Women's health

Choosing contraception: effectiveness and eligibility

How to rank methods by effectiveness, use the medical eligibility criteria, and handle the conditions where estrogen is unsafe.

9 min read·core·

Reviewed by a licensed nurse · 2 November 2026

Effectiveness tiers

Tier	Methods	Typical-use pregnancies per 100 women a year
Most effective	Implant, hormonal and copper IUD, sterilization	Under 1
Highly effective	Injection (DMPA)	About 4
Moderately effective	Pill, patch, ring	About 7
Less effective	Condoms, withdrawal, fertility awareness	About 13 to 20

Figures are approximate and come from the CDC and WHO family planning summaries.

·Migraine with aura.
·Current or past venous thromboembolism, or known thrombogenic mutation.
·Smoking at age 35 or older.
·Hypertension that is uncontrolled or with vascular disease.
·Breast cancer, now or in the past.
·Within 21 days after delivery, and in the early weeks for breastfeeding clients.
·Complicated valvular heart disease or ischemic heart disease.

·Breastfeeding: progestin-only methods, copper IUD, or implant.
·Heavy menstrual bleeding: levonorgestrel IUD or combined methods.
·Desire to avoid hormones: copper IUD or barrier methods.
·Adolescents: long-acting reversible methods are appropriate, with condoms for infection prevention.
·Drug interactions: enzyme inducers such as rifampin, carbamazepine and some antiretrovirals reduce the efficacy of pills, so use an IUD or injection.

Check yourself

1. A 30-year-old reports visual zigzag lines before her migraines and requests the combined pill. What is the best response?
2. Which method has the lowest typical-use failure rate?
3. A patient taking rifampin asks about contraception. Which is the best choice?