A contraceção não serve para todos — As perguntas que mudam a recomendação

What do you actually need contraception to do?

Pregnancy prevention is often the main goal, but it is rarely the only one.

A good consultation begins by asking what matters to you. At EC Clinic in Dublin that conversation sits inside a consulta ginecológica geral ou consulta sobre saúde reprodutiva, depending on your goals.

You might want:

• very high contraceptive effectiveness
• lighter or less painful periods
• fewer decisions day to day
• a method you can stop yourself
• a hormone-free option
• privacy
• acne improvement
• predictable bleeding
• rapid return to fertility when you stop

Two patients with identical medical histories can reasonably choose different methods because their priorities are different.

That is not “less scientific.” Preference is part of evidence-based care because a method only works well if the person can and wants to use it.

What are the main contraceptive categories?

For public education, it is more useful to compare categories than brands. The HSE overview of types of contraception is a useful public reference alongside a medical consultation.

Combined hormonal contraception. These methods contain oestrogen plus a progestogen and include the combined pill, patch and vaginal ring. They mainly prevent ovulation and also change cervical mucus and the uterine lining. Potential advantages can include more predictable bleeding and reduced period pain for some users. The important limitation is that oestrogen is not medically suitable for everyone.

Progestogen-only methods. These include the progestogen-only pill and longer-acting methods using a progestogen. They avoid oestrogen, so they can be suitable for some people who should not use combined hormonal contraception. Bleeding patterns can be less predictable, especially initially.

Intrauterine contraception. This includes hormone-releasing intrauterine systems and the copper intrauterine device. They are long-acting, highly effective and do not depend on remembering a daily pill. The hormonal intrauterine option can reduce bleeding for many people; the copper option is hormone-free but can make periods heavier or more painful in some users.

Implant. The implant is a long-acting progestogen-only method placed under the skin of the arm. It is highly effective and requires very little ongoing effort. Irregular bleeding is one of the main reasons some users dislike it.

Injectable contraception. The injection is a progestogen method given at intervals. It is effective but requires repeat administration, and return to ovulation can be slower after stopping than with many other reversible methods.

Barrier and non-hormonal methods. Condoms are important because they also reduce the risk of many sexually transmitted infections. Other barrier approaches and fertility-awareness methods require different levels of user involvement and have different effectiveness in typical use.

The point is not to crown a winner. It is to understand which trade-offs matter to you.

Why does migraine with aura change the recommendation?

Because “migraine” is not one category.

Migraine with aura includes focal neurological symptoms such as visual disturbance, sensory change or other reversible neurological features before or during the headache.

Migraine with aura is associated with a higher baseline risk of ischaemic stroke. Combined oestrogen-containing contraception also increases thrombotic risk. For that reason, major medical-eligibility guidelines generally classify combined hormonal contraception as inappropriate in migraine with aura. The CDC U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 is one of the detailed reference frameworks clinicians use for these decisions.

This is why I ask what your migraine actually feels like rather than simply ticking “migraine: yes.”

If you have never been sure whether your symptoms count as aura, describe them. Do not self-diagnose from a graphic online.

Why do smoking and age matter?

Smoking increases cardiovascular risk. Oestrogen-containing contraception can also increase the risk of blood clots and arterial events.

The combination becomes more concerning with increasing age. The HSE specifically states that the combined pill is not suitable if you smoke and are over 35 — see the HSE page on combined oral contraception.

This is a good example of why a method can be safe for one patient and inappropriate for another.

The question is not “Is the pill safe?” The question is “Is this category safe for you, given your risk factors?”

Why do we check blood pressure for some methods?

Because significant hypertension changes vascular risk.

A woman can feel completely well and still have elevated blood pressure. If an oestrogen-containing method is being considered, a properly measured blood pressure is part of safe prescribing.

It is not bureaucracy. It is risk assessment.

What if I have had a DVT or pulmonary embolism?

A previous venous thromboembolism — meaning a deep-vein thrombosis or pulmonary embolism — is a major part of contraceptive history.

The safest method depends on the exact history, whether the event was provoked by a temporary risk factor, whether there is an inherited thrombophilia, whether anticoagulation is being used and what other risk factors are present.

This is not a situation where I would want a patient choosing contraception from a “top five” article.

If you have a clot history, bring as much information as you can about what happened and when.

What changes after having a baby?

The postpartum period is special because blood-clot risk is temporarily higher after birth. Breastfeeding can also affect which methods are preferred and when they are started.

Some methods can be started immediately or early postpartum. Others, particularly oestrogen-containing methods, require more caution in the early weeks.

The plan should consider:

• how recently you delivered
• vaginal birth or Caesarean birth
• breastfeeding
• personal clot-risk factors
• bleeding
• whether another pregnancy is desired soon

There is no need to wait for periods to “be normal again” before discussing contraception.

Can medicines make contraception stop working?

Some can.

Certain medicines increase liver-enzyme activity and can lower the levels of some hormonal contraceptives, reducing effectiveness. Other interactions work differently.

This is why your full medication list matters, including medicines for epilepsy, some infections and other long-term conditions, as well as supplements or herbal products.

Never stop an essential medicine because you think it interferes with contraception. The contraception plan can usually be adapted.

What side effects are common, and what counts as a warning sign?

One of the most damaging myths online is that “any side effect means the method is dangerous.”

That is not how medicine works.

Expected effects can include changes in bleeding, breast tenderness, nausea, headaches or mood changes depending on the method and the individual. Some settle with time; some remain unacceptable even if medically harmless.

A side effect can be a perfectly valid reason to change method because quality of life matters.

A danger sign is different. New severe chest pain, shortness of breath, focal neurological symptoms, severe unusual headache or other acute symptoms need urgent medical assessment. The specific warning signs depend on the method and the patient’s history.

The goal of counselling is to teach both: what is expected, and what should never be ignored.

Will hormonal contraception make me infertile later?

For most reversible methods, no.

Fertility generally returns after stopping, although the timing varies. The HSE notes that many women can become pregnant shortly after stopping the pill, ring or patch, while the injectable method can be associated with a longer delay before ovulation returns. See the HSE page on contraceptive methods and fertility.

A temporary delay in return to ovulation is not the same as permanent infertility.

One reason this myth persists is that contraception can mask an underlying cycle disorder. If someone had irregular ovulation before starting contraception, the irregularity may return when the method is stopped. The contraception did not necessarily create the problem; it may have hidden it while it was being used.

Can contraception improve acne?

Some hormonal methods can improve acne, and others may have little effect or worsen it in some individuals.

The exact effect depends on the hormonal profile of the method and the patient’s skin biology. Acne can be a legitimate part of the decision, but it should not override medical eligibility.

A method that helps skin but is contraindicated by your clot or migraine history is not the right method.

Can contraception cause melasma or pigmentation?

Hormonal exposure can be associated with melasma in susceptible people.

But pigmentation is multifactorial, and not every woman who develops melasma needs to stop her contraceptive method. Light exposure, genetics, inflammation and skin type also matter.

If a pigmentation change coincided with starting or changing hormonal contraception, mention it. We can weigh how important that association appears in your individual case — including through a consulta de pele when the pigment pattern itself needs assessment.

What is the Free Contraception Scheme in Ireland?

Ireland’s Free Contraception Scheme is available to women, transgender people and non-binary people who meet the eligibility criteria from the day of their 17th birthday until the day before their 36th birthday. See the HSE free contraception page and the Department of Health Free Contraception Scheme campaign page.

The scheme covers consultations with participating providers and a range of prescription and emergency contraceptive services according to the HSE reimbursement arrangements.

The HSE lists both short-acting methods and long-acting reversible contraception within the service.

Eligibility and covered products can change over time, so always check the current HSE information rather than treat this article as a permanent reimbursement list.

Does “free contraception” mean I can skip a medical consultation?

Não.

The cost being covered does not remove the need to assess suitability.

A safe consultation can include:

• pregnancy-prevention goals
• bleeding pattern and period pain
• migraine history
• smoking
• blood pressure where relevant
• clot or cardiovascular history
• medications
• postpartum and breastfeeding status
• previous side effects
• acne or pigmentation concerns
• how often you want to think about contraception
• future fertility plans

Shared decision-making means you leave understanding the benefits, limitations and alternatives — not just holding a prescription.

Which method is “most effective” in real life?

Methods that require very little user action — such as long-acting reversible contraception — tend to have very high real-world effectiveness because there is less opportunity for forgotten doses or incorrect use.

Short-acting methods can also be highly effective when used correctly, but typical-use effectiveness is lower because humans are human: pills are missed, patches are delayed, condoms are sometimes used incorrectly.

Effectiveness matters. But it is not the only variable. A patient can reasonably decline the statistically most effective category because a different method fits her values and medical context better.

Medically reviewed by Dr. Eliana Castañeda, Obstetrician-Gynaecologist and Aesthetic Specialist · 24 September 2026

— Dra. Eliana Castañeda
Obstetra-ginecologista e especialista em medicina estética · Diretor médico, EC Clinic Dublin