Contraception is never a “one size fits all” situation. What works perfectly for one person may not be suitable for another – depending on their health, stage of life, relationship and other personal needs. The good news is that there are many ways to prevent pregnancy – from hormonal to mechanical to natural. In most cases, however, the responsibility lies with women. 

The Pearl Index shows how reliable a method is in everyday use: it indicates how many out of 100 women become pregnant within a year despite using the contraception method. For example, if four out of 100 women become pregnant in 12 months despite using the contraception, the Pearl Index is 4.

This means that the lower the number, the more reliable the method. However, the Pearl Index does not provide any guarantees, only guidelines. There are sometimes differences in the Pearl Index figures. This is because the study conditions are not always consistent and a distinction is made between correct and incorrect use. 

The critical factor remains how carefully the method is used in everyday life. The right information combined with medical advice leads to a confident decision. 

Condoms and femidoms 

The condom is a mechanical contraceptive made of latex that also protects against sexually transmitted diseases such as HIV, hepatitis B and sexually transmitted diseases – a benefit that no other contraceptive method offers. It is available in different sizes – and also in a latex-free version for people with allergies. It has no side effects, but its effectiveness depends largely on correct use and a proper fit. 

Since contraception with condoms requires some practice and they can slip off or tear in the heat of the moment, the Pearl Index range for condoms is between 2 and 12. It is important not to use condoms after their expiration date and to store them in a cool place protected from light until use. A variation of the condom is the femidom, which is inserted into the vagina. Its Pearl Index varies between 5 and 25. 

The pill

The contraceptive pill is widely used and provides reliable protection when taken correctly. Its Pearl Index is between 0.1 and 3. A distinction is made between oestrogen-progestogen combination preparations (micro pills) and products that only contain progestogen (mini pills or oestrogen-free pills).

The pill is usually taken at the same time every day for 21 days. This is followed by a seven-day break, during which menstrual bleeding occurs. The pill can also be taken continuously for various reasons, but this should be discussed with a doctor beforehand. 

The type of pill that is most suitable depends on individual factors, which is why it is important to consult a doctor. The pill can have a positive effect on menstrual cramps, menstrual cycle irregularities and skin blemishes, but there is also a long list of possible side effects.

These can include breakthrough bleeding, headaches, breast tenderness, nausea, reduced libido and mood swings. The risk of thrombosis also increases, especially in combination with other risk factors. In addition, the pill’s effectiveness may be impaired by incorrect use, vomiting, severe diarrhoea, or if taking certain other medications (e.g., antibiotics). 

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Vaginal ring 

The vaginal ring is a flexible plastic ring that releases low doses of oestrogen and progestogens. It’s similar to the pill, except that the active ingredients enter the bloodstream via the vaginal wall.

The ring is inserted by the user and remains in the body for 21 days. Bleeding occurs during the one-week break. After that, a new ring is inserted. It is important that the ring should not be noticeable. 

The advantage over the pill is that women do not have to remember to take it every day and its effectiveness is not compromised in the event of vomiting or diarrhoea.

However, discipline is still required, as the ring always needs to be removed and inserted on the same day of the week and at the same time. The side effects are similar to those of the pill, but the risk of thrombosis is higher. In addition, the ring may be noticeable and uncomfortable during sex. 

IUD: Hormonal IUD, copper IUD and copper chain 

The IUD is a long-term contraceptive and all types are inserted into the uterus by a gynaecologist. A distinction is made between the hormonal IUD and the copper IUD. Both consist of a small T-shaped plastic body with a retrieval thread. 

The hormonal IUD releases small amounts of progestogen directly into the uterine lining for up to five years and has a Pearl Index of 0.16. The copper IUD does not contain any hormones; instead, its shaft is wrapped in copper wire.

The copper ions released damage the sperm and thus prevent fertilization. The copper IUD can remain in the uterus for three to five years and has a Pearl Index of 0.4 to 3. The copper chain is a further development of the copper IUD. It works in the same way, but consists of several copper links strung on a surgical thread, the end of which is anchored in the uterine wall. 

The hormone progestogen contained in the hormonal IUD mainly acts on the uterus, but similar side effects to those of other hormonal contraceptives may occur, especially at the beginning of its use. Menstrual bleeding may become heavier, longer or irregular, especially in the first few months.

There is also a risk that the IUD may slip or be expelled. The uterus may also be injured during insertion – a risk that also applies to copper IUDs and copper chains. They can also increase menstrual bleeding and period pain. 

Contraceptive patch 

The patch releases hormones through the skin and must be changed on the same day each week. It is worn for a total of three weeks, followed by a one-week break. Side effects are similar to those of the pill, and skin irritation may also occur.

The advantage of the contraceptive patch is that it is easy to use, but the risk of thrombosis is twice as high as with modern micro pills. 

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Contraceptive implant 

The two-millimetre-thin implant is about four centimetres long and is inserted under the skin by a doctor, where it releases the hormone progestogen for a maximum of three years. The side effects are comparable to other hormonal contraceptives, but the risk of application errors is very low. The Pearl Index is correspondingly low at 0 to 0.08. 

Three-month injection 

With the contraceptive injection, a high dose of the progestogen hormone is injected into the upper arm or buttock. The effect lasts for about three months. The list of side effects is similar to that of other hormonal contraceptive methods, but long-term use also increases the risk of osteoporosis.

In addition, the injection cannot be stopped spontaneously and it can take several months after stopping before the natural cycle stabilises again and pregnancy is possible. The Pearl Index is between 0.2 and 1.4. 

Diaphragm 

The diaphragm is a dome-shaped device made of latex or silicone and a flexible wire ring. It is inserted into the vagina at least two hours before sexual intercourse and is usually combined with a contraceptive gel. The right size and application are crucial, as it must be placed exactly over the cervix.

The size must also be checked every two to three years, after childbirth, or if there is a weight gain or loss of more than five kilograms, and adjusted if necessary. 

It should be removed and cleaned with soap and water no sooner than eight hours and no later than 24 hours after sex. The Pearl Index ranges between 1 and 20, as it requires practice and its reliability depends heavily on correct use. Some women become more susceptible to bladder and vaginal infections when using it, and it also slightly restricts sexual spontaneity. 

Chemical contraceptives 

Chemical contraceptives such as foam suppositories or special creams immobilise or kill sperm and also form a thick mucus in front of the cervix. However, they are unreliable on their own, with a Pearl Index between 3 and 21.

They are inserted deep into the vagina about 20 minutes before sex and are effective for a maximum of one hour and only for a single ejaculation. They should only be used in combination with mechanical methods such as a diaphragm or condom. The most common side effects include irritation of the mucous membrane, burning and allergic reactions. 

Natural family planning (NFP) 

Natural contraception relies on observing the body – especially fluctuations in basal body temperature and changes in cervical mucus. Fertile days can be identified with the help of a thermometer, pen and paper, or apps and mini-computers. During this time, sex should be avoided or a condom should be used.

The Pearl Index depends heavily on how accurately the method is used. When used correctly, this method of contraception is as reliable as the pill, with a Pearl Index of 0.4 to 0.6. However, couples must be consistent and women must be prepared to pay close attention to their bodies and their cycles. The big advantage is that there are no side effects.