Contraception Methods What You Should Know

Contraception is more than preventing unintended pregnancy; it is one of the most basic ways to keep control over your own body and life. In the clinic, I still see many patients relying on withdrawal or the rhythm method of avoiding ovulation days, yet both of these are commonly reported to fail under typical, real-world use. Today, Dr. Lee Dong-hee, Director of Wooahan Women's Clinic, brings together the major contraceptive options — from condoms to oral pills, intrauterine devices, implants, and contraceptive injections — and compares their pros and cons. There is no single right answer; the goal is to find the method that fits you best.

The first thing to know when choosing a method is that actual effectiveness varies greatly between options. The World Health Organization (WHO, 2018) and the U.S. Centers for Disease Control and Prevention (CDC, 2024) describe contraception in several tiers based on effectiveness. At the top are the intrauterine device and the implant, which require no daily attention once placed; next come oral pills and contraceptive injections, which must be taken daily or on schedule; and at the bottom are condoms, which must be applied correctly every time, along with the rhythm method and withdrawal.

A key concept here is the difference between "perfect use" and "typical use." There is a large gap in failure rates between perfect use, exactly as instructed without error, and the typical real-world use where one forgets or applies a method late. The more a method depends on human action each time, the wider this gap grows.

In terms of contraceptive effect alone, condoms are moderate, but they have great value as nearly the only method that also helps prevent sexually transmitted infections and viruses. Used correctly and consistently, the failure rate stays fairly low, but failure is reported more often with real-world patterns such as not using one from the start or putting it on midway.

In my clinical experience, condoms shine most when used "together with" another method. For example, dual protection — preventing pregnancy with an oral pill while preventing infection with a condom — works this way. If you are concerned about sexually transmitted infections, I recommend also reviewing Recurrent STIs and STD testing.

By contrast, withdrawal or the rhythm method of counting ovulation days, while theoretically possible, has too many variables in practice and is not recommended as a standalone method. If you have relied on these for a long time, it may be time to consider other options.

The effectiveness of oral pills depends on "the consistency of taking them at the same time every day." Most pills on the market are combined preparations containing both estrogen and progestin, and recently a progestin-only preparation has also been released as an over-the-counter drug, widening the range of choices. For those for whom estrogen is a concern, a single-ingredient preparation may be an alternative.

Whether to use the pill is not decided by age alone. The U.S. CDC's Medical Eligibility Criteria for contraception (CDC, 2024) place more weight on cardiovascular risk factors such as smoking, high blood pressure, migraine, and a history of blood clots. Without these risk factors, hormonal contraception is reported to be continuable up to around menopause.

That said, combined preparations containing estrogen are associated with a risk of blood clots, so a consultation before prescription is important. Since risk varies by ingredient, it is good to review Birth control pills and blood clots: why a consultation is needed in advance.

The intrauterine device (IUD) is a cost-effective method in which a single placement provides contraception for several years. The initial cost is relatively high, but because it is used over a long span of 3 to 5 years, it is economical in the long run, and since there is no need for daily attention, the discontinuation rate tends to be low once a person adapts. The American College of Obstetricians and Gynecologists (ACOG) classifies the intrauterine device and the implant as the most effective group of reversible contraceptives.

The devices used domestically are broadly divided into hormonal and copper types. The hormonal type, Mirena, may be covered by national health insurance for certain indications such as menorrhagia and dysmenorrhea. The placement takes about 5 minutes, and removal is short — around 30 seconds if there are no particular problems. Even if menstrual volume decreases greatly or amenorrhea occurs during hormonal use, this does not stop ovarian function or ovulation, so women of childbearing age who plan to conceive later can use it with peace of mind.

The copper intrauterine device is also used for emergency contraception. The intrauterine device works by interfering with fertilization and preventing implantation of the embryo. If you want to know more about Mirena, see How Mirena works and precautions; for the procedure overall, you can check the Pregnancy and contraception clinic.

The progestin depot contraceptive injection is given once every 3 months, greatly easing the burden of daily attention. An active concentration is observed in the body from about 24 hours after the injection, and it sufficiently suppresses ovulation, often reducing menstrual-like bleeding. Because it contains no estrogen, it is known as a relatively safe choice even for those for whom combined hormonal preparations are a concern, such as smokers over 35.

That said, there are two things to know in advance: it may take several months or more for ovulation to return after stopping, and long-term use may affect bone mineral density. The American College of Obstetricians and Gynecologists (ACOG, 2014) notes that bone mineral density tends to recover after discontinuation, while advising caution about standalone use beyond about one year.

The implant (Implanon), inserted on the inner arm, is another long-term method in which a single procedure provides contraception for about 3 years. Fertility is reported to return relatively quickly after removal. You can read more in Implanon, the arm implant.

The table below summarizes the features of the major methods. Effectiveness and suitability may vary with individual health status, so please use it as a reference, and decide your final choice through a consultation with a specialist.

There is no absolute ranking of good contraceptive methods. The most suitable method differs from person to person depending on smoking, obesity, a history of blood clots, future pregnancy plans, and the rhythm of daily life. Even a highly effective method may not be a good choice if it does not match your body's risk factors, and conversely, a method you can use consistently and well can become the most reliable contraception.

If you have deep concerns about which method to choose, I recommend checking your risk factors together through a Contraception concerns consultation, with cost explained afterward. Rather than deciding alone, going over it once with a specialist is the fastest way.

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Written by Lee Dong-hee, Director · OB-GYN specialist · See physician profile

First published November 28, 2023 · Last reviewed May 30, 2026

References: CDC U.S. Medical Eligibility Criteria for Contraceptive Use (2024), ACOG Long-Acting Reversible Contraception Practice Bulletin (2017), ACOG Depot Medroxyprogesterone Acetate and Bone Effects (2014), WHO Family Planning Guidance (2018)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through a medical visit.