Contraception
If you are sexually active and want to avoid an unplanned pregnancy, it is important to learn about the contraceptive options available to you. Choosing an appropriate contraceptive method is part of taking care of your health—and today there is a wide range of options, so it is almost always possible to find the one that best suits you.
The following article aims to help you become familiar with all available contraceptive methods, their advantages and disadvantages, as well as the considerations for choosing the most suitable method for you.
What are contraceptives
Contraceptive methods are designed to help you control and choose if and when to become pregnant. Correct use of contraceptives allows you to enjoy a healthy and safe sex life without worrying about an unplanned pregnancy.
It is also important to note that condoms are the only method of contraception that also protect you against sexually transmitted diseases. Other contraceptive methods do not protect against sexually transmitted diseases.
Current methods of contraceptives
There is today a wide range of contraceptive methods, and it is important to find the one that best suits you and your needs.
Important to emphasize
Important to emphasize
When a range of contraceptive effectiveness rates is listed, the higher percentage refers to the theoretical effectiveness that can be achieved with perfect use. Alongside it, the practical effectiveness is also presented, which takes into account possible mistakes such as inexperience, improper use, inconsistent use, and similar factors. In other words, careful and correct use of the contraceptive method you choose will help increase its rate of effectiveness.
Hormone-based contraceptives
Birth control pills
How it works: Daily intake of the pill that contains hormones, generally estrogen and progesterone, that prevent ovulation (release of eggs from the ovary).
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Advantages
- Highly effective in in preventing pregnancy (92%-99%).
- Can alleviate menstrual pain, reduce acne and hair loss.
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Disadvantages
- Requires a medical prescription.
- Need to remember to take the pill every day at the same time. For most types of birth control pills, if you forget to take a pill and 12 hours have passed since the last time the pill was taken, the protection lapses.
- Some women may experience side effects during the first three months, such as headaches, nausea, light bleeding, mood changes, reduced sexual desire, etc.
- In cases of vomiting or diarrhea, there is a concern that the effectiveness of the pill may be reduced.
- Does not prevent contraction of sexually transmitted diseases.
- There are medical constraints that prevent some women from taking the pill.
Vaginal ring
How it works: A flexible ring that is inserted into the vagina (like a tampon) once a month, and releases hormones (estrogen and progesterone) that prevent pregnancy.
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Advantages
- Highly effective in in preventing pregnancy (90%-99%).
- It does not require it to be taken every day but instead needs to be replaced once a month.
- Self-use, with no need to visit a doctor or healthcare provider.
- May help with gynecological and hormonal conditions, such as acne.
- It is not absorbed through the digestive system, so its effectiveness is not affected by vomiting or diarrhea.
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Disadvantages
- It can cause hormonal side effects, such as mood swings, decreased libido and vaginal dryness.
- There are medical constraints that prevent some women from taking the pill.
- Requires a medical prescription.
- Inserting the ring requires you to feel comfortable inserting your fingers into the vagina.
- Does not prevent contraction of sexually transmitted diseases.
Weekly transdermal patch
How it works: A thin patch that is applied to the skin (upper back, upper arm, lower abdomen, or buttocks) and releases hormones (estrogen and progesterone) that prevent pregnancy. Is replaced once a week.
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Advantages
- Highly effective in in preventing pregnancy (90%-99%).
- Easy to use.
- Replaced only once a week.
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Disadvantages
- Requires a medical prescription.
- It may fall off when the skin is wet and sweaty, or due to friction in the area.
- May cause skin irritation at the patch site.
- It can cause hormonal side effects.
- Does not prevent contraction of sexually transmitted diseases.
Contraceptive injections
How it works: A progesterone injection administered every 12 weeks (four times a year) prevents ovulation, thickens the cervical mucus, and thins the uterine lining. The injection must be administered during menstruation.
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Advantages
- Highly effective in in preventing pregnancy (94%-99%).
- Does not require daily responsibility from you.
- It is not absorbed through the digestive system, so its efficacy is not affected by vomiting or diarrhea.
- Low cost.
- Extremely discrete.
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Disadvantages
- Administered with medical prescription only.
- Self-injection is not possible—you must go to a clinic to receive the injection.
- Some women may experience side effects during the first three months, such as breast tenderness, light bleeding, bloating, mood changes, reduced sexual desire, vaginal dryness, etc.
- Some women may experience heavy bleeding in the first few months after the first injection. In such cases, it is recommended to administer the second injection earlier, after 10 weeks, rather than waiting three months. In addition, some women may experience spotting during the first month of use (and some women may not have menstrual bleeding at all).
- Receiving the injection more than two weeks later than the scheduled time may reduce its effectiveness.
- The injection can cause amenorrhea (absence of menstruation throughout its use and for several months afterward), a condition that may affect fertility and delay the ability to become pregnant for about 9 months or even longer. In addition, the absence of menstrual bleeding can sometimes cause stress and concern about pregnancy.
- Long-term use may reduce bone density and requires medical monitoring.
- If you later decide to become pregnant, it is important to note that after stopping the injections, it may take some time (up to a year) before you are able to conceive.
- Does not prevent contraction of sexually transmitted diseases.
Progesterone pills (“The Nursing Pill”)
How it works: A pill that contains progestin (a hormone similar to progesterone) only taken daily. The hormone thickens the cervical mucus, making it harder for sperm to pass through while also thinning the uterine lining—reducing the likelihood of implantation and pregnancy. The pills are taken continuously, without a break between packs.
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Advantages
- High effectiveness in preventing pregnancy (about 91%–93% with typical use, and up to about 98%–99.5% with perfect use).
- Suitable for women who cannot use combined pills (for example, in cases of high blood pressure or blood clotting disorders).
- Suitable for use during breastfeeding and does not affect milk production.
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Disadvantages
- Requires a medical prescription.
- It is important to take it daily at the same hour —being more than 3 hours late may reduce its effectiveness and lead to bleeding or spotting.
- Possible side effects include irregular bleeding, headaches, nausea, breast tenderness, or acne.
- Largely does not prevent ovulation, so there is a theoretical possibility of pregnancy (however, the uterine lining is typically thin, which reduces the likelihood of implantation).
- Does not prevent contraction of sexually transmitted diseases.
Hormone-based IUD
How it works: Insertion of a small plastic device into the uterine cavity by a doctor or gynecologist that releases the hormone progesterone into the uterus. This hormone causes changes (thickening) in the cervical mucus, making it harder for sperm to reach and fertilize the egg, and leads to a thin uterine lining that does not allow implantation of a pregnancy.
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Advantages
- Highly effective in in preventing pregnancy (over 99%).
- Long-term efficacy (5-7 years).
- Does not require any additional action by you.
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Disadvantages
- The device may be inserted only by a doctor or gynecologist (it requires a medical prescription and purchase at a pharmacy), and may cause discomfort or pain.
- In the first weeks after the insertion of the device, irregular bleeding may occur, which can last for several months.
- In the days following insertion, cramping and pain may occur. In addition, breast pain and tenderness may occur and can last for several weeks to months (in approximately 8.5% of women).
- A high one-time cost (in most cases, the device can be purchased with a medical prescription, and the fee is uniform across all HMOs).
- Does not prevent contraction of sexually transmitted diseases.
Barrier, non-hormonal contraceptives
Non-hormonal IUD
How it works: Insertion of a small copper device into the uterine cavity by a doctor or gynecologist. The presence of the device in the uterus prevents pregnancy, as copper ions impair sperm motility and function and create an environment in which sperm cannot survive.
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Advantages
- Highly effective in in preventing pregnancy (approximately 99%).
- Long-term efficacy (for women under 40, the device shoul be replaced every 5 years; over age 40, it can be left in place for up to 10 years—provided there is no inter-menstrual bleeding or other side effects).
- Does not require any additional action by you.
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Disadvantages
- The device may be inserted only by a doctor or gynecologist (it requires a medical prescription and purchase at a pharmacy), and may cause discomfort or pain.
- In the first weeks after the insertion of the device, irregular bleeding, cramps and pain may occur.
- A high one-time cost (in most cases, the device can be purchased with a medical prescription, and the fee is uniform across all HMOs).
- Does not prevent contraction of sexually transmitted diseases.
Condom
How it works: A thin device, usually made of latex, that is worn on the male genitalia during sexual intercourse and prevents sperm from meeting the egg. Intended for vaginal, anal, and oral sexual contact.
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Advantages
- The only highly effective contraceptive method for protection against sexually transmitted diseases.
- Easy and widely available to obtain at any pharmacy or drugstore, without a prescription.
- No hormonal side effects.
- Relatively low cost.
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Disadvantages
- Less effective than other forms of contraception (82%–98%), especially if not used correctly or if it breaks.
- It is important to ensure it is within its expiration date and stored in a cool, dry, and dark place.
- For some people, using it may slightly reduce sensation.
- Some women may experience skin irritation or sensitivity from the lubricant on the condom.
Diaphragm
How it works: Insertion of a flexible cap made of medical-grade silicone into the vagina before sexual intercourse that covers the cervical opening. During sexual intercourse, the diaphragm acts as a barrier between the sperm and the uterus. Before use, a spermicide should be applied.
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Advantages
- No hormones.
- It can be used only when needed.
- Can be used multiple times.
- Almost no side effects.
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Disadvantages
- Moderately effective contraceptive (80%-90%).
- Before purchasing, you will need to undergo a fitting and sizing examination by a diaphragm fitter—a doctor or nurse specialized in this field—and receive instructions on how to use it. After that, once the correct size is determined, you can purchase it at a pharmacy (without a prescription).
- Insertion requires skill and involves feeling comfortable inserting your fingers deep into the vagina.
- Some women are sensitive to spermicide, and its use may cause irritation.
- Does not prevent contraction of sexually transmitted diseases.
- Difficult to obtain in Israel.
Sponge
How it works: Insertion of a small, round, soft sponge containing spermicide into the vagina before sexual intercourse to prevent the passage of sperm.
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Advantages
- No hormones.
- It can be used only when needed.
- It can be purchased at pharmacies and drugstores without a prescription.
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Disadvantages
- Moderately effective contraceptive (80%-90%).
- Proper placement requires accuracy (against the cervix), and it may shift without you noticing.
- Inserting the sponge requires you to feel comfortable inserting your fingers deep into the vagina.
- Some women are sensitive to spermicide, and its use may cause irritation.
- Does not prevent contraction of sexually transmitted diseases.
Spermicide
How it works: Chemical substances that come in the form of foam, gel, cream, suppositories, or a dissolvable film (VCF – Vaginal Contraceptive Film), whose purpose is to kill sperm. To use them, they must be inserted deep into the vagina, close to the cervix. Some people use them together with a diaphragm or a condom to increase effectiveness in preventing pregnancy.
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Advantages
- No hormones.
- Easy to use.
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Disadvantages
- Limited efficacy as birth control when used without another form of contraceptive (75%).
- In most cases, spermicide is effective for only one hour.
- Some women are sensitive to spermicide, and its use may cause irritation.
- Does not prevent contraction of sexually transmitted diseases.
Natural prevention - the behavioral method
The Fertility Awareness Method
How it works: Daily monitoring of fertility signs (measuring and recording basal body temperature upon waking, tracking vaginal discharge throughout the month, and checking the cervix) in order to identify fertile and infertile days. The method should be learned from a certified instructor (HE) and must be relied upon only after several months of practice and professional guidance.
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Advantages
- No outside intervention.
- No side effects.
- It is also suitable for women who cannot use hormonal contraceptives, as well as for religious women with halachic restrictions.
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Disadvantages
- Moderately effective contraceptive (80%-90%).
- It requires a high level of commitment, careful monitoring, and daily involvement.
- There may be errors in tracking or misinterpretation of physical signs.
- During the fertility window (fertile days), an additional form of contraception must be used: condoms, a diaphragm, or abstinence.
- Does not prevent contraction of sexually transmitted diseases.
Important to know
Important to know
Methods such as the “safe days” and withdrawal are not reliable forms of birth control and should not be relied upon. In the case of the “safe days” method, the timing of the menstrual cycle can vary, making it difficult to accurately predict the fertile days. In the case of withdrawal, sperm may be released before ejaculation.
Surgical contraception
Vasectomy
How it works: A surgical procedure to prevent sperm from reaching the semen. It is generally considered a permanent solution since reversal procedures are not always successful.
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Advantages
- Extremely effective.
- Permanent solution. The success of the procedure should be confirmed by performing a semen analysis three months after the procedure.
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Disadvantages
- Surgical procedure.
- Suitable only for those who are certain they will not want children in the future.
Tubal ligation
How it works: A surgical procedure in which the Fallopian tubes are cut, sealed, or tied, preventing the egg from reaching the uterus and preventing sperm from fertilizing it.
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Advantages
- Extremely effective as a permanent form of birth control.
- Does not require the use of additional contraception after the procedure.
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Disadvantages
- Surgical procedure that requires an operation and recovery
- Considered irreversible.
- Today, it is more common to remove Fallopian tubes rather than tie them, as the current theory posits that ovarian cancer may originate in the Fallopian tubes. For this reason, this procedure is largely not approved by the HMOs, thereby shifting the cost of the procedure and hospitalization to the patient.
Emergency solutions
The Day After Pill
How it works: A pill taken after unprotected sex to prevent pregnancy. There is currently a pill that can be taken up to 120 hours after sexual intercourse, and another pill that is effective only up to 72 hours after intercourse. The pill can be purchased at all pharmacies without a prescription.
Important to know
Important to know
It is an emergency method only and not a regular method of contraception. It should further be emphasized that the efficacy of the pill decreases the more time passes after sexual intercourse.
Insertion of a copper IUD
How does this work: Insertion of a copper IUD within 5 days of unprotected sexual intercourse can be used as an emergency contraceptive method.
Considerations to consider before making a choice
Before deciding which contraception is right, it is important to consider several factors to focus on specific needs and options, for example:
Medical condition: Are there medical conditions that prevent the use of certain contraceptive methods? For example, for individuals with a tendency toward blood clotting disorders, combination birth control pills are often not recommended, as many increase the risk of developing blood clots.
Lifestyle and habits: Which form of contraception is best suited to a specific lifestyle? Is a daily pill manageable, or is a method that does not require daily attention preferable?
Access to medical advice: Is there access to a doctor or gynecologist to obtain a contraceptive method?
Financial options: Are there financial resources available to purchase contraception?
Help in making a decision
To make an informed and appropriate decision, consultation with a gynecologist or a family doctor is recommended. These professionals can help choose the contraceptive that best suits a person's lifestyle and determine whether there are medical reasons to avoid a specific method.
Additionally, several organizations offer discreet consultations with professionals, such as Open Door and Ladaat (HE).
Important tips
- Ask questions: Health concerns warrant clear answers; no question is insignificant.
- Involve the partner: Contraception is often a shared responsibility.
- Autonomy: Decisions regarding one's body and health should be self-determined.
- Monitor side effects: If physical changes or discomfort occur, speaking with a doctor is important to address them or consider switching methods.
In brief, choosing contraception is a significant step toward a healthy and responsible sexual life. Taking time to consult with professionals and listening to one's body is essential. Many sources of information and support are available to assist in this process.