Contraception: pill, condom or IUD?

There is no such thing as the ideal contraceptive. Personal desires, life situation, partnership, health - all of these influence the choice. Here you can find out everything you need to know about the various methods

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Which contraceptive is the right one? Every woman has to find the answer for herself

© Your Photo Today / Phanie

A variety of contraceptives prevent unwanted pregnancies. The pill has been the first choice for many women and couples for decades. It is not undisputed: Blood clots have recently come to the fore in the contraceptive debate as a rare but dramatic side effect of modern birth control pills. It is all the more important to consider for yourself which remedy is best for you.

On the market since 1960, birth control pills have revolutionized the position of women in society and enabled couples to plan their families. It is estimated that up to one hundred and fifty million women around the world use the hormone pill (combination pill) to use contraception every day. However, it does not protect against sexually transmitted diseases. Condoms are safer here.

Contraception: a little statistics beforehand

55 percent of all adults who use contraceptives opt for the pill, according to a representative survey by the Federal Center for Health Education.

Around a third of women and men choose condoms, around 11 percent use an IUD for contraception. Contraceptives such as the vaginal ring and three-month tip are used relatively rarely (two percent each), although they are as safe as the pill. Sterilization of the man (three percent) or the woman (two percent) is only possible after family planning has been completed. With hormone implants, the temperature method and baby computers, only about one percent of adults use contraception.

How safe is my method? The Pearl Index provides information

Which contraceptive method a woman should choose should be decided in consultation with her gynecologist. Perhaps she will also involve the partner in the decision. Not every woman tolerates the pill or other hormonal preparations equally well. The side effects can vary greatly from woman to woman.

Most often, women who use hormonal contraception complain of breast tenderness, weight gain, changes in hair appearance, irregular bleeding, headaches and impaired sexual desire. The safety of the contraceptive method naturally plays a decisive role in the choice.

The Pearl Index, named after the American biologist Raymond Pearl (1879–1940), is used to indicate safety. The Pearl Index is a statistical value. He gives the number of (unwanted) pregnancies that occur if a hundred women use a certain contraceptive for a year.

A low Pearl Index means: few pregnancies and thus high safety of the contraceptive method. A higher Pearl Index means: more pregnancies and less security. If there is no contraception at all, the Pearl Index for women of fertile age is around 85 (upper mean). In the period before menopause it decreases increasingly, in the menopause it finally reduces to zero.

The sometimes large ranges in the security of the individual methods are due to the fact that they are not always applied correctly. For example, it can happen that the pill is forgotten. Apart from the calculation, there are also no uniform conditions for data collection in studies with a new contraceptive.

Video: What is the Pearl Index?

All important contraception methods with Pearl index and profile

© Your Photo Today / All Medical


© Your Photo Today / All Medical

The pill:

The birth control pill (micropill) provides good protection against unwanted pregnancy and is easy to use. Pearl index 0.1 to 0.9 (DGGG). Profile: More about the pill >> content: linkbyidcontent: linkbyid

© Your Photo Today / Phanie

The contraceptive ring:

The vaginal ring releases low-dose hormones in the vagina for contraception. Pearl index 0.4 to 0.65 (DGGG). Profile: How to use the contraceptive ring correctly >> content: linkbyid

© Your Photo Today / BSIP

Hormone IUD (contraceptive umbrella):

This type of IUD works almost exclusively in the uterus via the evenly released hormone progestin. Pearl index 0.16 to 0.41 (DGGG, manufacturer). Profile: More about the different hormonal IUDs >> content: linkbyid

© Your Photo Today / BSIP

The contraceptive patch:

The contraceptive plaster continuously releases hormones through the skin into the blood. Pearl index 0.72 to 0.9 (DGGG). Profile: Interesting facts about the contraceptive patch >> content: linkbyid

© Your Photo Today / BSIP

The contraceptive stick (hormone implant):

The long-term contraceptive is placed under the skin and releases the hormone progestin in low doses. It is enough to safely use contraception for three years. Pearl index 0 to 0.08 (DGGG). Profile: advantages and disadvantages of the contraceptive stick >> content: linkbyid

© Imago stock & people GmbH / blickwinkel

The three-month injection:

Depot injections with progestin are only an option if a woman cannot tolerate or use any other method of contraception. The hormone is injected into the muscle every three months. Pearl index 0.2 to 0.88 (DGGG). Profile: three-month injection >> content: linkbyid

© Your Photo Today / A1PIX

Copper spiral, copper chain:

Copper with or without gold and silver, solid rod or flexible chain: there are many models. Duration depending on the copper content: up to three, five or ten years. Pearl index (copper spiral) 0.9 to 3 (DGGG); 0.4 to 1 (BVF). Copper chain: 0.1 to 0.5. Profile: We reveal the secret of copper ions ... a little >> content: linkbyid

© Strandperle / Bildstelle

The condom:

Condoms are firmly held in second place among contraceptives. No wonder, for half of humanity the "Parisian" is the only flexible method. The need for development is high, as is the Pearl Index, currently still at 2 to 12 (DGGG). Profile: What men and women should know about condoms >> content: linkbyid

© W & B / Brigitte Sporrer

Diaphragm and contraceptive cap (cervical cap):

These are the barrier methods that are most likely designed and used by women. Pearl index depending on routine 1 to 20 (DGGG), a contraceptive gel is also applied for better safety. Profile: diaphragm and contraceptive cap - this is how it works >> content: linkbyid

© W & B / Brigitte Sporrer

Chemical contraceptives:

These products, such as foam suppositories or gels, contain substances that checkmate sperm. Applied alone, the preparations are considered to be very unsafe. Pearl index 3 to 25 (DGGG). Profile: Read more >> content: linkbyid

© Glow Images / Sozaijiten / Imagenavi

Natural contraceptive methods:

Contraception without hormones and mechanical means: That sounds convincing, and it is also if, as a woman, you are really familiar with your own body and the lifestyle is appropriate. Of course, you can also plan a pregnancy this way. The symptothermal method with a Pearl index of 0.4 to 2.3 is fully developed. Profile and background >> content: linkbyid

© Shotshop / Marcin Balcerzak

Emergency contraception: morning-after pill, morning-after coil

There are two types of over-the-counter pills available from pharmacies. The (copper) coil afterwards prevents the implantation of a fertilized egg cell up to the fifth day after fertilization at the latest and is used for further contraception (the gynecologist must insert it). Profile: This is how emergency contraception works >> content: linkbyid

content: linkbyid

content: linkbyid

© Fotolia / W. Heiber Studio

Sterilization of the man:

This measure, also known as a vasectomy, is significantly easier than sterilization for women, it is quite safe and a permanent solution for couples in a stable relationship with family planning completed. Pearl index about 0.1. Profile: Sterilization in Men >> content: linkbyid

© iStock / 66North

Sterilization of the woman:

The doctor makes the fallopian tubes impermeable to sperm and single cells in one operation. In a sense, this is a decision forever that needs to be carefully considered. Profile: Sterilization in women >> content: linkbyid


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Contraception check-up soon

  • Micropill

Micropills contain the hormones estrogen and progestin in low doses and prevent ovulation. Most common mistake: forgetting to take the pill, or vomiting or diarrhea prevents the body from absorbing it. Taking other drugs, such as antibiotics, can also compromise its effectiveness. Low-dose hormone delivery systems of the type contraceptive ring or contraceptive plaster (see below) have a similar effect to the micropill.

  • Desogestrel mini pill (non-estrogenic ovulation inhibitor)

The active ingredient is the progestin desogestrel in a dosage that inhibits the maturation of the egg cell or ovulation. So it works similarly and as safely as the micro pills, but belongs to the mini pills. Because the hormone dose is still small. Like all mini pills, it does not contain any estrogen. It is an option, for example, for women who cannot tolerate or do not want to use contraceptives containing estrogen.

  • Conventional mini pill

These mini pills contain the progestin levonorgestrel. The dose is even lower than that of the desogestrel minipill. Among other things, the preparations cause the mucus in the cervix to thicken and thus prevent the egg cell from being fertilized. They do not inhibit ovulation. With traditional mini pills, it is even more important than the other pills to take them at the same time each day. The leeway is only a maximum of three hours.

  • Contraceptive ring (vaginal ring, hormone ring)

The plastic ring releases progestin and estrogen. It is inserted into the vagina and remains there for three weeks. A week later the new ring is inserted. Small amounts of the hormones enter the bloodstream directly through the vaginal wall and not through the digestive tract, as is the case with the pill. They inhibit ovulation. The vaginal ring is also effective when the woman is suffering from diarrhea or vomiting. With the pill, on the other hand, the effect can be impaired in such cases. A loss of effectiveness is to be feared for the ring if it has been outside the vagina for more than three hours.

  • Hormonal IUD

The hormone coil is made of flexible plastic and releases the hormone progestin directly in the uterus. The preventive effect is primarily based on the local changes in the uterus and the effects on the sperm. One of the two smaller versions (with the lowest hormone dose) can be used for a maximum of three years. The other two hormonal IUDs can remain "active" in the uterus for up to five years. IUDs are one of the long-acting contraceptives. Side effects of the hormones can be significant.

  • Contraceptive patch (hormonal patch)

Contraceptive patches also work by releasing hormones - this time through the skin - and must be changed once a week. Diarrhea and vomiting do not affect safety. However, the plaster can come off. Skin irritation is also possible, as well as side effects of course from the hormones contained (estrogen-progestogen combination).

  • Contraceptive stick (hormone implant, hormone stick)

Hormone implants only contain progestin. The small amounts of hormones released mainly inhibit ovulation and thicken the cervical mucus. Your Pearl Index is very low, as there are no mistakes in taking it. The implant is also one of the long-acting (here: hormonal) contraceptives. It is placed under the skin in a small procedure and usually stays there for three years. It is therefore suitable, for example, for women who do not want to have a child in the medium term.

  • Three-month injection

The depot injection is actually only suitable for women who cannot tolerate other contraceptive methods or who cannot use contraceptive pills. The active ingredient is the hormone progestin. It is injected into the gluteal or upper arm muscle every three months. With this method, too, the risk of revenue errors is zero. Diarrhea and vomiting do not limit safety. But: If the last injection was more than 13 weeks ago, contraceptive protection is no longer safe. Under the influence of the three-month injection, the bone density sometimes decreases, which can promote osteoporosis.

  • Copper spiral

Like the hormone IUD, the copper IUD is made of plastic. Its shaft is wrapped with a copper wire. Under the influence of the copper ions, the mucus in the cervix and in the uterus changes so that the sperm can no longer reach the egg; the implantation of an egg cell that is still fertilized is inhibited. The copper IUD (possibly also with gold or silver content) does not contain any hormones, application errors are as good as impossible. Depending on the model, it can have a preventive effect for up to ten years.

  • Copper chain

The copper chain is a further development of the copper spiral and has a similar effect. Since it does not have a fixed frame, it adapts well to the uterus.

  • condom

Condoms are not as safe as pills, IUDs, etc.But they are the only contraceptive - in addition to the female condom, which we rarely use - to reduce the risk of transmitting diseases such as HIV / AIDS, gonorrhea, chlamydial infections, syphilis or hepatitis B during sexual intercourse. Men and women who are not sure whether their sexual partner is healthy in this regard should definitely use condoms as well.

  • Diaphragm / contraceptive cap

The classic diaphragm or the contraceptive cap must be expertly fitted and sit exactly over the cervix. The woman learns how to use such a vaginal pessary correctly and control the fit. The pessaries are always combined with a contraceptive gel. The methods are hormone-free. Security stands and falls with the right application. For example, if the pessary slips, it no longer offers any protection. In pharmacies, for example, there is now a diaphragm in a standard size.

  • Chemical contraceptives

Sperm paralyzing or killing (spermicidal) agents, for example as vaginal suppositories (ovules), are not very safe when used alone. In combination with a diaphragm or a contraceptive cap, safety increases. However, follow the instructions for use carefully. Some chemical contraceptives can make condoms less safe.

  • Natural birth control methods

The main focus is on the temperature method and the Billings method for determining the amount of mucus from the cervix. Both are summarized as the so-called symptothermal method. It is an important part of natural family planning. There are also modern electronic aids such as small computers and various apps.

Which method suits me?

Women who clearly do not want a child in their current phase of life should choose a method of contraception with good security. Women who do not want to become pregnant should definitely not rely on contraceptive protection only during the "fertile days".

Contraceptive safety, living conditions, tolerance, health restrictions: The requirements for a method of contraception vary greatly from woman to woman and can change in the course of life. Appropriate care is particularly important for methods that can result in application errors. Always think about the recommended check-ups at the gynecologist.

Contraception failure? What to do in an emergency

If a woman is concerned that she could become pregnant unintentionally, if she is using a contraceptive, she should immediately find out what to do in the package insert (printed insert, online). The morning-after pill can prevent an unwanted pregnancy. To be effective, it should be taken as soon as possible after unprotected sex (see link "Emergency contraception" below).

Another possibility is the IUD afterwards (the gynecologist places it in the uterus). If a person concerned would like to consider this variant, which also enables subsequent contraception, they should contact their gynecologist as soon as possible. The morning-after pill is (also) available without a prescription in pharmacies.

Attention: Women up to their 20th birthday can use the appropriate medication on prescription received free of charge (from 18th to 20th birthday with an additional fee). Medical advice in the event of a suspected unwanted pregnancy can therefore be useful, not least if there are uncertainties about emergency contraception due to possible health problems. You can find out more about the "morning-after pill" and "morning-after coil" methods in the picture gallery above and in the article "emergency contraception".


Professional Association of Gynecologists (BVF) (Ed.) In cooperation with the German Society for Gynecology and Obstetrics e. V .: Prevention. In: gynecologists on the net. Online:ösungen (accessed on February 13, 2019)

Iversen L, Sivasubramaniam S, Lee AJ, et al .: Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners ’Oral Contraception Study. American Journal of Obstetrics & Gynecology, 2017. Online (abstract): Am J Obstet Gyneccol. 2017 Jun; 216: 580.e1-580.e9. doi: 10.1016 / j.ajog.2017.02.002. Epub 2017 Feb 8. (Retrieved February 13, 2019)

Guidelines of the German Society for Gynecology and Obstetrics (DGGG) e.V .: Contraception, AWMF 015/015 (in revision; accessed on February 13, 2019)

Everything about contraception

  • Chemical contraceptives
  • Natural birth control methods
  • Emergency contraception: morning-after pill
  • Sterilization of the woman: blockage of the fallopian tubes
  • Sterilization of the man: the vasectomy
  • Contraception: diaphragm and contraceptive cap
  • Contraception: the pill
  • Contraception: three-month injection (depot injection)
  • Contraception: IUD
  • Contraception: condom
  • Contraception: copper IUD
  • Contraceptive patch
  • Contraceptive ring
  • Contraceptive stick (hormone implant)


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