Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice

Figures & data

Table 1. Efficacy, advantages, and disadvantages of different contraceptive methods.

	Type of method	Efficacy	Benefits/advantages	Risks/disadvantages
Natural contraceptive methods	Lactational amenorrhea method	>98% success in the first 6 months post-partum	- Unexpensive - No drugs needed	- Temporarily (only for 6 months)
	Billing ovulation method	- Method-related PI: 2.8 - Teaching-related PI: 3.5	- Unexpensive - No drugs needed - Women gain more self-awareness	- The learning period can be long, and pregnancies can occur during this time - PI is generally higher than other methods - Failure rate of 84.1% for imperfect use - Unfavorable for occasional sexual intercourses - Menstrual irregularities may make it harder to use
	Symptothermal method	Unintended pregnancy rate per 100 women per 13 cycles: 1.61 (0.43 for perfect use)	- Overall satisfaction rate >90% - Unexpensive - No drugs needed - Women gain more self-awareness	- The learning period can be long, and pregnancies can occur during this time - PI is generally higher than other methods - Unfavorable for occasional sexual intercourses - Menstrual irregularities may make it harder to use
Non-hormonal contraceptive methods	Copper IUD	PI: 0.16-1.26	- It does not depend on daily compliance - It can be used when hormones are contraindicated	- Risk of AUB (i.e. spotting) - Risk of ectopic pregnancies
Hormonal contraceptive methods	Combined oral contraceptives	PI: 0-2.18 Perfect use pregnancy rate: 0.3%	- Medical effects (i.e. endometriosis, fibromyomas, hyperandrogenism, PMS…) - Useful to treat hormone deficiency - Protective against some gynecological cancer and colo-rectal cancer	- Age and socioeconomic status may affect the failure rate - Estrogen-related side effects (i.e. VTE risk, dyslipidemia, mood disorders…) - Risk of forgetfulness - Pay attention to contraindications - Possible drug interactions
	Combined non-oral contraceptives	PI:	- Medical effects (i.e. endometriosis, fibromyomas, hyperandrogenism, PMS…) - Useful to treat hormone deficiency in POI - Less systemic effects than oral-CHCs - Protective against some gynecological cancer and colo-rectal cancer	- Age and socioeconomic status may affect the failure rate - Estrogen-related side effects (i.e. VTE risk, dyslipidemia, mood disorders…) - Risk of forgetfulness - Pay attention to contraindications - Possible drug interactions
	Progestin-only pills	PI: 0.41 Perfect use pregnancy rate: 0.3%	- Medical effects (i.e. endometriosis, fibromyomas, hyperandrogenism, PMS…) - No side effects related to estrogens	- Age and socioeconomic status may affect the failure rate - Risk of forgetfulness - Pay attention to contraindications - Possible drug interactions - Risk of AUB
	LNG-IUD	PI: 0.09-0.11	- Medical effects (i.e. chronic treatment of fibromyomas) - No systemic effects - Forgettable contraception	- Pay attention to contraindications - Risk of AUB - Risk of ectopic pregnancies
	Subdermal implants	PI: 0-0.3	- No systemic effects - Forgettable contraception - Medical effects (i.e. treatment of AUB)	- Pay attention to contraindications - Risk of AUB - Estrogen-related side effects

AUB, abnormal uterine bleeding; CHC, combined hormonal contraception; IUD, intrauterine device; LNG, levonorgestrel; PI, Pearl Index PMS, premenstrual syndrome; POI, premature ovarian insufficiency; VTE, venous thromboembolism.