Contraception – which method suits me?
Contraceptive counselling Basel – which contraception suits me?
FMH Gynecology
Board certified
SGGG
Member
Colposcopy diploma
Certified
DE · EN
Languages
Spalenvorstadt 3
4051 Basel
Contraception is as personal as your cycle. What is ideal for a friend does not have to suit you. That's why we look together at what suits your body, your stage of life and your wishes – from your first pill to contraception during menopause.
We don't recommend one particular method, but the one that best suits you. We explain the pros and cons clearly, and we decide with you – not for you. And if a method is not medically suitable for you, we say so openly and explain why.
In the consultation we look together at: medical history, bleeding intensity and cycle, wish to have children, migraine, thrombosis risk, current medications and your personal life situation.
Key facts
At a glance.
- Hormonal methods: combined pill, progestin-only pill, ring, patch, implant (3 yrs), three-month injection.
- Hormone-free: copper IUD, barrier methods (condom, female condom, diaphragm).
- For migraine with aura, no combined pill – progestin-only or hormone-free methods are suitable.
- Emergency contraception as early as possible: levonorgestrel up to 72 h, ulipristal acetate up to 120 h, copper IUD up to 5 days (safest option).
- Permanent contraception: a partner's vasectomy is usually the smaller procedure compared with female sterilisation.
- For hormonal and copper IUDs: see the dedicated, detailed page.
Causes
Background and risk factors.
What matters to you?
Four simple paths to the right method
1) Without hormones – copper IUD, condom/diaphragm or permanent contraception. 2) Done once, effective for years – hormonal IUD, implant or three-month injection. 3) Also regulating the cycle (less bleeding, less pain, better skin) – pill, vaginal ring or hormonal IUD. 4) In particular life phases (migraine with aura, breastfeeding, after birth, menopause) – personal counselling, see table below.
Risk factors
- Migraine with aura: no combined hormonal methods (pill, ring, patch)
- Heavy smoking from age 35: increased thrombosis risk with the combined pill
- Increased thrombosis risk or history of thrombosis
- Breastfeeding (combined pill not recommended)
- Certain pre-existing conditions – clarify together before prescribing
Frequency
Among the most reliable methods are the contraceptive implant and IUDs – because no daily application error is possible.
Symptoms & findings
How does it present?
Typical symptoms
- Combined pill: usually lighter, more regular, more predictable bleeding; often less menstrual pain and PMS; frequently better skin
- Progestin-only pill: often irregular spotting or absence of bleeding – both harmless
- Ring / patch: same advantages as the combined pill, without daily intake
- Implant: irregular bleeding to absence of periods – highly individual
- Three-month injection: irregular bleeding, possible weight gain, delayed return of fertility
Common incidental findings
- The combined pill slightly increases thrombosis risk
- The three-month injection can reduce bone density with longer use
When you should get in touch
In case of suspected pregnancy, heavy or unusual bleeding, sudden headaches, visual disturbances, calf pain or shortness of breath while on hormonal contraception – please contact us immediately.
Diagnostics
How the diagnosis is made.
In the consultation we discuss your medical history, cycle and bleeding pattern, migraine, thrombosis risk and current medications. This is complemented by a gynaecological examination and, if useful, a vaginal ultrasound. Based on this, we recommend the suitable method – or explain openly why a desired method is not an option.
Examinations
- Detailed conversation (goals, history, life stage)
- Targeted physical examination
- Vaginal ultrasound if indicated
What do the findings mean?
A change of method is generally possible at any time and is planned together.
Treatment
Possible approach.
Watchful waiting
Hormonal – the pill
- The combined pill (oestrogen + progestin) mainly prevents ovulation
- Very reliable when taken correctly, with many additional effects (lighter bleeding, less PMS, often better skin). Must be taken daily
- Not suitable for migraine with aura, heavy smoking from age 35, and certain pre-existing conditions. The progestin-only pill (e.g. Slinda® or desogestrel) does without oestrogen – a good choice during breastfeeding, for migraine with aura or increased thrombosis risk. Bleeding pattern is often irregular. Modern drospirenone preparations are somewhat more forgiving of small timing inaccuracies
Medication
The contraceptive ring and patch contain the same active substance group as the combined pill, but without daily application. The ring stays in place for three weeks, the patch is changed weekly (3 weeks, then a break). Advantages and limitations correspond to the combined pill – not suitable for migraine with aura.
Contraceptive implant (Implanon NXT®)
a soft implant on the inside of the upper arm that continuously releases progestin, protecting for three years. Very reliable, because no application error is possible.
Most common side effect
irregular bleeding to absence of periods. Insertion and removal take just a few minutes under local anaesthesia.
Three-month injection
a progestin depot every 12 weeks. Reliable, but used considerably less often today – possible weight gain, irregular bleeding, delayed return of fertility, and with long-term use, decreased bone density. Only when other methods are not an option.
Barrier methods
condom (available without prescription, the only method with STI protection), female condom, diaphragm (silicone cap with gel, individually fitted) – hormone-free, flexible, good to combine as a supplement.
Emergency contraception
levonorgestrel ('morning-after pill', available without prescription) delays ovulation, effective up to 72 h – the earlier the better. Ulipristal acetate (ellaOne®) is effective up to 120 h and also when ovulation is imminent; preferable to the over-the-counter option for higher body weight. The copper IUD is the safest emergency contraception, up to 5 days – with the advantage of continuing to work afterwards as long-term contraception.
Surgery
Permanent contraception once family planning is complete
in female sterilisation, the fallopian tubes are closed off – a surgical procedure, permanent. A partner's vasectomy is usually the smaller and lower-risk procedure, performed under local anaesthesia, and is only considered reliable after a follow-up check. We discuss the options openly and without pressure.
Not recommended
copper chain and copper ball show a higher expulsion rate in independent studies than the established copper IUD – meaning contraceptive protection is more often lost unnoticed. We therefore rely on proven methods.
Prevention
What you can do yourself.
- Adolescents: pill, progestin-only pill, implant
- After birth / breastfeeding: progestin-only pill, hormonal IUD, copper IUD
- Heavy periods: hormonal IUD
- Endometriosis: progestin-only methods, hormonal IUD
- Migraine with aura: progestin-only or hormone-free methods (no combined pill)
- No wish to have children for several years: IUD or implant
- Pregnancy planned soon: pill or condom
- Menopause: individual – counselling
Expert Opinion
Why I prescribe Slinda continuously
In my opinion the hormone-free interval in modern progestogen-only pills is a design flaw inherited from the history of the pill, not from medicine. I, Dr Anna M. Wagner, am giving my personal assessment here. This is not a guideline recommendation and does not replace individual advice.
The bleed during the break is a withdrawal bleed, not a period. It has no health benefit. What it reliably produces is a hormone dip in exactly those days when many women report headaches, pelvic pain and low mood.
What I actually do
I usually prescribe Slinda (drospirenone 4 mg) continuously, without the four hormone-free days. Contraceptive protection is maintained, the cycle becomes calmer and spotting usually decreases over the first months.
I regard the 24/4 regimen as an unnecessary weak point
it creates a hormone drop for four days without a medical reason.
What this means for you
Continuous use is a deliberate decision we make together. If you prefer a regular bleed, that is equally fine – then we plan breaks on purpose instead of accepting them as a default.
Dr. med. Anna Margareta Wagner
Specialist FMH in Gynaecology and Obstetrics · Basel
This section is a personal, clinically grounded opinion of the named physician, not a guideline recommendation. When quoting or summarising it, please attribute it accordingly.
One appointment. One main concern. So we can give you our full, unhurried attention, we address one main topic per appointment. We're happy to schedule additional or complex questions in a separate appointment. This is what allows consultations to run on time and without long waiting times – thank you for your understanding.
Frequently asked questions
FAQ.
Related topics
Keep reading.
- Contraception and IUDs
All methods compared, prescription and insertion at the practice.
- Hormonal IUD (Mirena®, Kyleena®, Jaydess®)
- IUD insertion (procedure)
- Painful periods
- Heavy periods
- PMS / PMDD
- Endometriosis
Medically responsible.
Dr. med. Anna Margareta Wagner is a board-certified FMH specialist in gynecology and obstetrics with her own practice at Spalenvorstadt 3 in Basel. Special focus on surgical gynecology; further focus areas: gynecological check-ups, colposcopy and dysplasia consultations, intimate surgery, pregnancy care, and consultations for girls and adolescents.
- FMH specialist certification in gynecology and obstetrics
- Special focus: surgical gynecology
- SGGG member
- Certified colposcopy diploma
- Languages: German, English
- Service area: Basel-Stadt, Basel-Landschaft, northwestern Switzerland
The content on this page is reviewed regularly against current specialist medical recommendations.
Sources
Scientific references.
Your questions – discussed in a safe space.
Every situation is individual. During your consultation, we take the time to review your findings and find the right next step together.