The question women ask most frequently is: 
“Which birth control is best for me?” 

There is no single "best" answer. 
Rather, the best choice is the one that "fits your body and lifestyle." 

At Femily Wellness Clinic, 
many patients find themselves choosing among 4 main methods: 

• Oral contraceptive pills 

• Intrauterine devices (IUDs) 

• Contraceptive implants 

• Contraceptive injections 

This article provides a detailed, straightforward explanation of each. 

1️⃣ Oral Contraceptive Pill (oral contraceptive pill) 

How It Works 

Contains estrogen + progestin 
to suppress ovulation and thin the uterine lining. 

Effectiveness 

• With perfect use: >99% 

• With typical use (occasional missed pills or irregular timing): around 91% 

Pros

• Helps regulate menstrual cycles 

• Reduces menstrual cramps 

• Helps clear up acne in some individuals 

Cons 

• Must be taken daily 

• May cause nausea initially 

• Risk of forgetting a dose 

• Not recommended for those with certain underlying medical conditions 

Best Suited For

• Women who are disciplined about a daily routine and wish to regulate their period. 

  
  

2️⃣ Intrauterine Device (Intrauterine Device: IUD) 

Available in 2 types: 

• Copper IUD (hormone-free) 

• Hormonal IUD 

Effectiveness: 99% 

Pros 

• No daily routine to remember 

• Lasts for 3 to 10 years 

• Rapid return to fertility after removal 

Cons

• Requires insertion and removal by a healthcare professional 

• May cause irregular spotting in the initial months 

Best Suited For

• Women looking for highly effective, long-term contraception 

• Hormonal IUDs are particularly effective at reducing heavy menstrual bleeding 

3️⃣ Contraceptive Implant (Implant Contraception) 

A small rod inserted under the skin of the inner upper arm 
that continuously releases progestin. 

Effectiveness 

99% (highly effective) 

Pros 

• Lasts for 3 to 5 years 

• Excellent for those who prefer not to remember a daily or weekly routine 

Cons 

• Irregular spotting is a common side effect 

• Requires insertion and removal by a healthcare professional 

Best Suited For

• Busy working professionals; the implant is a highly popular choice due to its convenience and reliability. 

4️⃣ Contraceptive Injection (Injectable Contraception) 

 The contraceptive injection delivers hormones intramuscularly 
to prevent ovulation and thin the uterine lining. 

There are 2 main types commonly used: 

1. Once-a-month injection 

2. Every-3-months injection  

🔹 Once-a-Month Injection (Combined Injectable) 

Contains 
estrogen + progestin. 

Key Features 

• Menstrual periods usually remain relatively regular 

• Lower incidence of irregular spotting compared to the 3-month injection 

• Hormonal profile is similar to combined oral contraceptive pills 

Important Considerations 

• Requires monthly visits for the injection 

• Contraindicated for individuals with blood clot risks, such as heavy smokers or those over age 35 with other risk factors 

🔹 Every-3-Months Injection (DMPA – Progestin only) 

Contains only progestin. 

Key Features 

• Estrogen-free 

• Suitable for individuals with contraindications to combined hormones 

• Requires only 4 injections per year (every 3 months) 

Important Considerations

• Menstrual periods may stop temporarily 

• Irregular spotting is common, especially in the beginning 

• After stopping, it can take several months for ovulation to fully return 

• Long-term use may warrant a periodic evaluation of bone health as appropriate 

According to guidelines from the 
World Health Organization 
and the American College of Obstetricians and Gynecologists, 
long-term DMPA use is acceptable for individuals with no contraindications, provided patients are fully informed about its potential effects on bone mineral density. 

How to Choose 

For busy working professionals who prefer a regular menstrual cycle, 
the monthly injection is often preferred. 

However, for breastfeeding mothers or those with estrogen contraindications, 
the 3-month injection is generally the more appropriate option. 

It is essential to discuss the possibility of "initial irregular bleeding" beforehand, 
as many individuals discontinue use due to concern, even though this is a common side effect that typically improves over time. 

Summary of Choice 

• Prefer regular periods → Choose the monthly injection 

• Cannot use estrogen / Currently breastfeeding → Choose the 3-month injection 

• Prefer fewer menstrual periods → Choose the 3-month injection 

Your choice should be discussed and evaluated with a healthcare professional to assess your unique medical history and risk factors. 

So, which is the "best" option? 

There is no single best method. Factors to consider include: 

• Age 

• Underlying medical conditions 

• Smoking status 

• When you plan to have children 

• Any current menstrual issues 

The 
American College of Obstetricians and Gynecologists 
recommends considering Long-Acting Reversible Contraception (LARC), such as IUDs and implants, as first-line options for women who do not have contraindications. 

Frequently Asked Questions

Does the implant cause weight gain?
Some individuals may experience a minor weight increase, but this does not affect everyone.

Is IUD insertion painful?
You may experience temporary, mild cramping that lasts only a few minutes during insertion.

Will it take longer to get pregnant after stopping contraceptive injections?
It can take 6–12 months for your natural menstrual cycle and fertility to fully return.

What should I do if I miss an oral contraceptive pill?
The next steps depend on which week of the pack you are in. Please refer to the package instructions or consult your doctor.

Summary 

For maximum convenience → Choose the implant or an IUD. 
To actively manage your cycle → Choose the pill. 
To avoid estrogen → Choose the injection, implant, or an IUD. 

For personalized advice and to find the best fit for your body, please consult with a specialist. 

Written by 

Dr. Wichadet Wichulada 
Obstetrician-Gynecologist specializing in Maternal-Fetal Medicine, King Chulalongkorn Memorial Hospital 

Research published in the International Journal of Transgender Health 

References 

1. American College of Obstetricians and Gynecologists (ACOG). Long-Acting Reversible Contraception Practice Bulletin. 

2. World Health Organization. Medical eligibility criteria for contraceptive use. 

3. Williams Obstetrics, 26th Edition.