Contraception Choices: Condom, Pills, and Diaphragm

The Pill is not for me. What other contraception options do I have?

The oral contraceptive pill is a very common and reliable form of preventing unwanted pregnancy as well as helping manage menstrual cycles and periods.  Unfortunately, not all women will find an oral contraceptive that works well for them without significant side effects whilst other would prefer not to be taking hormones at all.  Fortunately, there are many other options to prevent pregnancy and they can roughly be divided into short-acting and long-acting contraceptive options.

Short-acting contraceptive options, other than the oral contraceptive pill, are limited to condoms, although some would also consider the “withdrawal method” in this group.  The major downside with both condoms and the withdrawal method is the high rate of pregnancy that still may occur. When condoms are used as the sole method of contraception, perfect use results in a conception rate of 1 in every 50 couples per year (2%).  This however is only achievable when a condom is used every time, with spermicidal lubricant, and the condom is withdrawn intact.  The conception rate with average use, the way that most people would use it on a day-to-day basis, may be as high as 9 in every 50 couples per year (18%).  The withdrawal method is slightly worse again, with perfect technique there are still 2 conceptions in every 50 couples per year but average technique leads to around 11 conceptions in every 50 couples per year (22%).

Long-acting reversible contraceptives (LARCs) are options which last for long periods of time and don’t need to be remembered on a daily basis but are completely reversible. There are a number of options currently on the market, including a rod which is injected under the skin of the upper arm, intra-uterine devices (either progesterone releasing or the copper IUD with no hormones) and the 3-monthly progesterone Depo? injection.

In general, LARCs are very well tolerated and have a high continuation use rate which is evidence of their acceptability in the general population.  In addition, they have the most effective contraception rates and the difference between perfect use and average use is minimal as once the device is inserted there is no chance of forgetting to take it like the pill or use it correctly like the condom.  The following table highlights the difference between the oral contraceptive pill, the hormone rod and the intrauterine devices with the percentages reported representing the number of women per hundred couples per year who would conceive on that method.

Contraceptive Method

Perfect Use

Average use

Oral Contraceptive Pill



Progesterone Rod



Intrauterine Device (Copper)



Intrauterine Device (Progesterone)



Despite stories that you may have heard in traditional and social media, LARCs are better tolerated than the oral contraceptive pill.  In addition, because of their long time frame, the cost of LARC contraception is much cheaper compared to the oral contraceptive pill, making it a very cost-effective option for many women.

Finally, LARCs can be used by many women while the oral contraceptive pill is not suitable for some women due to medical or other health related risks such as clotting disorders and migraines.  LARCs can be used in the teenage years right through to the menopause. For the prevention of teenage pregnancy they are the most effective option available (see the above regarding ‘typical use’ of the pill which is worse in teenagers!).