditions are met.

Myth: “Withdrawal is just as safe.” Fact: with typical use, about 1 in 5 women becomes pregnant within a year (WHO).

09Contraception after birth, while breastfeeding, after abortion, for teenagers and in perimenopause

Contraception after birth and while breastfeeding Ovulation can return before your first period. Women who are not breastfeeding can become pregnant from around week 4 after birth (WHO). The WHO recommends waiting at least 24 months after a birth before the next pregnancy. Under WHO criteria:

• Progestogen-only methods (mini-pill, implant) can be started early and do not affect milk supply.
• An IUD can be inserted within 48 hours of birth or from week 4 onwards.
• Oestrogen-containing methods are not recommended in the first 6 weeks of breastfeeding and usually until 6 months; in women who are not breastfeeding, not before 21 days after birth.
• Condoms can be used at any time.

Contraception after abortion Fertility can return within about 2 weeks after a first-trimester abortion. According to the WHO, almost all methods can be started immediately, even on the same day; an IUD can be inserted straight away if there is no infection.

Teenagers and the first consultation

• The consultation is confidential and non-judgemental. You can come alone or with someone you trust.
• According to the WHO, age alone is not a reason to refuse any method; ACOG considers the implant and the IUD first-line methods for adolescents too.
• Starting the pill, injection or implant usually does not require an internal gynaecological examination (WHO).
• Condoms are always recommended for protection against STIs.

Perimenopause (usually after 40) Fertility declines, but pregnancy is still possible. According to the FSRH (UK), contraception is recommended until 12 months after your last period if you are over 50, or 2 years if you are under 50; most women can stop at 55. The hormonal IUD also helps with heavy periods, which are common at this stage. The combined pill can be used by women without risk factors, after a medical assessment.

10Who should not use the combined pill or oestrogen-containing methods?

According to the WHO Medical Eligibility Criteria (MEC), oestrogen-containing methods (combined pill, patch, ring) should not be used, or are generally not recommended, in these situations:

• Age 35 or over and smoking: 15 or more cigarettes a day (should not be used); fewer than 15 a day (generally not recommended).
• Migraine with aura, at any age.
• A current or past blood clot (deep vein thrombosis or pulmonary embolism), or known mutations that increase clotting risk.
• Major surgery with prolonged immobilisation.
• Blood pressure of 160/100 mmHg or higher, or hypertension with vascular disease; readings of 140–159/90–99 also call for caution.
• Ischaemic heart disease, stroke or complicated heart valve disease.
• Current breast cancer.
• Breastfeeding in the first 6 weeks after birth, or the first 21 days after birth in women who are not breastfeeding.
• Diabetes with vascular complications.
• Severe liver disease or liver tumours.
• Lupus with antiphospholipid antibodies.

If oestrogen is not right for you, you still have many safe options: the mini-pill, the implant, the injection, the copper or hormonal IUD and condoms. That is why, before you start a combined method, the doctor measures your blood pressure and asks about smoking, migraine and any family history of blood clots.

11What happens at a contraception consultation? Step by step

A contraception consultation at Klinika Gjata is a confidential conversation with Assoc. Prof. Dr. Elinda Gjata, in which the final decision is always yours.

1. A conversation about your needs: plans for pregnancy, methods you have used before and what has bothered you.
2. Medical history: menstrual cycle, births, breastfeeding, illnesses, medicines you take, smoking, migraine and family history of blood clots.
3. Blood pressure and weight, especially before oestrogen-containing methods.
4. Ruling out pregnancy, with a test when needed.
5. A gynaecological examination and ultrasound when needed, for example before an IUD; if you are due, a cervical screening check too.
6. An explanation of the methods suitable for you: effectiveness, side effects, how they are used and what is available in Albania.
7. Your decision: the doctor advises you and arranges the method that suits you.
8. A follow-up plan: when to come back for a check-up, what to do if you miss a dose and which signs need an immediate visit.

What to bring:

• The date of your last period.
• A list of the medicines and supplements you take.
• Results of previous tests or scans, if you have them.

What affects the cost:

• The type of method and whether the device or medicine is bought separately.
• Whether ultrasound, blood tests or STI testing are needed.
• The insertion or removal procedure, for the IUD and the implant.
• The number of follow-up visits.
• Long-acting methods cost more up front but often less per year of use.

For exact information about your visit, call the clinic on +355 4 234 0059.

12When should you see a doctor, and why choose Klinika Gjata in Tirana?

Seek urgent medical help if you have:

• Pain or swelling in one leg.
• Chest pain or difficulty breathing.
• A sudden severe headache, or problems with vision or speech, especially on oestrogen-containing methods.
• Severe abdominal pain, especially with an IUD or a positive pregnancy test.
• Fever, pelvic pain or foul-smelling discharge after IUD insertion.
• Very heavy bleeding.

Book an appointment when:

• Side effects last more than 3 months.
• You cannot feel your IUD threads, or you can feel the hard part of the device.
• Your period is late and you have signs of pregnancy.
• You want to change method or plan a pregnancy.
• You need emergency contraception.

Why Klinika Gjata?

• An obstetrics and gynaecology clinic in Tirana since 2009.
• Consultations with Assoc. Prof. Dr. Elinda Gjata, MD, Dr. Sc., an obstetrician-gynaecologist with more than 25 years’ experience and Associate Professor at the University of Medicine, Tirana.
• Counselling and gynaecological ultrasound can take place in the same visit.
• Personalised advice based on WHO criteria, in a confidential, non-judgemental setting.
• Continuous follow-up: from choosing a method to planning a pregnancy when you are ready.

Klinika Gjata is on Rruga Hasan Sufa, Tirana. To book a contraception consultation, call +355 4 234 0059.