Hormonal contraception is very good at reducing period pain. Many people find that their periods are much less painful when they are using hormonal contraception. 

Hormonal contraception works by levelling the normal ups and downs of the body's hormones, and by stopping an egg being released (ovulation). This keeps the lining of the womb thin which reduces the pain when it comes away (a period).

Most hormonal contraception is very good at making periods lighter.

The body's hormones naturally go up and down. The hormonal methods of contraception work by levelling the ups and downs, and by stopping an egg being released (ovulation). The hormones in contraception are very similar to the body's natural hormones, but the levels are steady instead of up and down. The steady level of hormones usually means that period bleeding is lighter, and also less painful.

The implant, pills, patches, and the ring are all ‘low dose’ methods. The lowest hormone level of all the methods is the IUS (hormonal coil) which is released into the womb slowly over 5 years.

Nearly half of all pregnancies are unplanned (45%) – but that doesn’t necessarily mean that they are unwanted.

• If an unplanned pregnancy would be a big concern, the implant, the injection, the IUS and the IUD are the best at preventing pregnancies.  Because they are long acting, you don't need to remember to use them every day
• As long as they're taken correctly, the combined pill, the patch, the contraceptive ring, and the mini pill are also great at preventing pregnancies
• If you want to delay getting pregnant, but want to get pregnant within a few months, the combined pill, the patch, the contracepive ring, and the progestogen only pill might be suitable as they come out of the body's system very soon after they are stopped, meaning that levels of fertility return to normal very quickly and might help with planning or delaying getting pregnant
• If pregnancy could be a happy accident, condoms, the diaphragm, fertility awareness and withdrawal are generally less effective methods of contraception, and so could be suitable
• Currently, contraceptive options for men are limited to condoms, withdrawal, or sterilisation (which is permanent).  An unplanned pregnancy can cause stress for both both partners, and using contraception such as condoms is a way for men to have control over when they become a father.  Men can talk to their partners about when they would like to have a baby, and ask them about preferred methods of contraception

There’s no need to have a period every month – on the pill, patch or ring it’s easy to control when a period comes, by taking the method continuously without a break. A period will come when you stop the method (for a week).

You can decide when a bleed will happen, and can also take the pill, patch or ring continuously to temporarily stop your periods.

It’s safe to use two or three pill packets back to back to delay a period, going straight from one packet on to the next with no break (or changing the patch once a week with no break, or using the vaginal ring continuously). 

The Combined Pill, The Patch and The Vaginal Ring are best for controlling when periods come, since these contain the hormone oestrogen.

Hormonal contraception makes it possible to have no periods at all.

Some methods are quite likely to stop periods so there is no bleeding at all, or only occasional light bleeding. The best method to stop periods is the Injection. Almost half of users (47%) will have no periods after a year of using the injection. The implant can also cause a pause in periods – periods will stop for about one in five users, and more than half have bleeding which is light and less frequent. Implant.

Periods can be delayed by using the The Combined Pill, The Patch or The Vaginal Ring continuously. So for example you can choose to have a period once every three months only.

It is safe, and there is no harm to future fertility in having a break from periods. When there is no period, the lining of the womb stays thin - blood doesn’t build up inside the body. There are some benefits to stopping periods - less bleeding helps to save iron (many people are anaemic because of their periods). Once the contraception is stopped, the body returns to it's normal cycle. Periods.

Having no periods on contraception is a temporary effect which is completely reversible, and makes no difference to future fertility - having no bleeding does not affect the chance of getting pregnant in future. All of the methods are very quickly reversible (except the injection - it can take a few months to get periods back again).

The Combined Pill, The Patch or The Vaginal Ring can make breasts bigger, since these contain the hormone oestrogen.

Oestrogen can make breasts feel tender and swollen, particularly at first.

Premenstrual Syndrome is shortened to PMS. It's also known as PMT (premenstrual tension).

The body's hormones naturally go up and down. There’s a lot more progesterone in the week before a period, and that can cause pre-menstrual symptoms like bad moods and hunger. Hormonal contraception works by levelling out hormones, and so can be ideal for reducing PMS/PMT.

Some people get mood changes when they are not on hormonal contraception, and some get mood changes when they are on hormonal contraception. Often swapping to a different method solves the problem (e.g. choosing a different brand of pill)

These methods can help with PMS:

The Injection

The injection is the most invisible – there might be a tiny plaster put over the injection place (usually on the bum), but that’s all.

The Implant

The implant is on the inside of the arm, just under the skin – sometimes there is a small scar where it’s gone in, and you can sometimes see the outline of it if you have slim arms. In people with darker skin, a visible line can develop where the implant is resting. Since it’s on the inside of the arm, the implant is discreet.

Coils (IUD/IUS)

Coils are put into the womb, so cannot be seen. Occasionally a partner can feel the thin string of a coil during sex, and if this happens, it can be cut short so they don't feel it.

Do I need contraception if I’m breastfeeding?

Breastfeeding can help to delay when you start ovulating and having periods again after giving birth.  

Breastfeeding can help to prevent pregnancy on three conditions:

1. If your baby is less than six months old
2. If you're fully breastfeeding (only giving your baby breast milk)
3. If you haven't had your first period since giving birth

Breast feeding can be 98% effective in preventing pregnancy if all three conditions apply. But the risk of pregnancy becomes higher:

• if you are breastfeeding less often
• if there are long intervals between feeds during the day or night
• if the baby is having other liquids as well as your breast milk
• if your periods return

Once your baby is more than 6 months old, you will need to use another contraceptive method even if you are fully breastfeeding and haven’t had a period.

Which methods are safe if I’m breastfeeding? 

The contraceptive implant, injection, progestogen-only pill, IUD, IUS and condoms are safe if you are breastfeeding. If you're using a hormonal method of contraception, a very small amount of hormone will enter the milk, but this has not been shown to be harmful to breastfed babies.

Emergency contraception (IUD and emergency pills) are safe when breastfeeding. If you use the IUD or emergency pill containing levonorgestrel you can continue to breastfeed normally. If you use the emergency pill containing ulipristal acetate (ellaOne®) you should not breastfeed for one week after taking it. During this week you should express and discard your breast milk, because the effects of ellaOne® on breastfed babies have not been studied.

Which methods are not suitable?

The combined pill, contraceptive patch and vaginal ring may make it harder for your milk to come in (because they contain the hormone oestrogen).  So if you’re breastfeeding, it’s best to wait until your baby is six weeks old before starting one of these methods.

Fertility awareness methods are less reliable while breastfeeding because it is difficult to identify the signs of fertility. You should have 3 normal, regular periods before using fertility awareness methods, and this is unlikely to happen in the first 6 months after giving birth if you are breastfeeding.

Recommended methods: Implant, Injection, Mini pill, IUD, IUS, Condoms

Many unplanned pregnancies happen soon after having a baby.

How soon is it possible to get pregnant again?

You can get pregnant as soon as 21 days after having a baby. It is possible to get pregnant before you have your first period and if you’re breastfeeding.

Which methods can be started immediately after having a baby?

The contraceptive implant, injection, progestogen-only pill and condoms can be started immediately after having a baby.

The IUD and IUS (coils) can be fitted at the time of a caesarean section or immediately after a vaginal birth. If they are not fitted within the first 48 hours, fitting should be at least four weeks after giving birth.

Emergency oral contraception (Emergency pills) are safe after having a baby but are not needed until 21 days after birth. All oral Emergency Contraception can be used after 21 days and the IUD can be inserted 28 days after birth. Emergency Contraception containing Levonorgestrel is not known to be harmful when breastfeeding.

Which methods are not suitable after having a baby?

The combined pill, contraceptive patch and vaginal ring should not be used in the first 3 weeks after having a baby. This is because the risk of blood clots is higher after giving birth. Those who have had uncomplicated births, with no risk factors for blood clots and who are not breastfeeding may be able to start as early as 21 days following birth. However, if you are at increased risk of blood clots, you may be advised to wait 6 weeks before starting one of these methods. Speak to your doctor or nurse who can advise you.

The diaphragm is not recommended in the first 6 weeks because the cervix (neck of the womb) and vagina change shape and size during pregnancy and birth.  These changes make the diaphragm less good at preventing pregnancy.

Fertility awareness methods are less reliable after giving birth because it is difficult to identify signs of fertility. You should have 3 normal, regular periods before using fertility awareness methods.

How long should I wait before getting pregnant again after having a baby?

The advice is to ideally wait for 24 months, or at least 12 months, before becoming pregnant again. This is because if you get pregnant again quickly, the next baby might be too small, or be born too soon. 

Leaflet: Contraception after having your baby

Is pregnancy possible?

Trans and non-binary people who were assigned female at birth (AFAB) can get pregnant if sperm can meet egg, i.e. someone with a womb and ovaries is having penetrative sex with someone who produces sperm.

• It’s possible to become pregnant on masculinising hormones, even if periods have stopped
• It is not possible to get pregnant if the womb or ovaries have been removed.

Planning a pregnancy

Transmen and non-binary AFAB people with womb and ovaries can get pregnant and carry a baby.

Masculinising gender-affirming hormones need to be stopped before trying to get pregnant, for two reasons:

• Androgens like testosterone tend to prevent ovulation
• Masculinising hormones would harm a developing baby

Avoiding a pregnancy

Contraception methods suitable for people taking masculinising hormones

 Condoms (internal or external)

• Best protection against sexually transmitted infections
• Might be uncomfortable if the front (vagina) is more dry on masculinising hormones
• Might need water-based lube as well

Progestogen-only (mini) pill

• Can reduce or stop periods, but might cause spotting
• Doesn’t affect the masculinising effects of androgens/testosterone

Implant

• Very effective at preventing pregnancy
• Can reduce or stop periods, but might cause spotting
• Doesn’t affect the masculinising effects of androgens/testosterone

IUS (hormonal coil)

• Very effective at preventing pregnancy
• Needs to be fitted into the womb (which involves a speculum in the vagina)
• Likely to reduce or stop periods, but might cause spotting
• Doesn’t affect the masculinising effects of androgens/testosterone

Injection

• Very effective at preventing pregnancy
• Likely to reduce or stop periods, but might cause spotting
• Doesn’t affect the masculinising effects of androgens/testosterone

IUD (copper coil)

• Can cause heavier, more painful periods
• Needs to be fitted into the womb (which involves a speculum in the vagina)

Diaphragm

• Must be inserted so that it covers the cervix (neck of the womb)

Emergency Contraception

• The 3-day or 5-day emergency contraception pill is suitable for transmen or non-binary people taking masculinising hormones
• The copper IUD is the most effective method for preventing pregnancy, up to 5 days after unprotected sex. This needs to be fitted into the womb.

Sterilisation

• Gender-affirming surgery which removes the womb and ovaries means that pregnancy is not possible
• Sterilisation can also be achieved with a small operation to tie or clip the fallopian tubes

Contraception methods not suitable for people taking masculinising hormones

Combined contraceptive pill, patch or vaginal ring

These methods contain two hormones - estrogen and progestogen.

• The combined pill, patch or ring can be used continuously (with no breaks) to stop periods
• Side effects can include tender or swollen chest tissue
• Estrogen counteracts masculinising hormones

Fertility Awareness methods

• Fertility awareness methods rely on monitoring bleeding patterns and other fertility indicators such as fluid in the vagina (front)
• Masculinising hormones are likely to make cycles irregular and also to change the fluid in the vagina so that these will not be reliable ways of predicting fertile times.

Accessing health services in the UK

Individual factors (e.g. age, smoking, BMI), medications, medical history, family history etc. need to be considered when choosing a contraception method. A doctor or nurse can advise.

Guidance for health professionals

Do I have to change contraception because of my age?

Maybe.

Most contraception methods are safe and suitable for people over 40.

Methods with two hormones carry more risk as you get older (the combined pill, patch, vaginal ring), but non smokers in good health can use these methods until age 50. 

Which methods are safe and suitable until menopause?

Menopause is when periods stop, and there is no chance at all of pregnancy. See Perimenopause and menopause.

The copper IUD, implant, progestogen-only pill, IUS (hormonal coil) and injection can generally be used all the way to menopause.

It is safe use hormonal methods continuously for many years without a break (unless your health changes). See Taking a break.

Which contraception methods are suitable for people over 40?

Which methods have increased health risks for over 40s?

Combined Hormonal Methods: the Combined Pill, Patch and Ring

There is a small increase in the chance of blood clots, heart attack and stroke while taking combined hormonal methods. This becomes important for those with existing risk factors, such as high body weight, smoking or high blood pressure.

Some research shows a small increased risk of breast cancer and cervical cancer. This risk reduces once you stop taking it. 

Injection

Some research shows a temporary thinning of the bones when using the injection. Bone density naturally decreases following menopause, and the injection does not make this worse.

What are the benefits of hormonal contraception?

Combined hormonal methods (combined pill, patch and ring) protect against endometrial, ovarian, and colon cancer, so there is less risk of these cancers. Combined methods also help maintain healthy bone density, and can also help prevent perimenopausal symptoms such as vaginal dryness and hot flushes.

When can contraception be stopped?

Fertility decreases with age, but contraception is still needed to prevent unwanted pregnancies until you stop ovulating (releasing eggs).

If you are not on any hormonal contraception you can safely stop using contraception if:

• You are under 50 and have not had any periods for 2 years
• You are 50 or over and have not had any periods for 1 year 

Once you reach 55 contraception is no longer needed.

My contraception changes my periods. How do I know if I’m approaching menopause?

Hormonal contraception influences the hormonal cycle so it is not possible to tell if your periods have stopped because of the contraception, or because of menopause. However, once you reach 55, contraception is no longer needed.

If you want to stop hormonal contraception before 55 you will need to use a non-hormonal contraception method until menopause is confirmed.

Which methods can be used until menopause?

If the copper IUD is inserted at age 40 or over, it can be used for contraception until menopause (when periods stop)

If the IUS (hormonal coil) is inserted at age 45 or over, it can be used for contraception until 55, when no further contraception will be needed

The progestogen only pill, injection, and the Implant can normally be used until 55, when contraception is no longer required.

Which contraceptive methods can help with perimenopausal symptoms (e.g. irregular bleeding, hot flushes, vaginal dryness)?

All contraception methods which contain oestrogen can be used to treat perimenopausal symptoms (the combined pill, the Patch and the Ring). These two hormone methods can be used instead of Hormone Replacement Therapy (HRT) for people under 50. HRT contains two hormones, but at a low level which would not prevent pregnancy.

The IUS (hormonal coil) is good at reducing heavy and irregular bleeding at all ages.

Lubricants and oestrogen creams are good treatments for vaginal dryness.

Will taking contraception affect when I go through menopause?

No. Contraception methods do not change the time that menopause happens. However, regular bleeding will continue on the pill, patch and ring even after the menopause. It is only possible to tell whether your periods have stopped when you stop the contraception method. See Perimenopause and Menopause

Does HRT prevent pregnancy?

No.  Although Hormone Replacement Therapy (HRT) uses the same types of hormones as contraception, they are not given at the right levels to prevent pregnancy. You can use a progestogen-only method e.g. progestogen-only pill, implant, IUS (hormonal coil) or injection for contraception alongside HRT. You can also use a method without hormones such as the copper IUD, condoms or a diaphragm.

Which contraception methods can be used with HRT?

Most people need two hormones for hormone replacement: Oestrogen helps to reduce perimenopausal symptoms (e.g. hot flushes, vaginal dryness, heavy bleeding). Progestogen protects the womb from thickening or developing a cancer.

Some forms of HRT contain the two hormones together (e.g. HRT patches).

Oestrogen can also be taken on its own as a tablet, patch, or implant. The IUS (hormonal coil) can be used as the progestogen part of HRT and act as contraception at the same time.

There is more information on Hormone Replacement Therapy in Perimenopause and Menopause.

Which contraception methods are permanent?

Vasectomy and Sterilisation are surgical procedures that provide permanent, effective contraception.