Contraception

Perfect use and typical use

Effectiveness is quoted two ways. Perfect use assumes the method is used exactly as intended every time. Typical use reflects what happens in real life — a missed pill, a late injection, a condom used incorrectly.

For methods that require nothing from the user once in place, the two figures are the same. For methods that require daily or per-occasion attention, the gap is substantial, and it is the typical-use figure that describes what actually happens.

• Contraceptive implant — over 99% with both perfect and typical use; lasts 3 years
• Hormonal IUD — over 99% with both; the 52 mg device is approved for 8 years of contraception, smaller devices for 5
• Copper IUD — over 99% with both; 5 to 10 years depending on the device
• Contraceptive injection — over 99% perfect use, about 96% typical use; every 3 months
• Combined pill — over 99% perfect use, about 93% typical use; taken daily
• Progestogen-only pill — over 99% perfect use, about 93% typical use; taken daily
• Vaginal ring — over 99% perfect use, about 93% typical use; replaced every 3 weeks
• External condom — 98% perfect use, about 88% typical use; the only method that also protects against sexually transmitted infections
• Diaphragm — 86% perfect use, about 82% typical use
• Vasectomy and tubal ligation — over 99%; intended to be permanent

Why long-acting methods are usually raised first

Implants and intrauterine devices are described as long-acting reversible contraception. Once in place they require nothing day to day, which is why their typical-use effectiveness matches their perfect-use effectiveness — there is nothing left to get wrong.

Australian guidance encourages discussing these methods first, not because they suit everyone but because people are often not told about them properly. Users of long-acting methods are about three times more likely to still be using their method a year later than people using other methods.

Reversibility is frequently misunderstood. Fertility returns quickly after an implant or IUD is removed, and periods usually return within about a month after implant removal. The exception is the injection, where return of fertility can be delayed — Australian sources give figures ranging from up to twelve months to as long as eighteen. If a pregnancy is being considered within the next year or two, that matters.

What insertion involves

The implant is a small flexible rod placed under the skin on the inner upper arm using local anaesthetic, so the insertion itself is not painful. Some bruising or soreness afterwards is normal, and a small scar remains. Backup contraception is needed for seven days unless it is inserted at a particular point in the cycle.

IUD insertion takes a few minutes, within an appointment of around fifteen minutes, and people are usually asked to stay a little afterwards. A speculum is used, as for a cervical screening test, and a fine thread is left through the cervix.

Pain varies genuinely between people. Many describe cramping similar to period pain; for some it is briefly more intense than that. Australian guidance is clear that pain relief options should be discussed and offered to everyone having an IUD inserted — that can include taking simple analgesia beforehand, local anaesthetic applied to or injected around the cervix, inhaled analgesia, or in some cases referral for sedation or a general anaesthetic. It is entirely reasonable to ask what will be offered before booking.

Afterwards, mild cramping and some bleeding for a day or two is normal and most people return to usual activities. It is worth checking the threads occasionally, and seeking review if they feel much longer or shorter or cannot be felt at all.

Not every GP inserts implants and IUDs — it requires specific training. Many practices offer it and others refer to a colleague, a family planning clinic or a gynaecologist, so it is worth asking.

What makes some methods unsuitable

A handful of factors genuinely change what can safely be used, which is why a contraception appointment includes questions that may seem unrelated.

Migraine with aura is a firm contraindication to oestrogen-containing contraception, including the combined pill and the vaginal ring. Progestogen-only methods and the copper IUD remain appropriate. Combined hormonal contraception also increases the risk of venous thromboembolism, so a personal or strong family history of clots, or a known clotting disorder, points away from it — progestogen-only methods do not carry that increase.

Oestrogen-containing methods are generally avoided in people who smoke and are over 35, in the period immediately after birth, and where BMI is 35 or above. Blood pressure is checked because it influences the choice. When breastfeeding, progestogen-only methods can all be used safely.

Emergency contraception

Three options are available in Australia and they are not equivalent.

The levonorgestrel pill can be used up to 72 hours after unprotected sex, and the ulipristal acetate pill up to 120 hours — ulipristal is the more effective of the two. Both are available from pharmacies without a prescription, and both work best the sooner they are taken. Between them they prevent roughly eight in ten expected pregnancies.

The copper IUD is the most effective form of emergency contraception, preventing around 99 per cent of expected pregnancies when inserted within five days — and it is the only option that then continues as ongoing contraception for years afterwards. It is also the least used, largely because people do not know it is an option.

Body weight, other medicines and existing medical conditions can affect which pill is recommended, so it is worth mentioning these to the pharmacist or doctor. Whichever option is used, a follow-up to confirm the result, arrange ongoing contraception and consider testing for sexually transmitted infections is sensible.

Access has improved recently

Several changes have made contraception more affordable in Australia. In March 2025 two combined oral contraceptives were added to the Pharmaceutical Benefits Scheme — the first new oral contraceptives listed in over 30 years — substantially reducing their annual cost. The vaginal ring was PBS-listed in November 2025.

From November 2025, Medicare rebates for inserting and removing implants and IUDs increased considerably, and funding was committed to training more practitioners to provide them. Pharmacist prescribing of some contraceptives has also been expanding state by state, on different terms in each.

When to seek help sooner

Severe abdominal pain, heavy or prolonged bleeding, fever, or unusual vaginal discharge after an IUD insertion should be assessed promptly. So should being unable to feel the IUD threads, or being able to feel the device itself.

A severe headache, a first migraine or a change in migraine pattern while using oestrogen-containing contraception, chest pain, breathlessness, or pain and swelling in one leg need urgent assessment. If a pregnancy occurs with an IUD in place, that also needs prompt review.