Contraception Guide: Pills, Injections, IUD, Condoms and Emergency Contraception

Family planning (khandani mansooba bandi) is a normal part of married life, and it protects the health of mothers and babies. Spacing births by at least two to three years lowers the risk of anaemia, miscarriage, premature birth and maternal death. Yet many couples in Pakistan make decisions based on rumours, whispers from relatives or guesswork, and many women do not know that more than one safe, reversible method exists.

This guide explains the main methods of contraception in simple terms, how well each works, their side effects, which methods suit breastfeeding mothers, how emergency contraception works, and the myths that cause the most confusion.

Why plan the spacing of children?

• A mother’s body needs time to recover and rebuild iron and calcium between pregnancies. See our guides to iron deficiency and calcium deficiency.
• Babies born after a gap of two to three years or more are healthier and more likely to survive.
• Couples can plan finances, education and care for each child.

Methods: how they work and how well

Effectiveness is shown for typical use. Out of 100 women using a method for a year, how many become pregnant?

Long-acting reversible methods (most effective)

• Copper IUD (the coil): a small device inserted into the womb by a doctor, works for up to ten years, with fewer than one pregnancy per 100 women. It can make periods heavier and crampy at first. It has no hormones.
• Hormonal IUD: releases a small amount of hormone, lasts years, and often makes periods lighter.
• Implant: a small rod under the skin of the arm, lasts about three years, with fewer than one pregnancy per 100. It may cause irregular bleeding.

Injections

An injection of medroxyprogesterone (DMPA, for example Depo-Queen, see the medroxyprogesterone page) every three months is very popular. About 4 in 100 become pregnant with typical use. Side effects: irregular or absent periods, spotting, weight gain, and a delay of some months in return to fertility after stopping. Long-term use can reduce bone density slightly. It is private, and does not need to be remembered daily.

Pills

• Combined pills (oestrogen and progestin), such as Sulvo, and the Famila range (Famila-28F), prevent ovulation. About 7 to 9 in 100 get pregnant with typical use, because pills are missed. They are taken daily, and make periods regular and lighter. They are not suitable for women who smoke over 35, have had blood clots, have migraine with aura, high blood pressure, certain liver or breast conditions, or who are breastfeeding in the first six months. Rare, serious risk: blood clots.
• Progestin-only pills (mini-pills) are suitable during breastfeeding, and for women who cannot take oestrogen. They must be taken at the same time every day.

Barrier methods

• Male condoms are about 13 in 100 pregnancies with typical use, and about 2 in 100 with perfect use. They are the only method that also protects against sexually transmitted infections. Use a new one each time, check the expiry date, and store them in a cool, dry place. Browse the sexual wellness category.
• Female condoms, diaphragms and spermicides exist, with lower effectiveness.

Natural methods

• Breastfeeding (LAM): works for up to six months only if the baby is exclusively breastfed day and night, and your period has not returned. It is not reliable after that.
• Calendar and withdrawal methods have high failure rates (about 20 to 25 in 100). They are better than nothing, but not dependable.

Permanent methods

Tubal ligation for women and vasectomy for men are very effective, and are for those who are sure that they do not want more children. Vasectomy is simpler and safer than female sterilisation.

Choosing a method

Think about how soon you want a pregnancy, how comfortable you are with remembering a daily pill, your health, side effects you can accept, and how private you want it. Your doctor or a family planning clinic can help, free of judgement. Government health centres and many NGOs offer free counselling and methods.

Emergency contraception

Emergency contraceptive pills, containing levonorgestrel, reduce the chance of pregnancy after unprotected intercourse, a condom accident, or missed pills. Examples include ECP Tablets, Emkit, Emket DS and Emergency Pills. See the levonorgestrel page.

• They work best as early as possible, ideally within 72 hours (three days), and have some effect up to 120 hours, depending on the product.
• They work mainly by delaying ovulation. They do not end an existing pregnancy, and they are not the abortion pill.
• They are for emergencies, not regular use. They are less effective than regular methods, and can upset your cycle.
• Side effects: nausea, headache, tiredness, breast tenderness, and early or late periods. If you vomit within a few hours, ask whether you need another dose.
• If your period is more than a week late, take a pregnancy test. See our guide to pregnancy vitamins and supplements for what to do next.
• A copper IUD placed within five days is the most effective emergency method.

Interactions to know

• Rifampicin (TB), some anti-seizure medicines such as carbamazepine, and St John’s wort can reduce the effect of hormonal contraceptives. Read our guides to TB treatment and epilepsy medicines. Use another method as well.
• Vomiting or severe diarrhoea can reduce pill absorption.
• Most antibiotics do not reduce the effect of the pill, with the exception of rifampicin, but ask your doctor.

Common myths

• Myth: the pill causes permanent infertility. No. Fertility returns after stopping, with injections taking a few months longer.
• Myth: contraception causes cancer. Hormonal methods slightly raise some risks (such as breast and cervical cancer) in some women, and clearly reduce the risk of ovarian and womb cancer.
• Myth: you must take a break from the pill. No.
• Myth: breastfeeding alone is always safe. Only if the strict conditions are met.
• Myth: contraception is against religion. Many scholars and religious authorities accept spacing births for the health of mother and child. Discuss with someone you trust.

When to see a doctor

• Before starting any hormonal method, to check blood pressure and your history.
• Severe leg pain or swelling, chest pain or sudden breathlessness, severe headache, vision changes or weakness. These can be signs of a clot, and are emergencies.
• Heavy or very prolonged bleeding.
• A missed period, or severe lower belly pain, especially with an IUD or after an emergency pill.
• Difficulty with side effects. There are many options.

Frequently asked questions

Which method is best for breastfeeding mothers?

Progestin-only methods (mini-pill, injection, implant, hormonal IUD), copper IUD and condoms are suitable. Combined pills are generally avoided in the first six months.

Can I get pregnant straight after stopping the pill?

Yes, it can happen quickly.

Can a husband and wife both use methods?

Yes. Using condoms in addition to another method adds protection against infections.

Is it all right to use emergency pills again and again?

It is safe for health, but it is not a good regular method. Choose an ongoing method.

Order contraceptives and family planning supplies from Khasmart, with discreet delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor. It does not include doses; your doctor decides the medicine and amount. Always follow the directions on the pack or from your doctor.