Anticoncepción

Uso actual de anticonceptivos en el Reino Unido¹²

It is difficult to get full data on contraception use in the UK, as the surveys done (for example by NHS Digital in 2024-25) only cover provision from sexual and reproductive healthcare clinics and not provision in primary care (where about 50% of women get their contraception from). Given that caveat, the most recent data shows the following:

• 51% of women accessing contraception choose a long-acting reversible contraceptive (LARC), compared to 49% using a method with user dependency (eg, the pill or patch).

• The implant is the most popular LARC, used by 20% of women, compared to 14% who use a levonorgestrel intrauterine device (LNG-IUD) and 10% who use a copper intrauterine device (Cu-IUD). Implants are more popular in the younger age group and intrauterine devices in the older age group.

• Younger women are more likely to choose a LARC (55% of those aged <16, compared to 38% of those aged >45).

• There is a steady drop in the provision of emergency contraception (EC), possibly related to the fact that it can be accessed over the counter.

• There is a long-term downward trend in female sterilisation, with the 2024-25 total being 22% lower than 10 years earlier. Conversely, the number of vasectomies grew by 16% between 2023-24 and 2024-25.

Tasas de fallo de los anticonceptivos

Dos tipos de fallos anticonceptivos:

• Fallo del usuario: cuando el método anticonceptivo no se estaba utilizando correctamente.

• Fallo del método: se produce un embarazo a pesar de que el método anticonceptivo se utilizó correctamente.

Las tasas de fallo del usuario son mucho más altas que las tasas de fallo del método, especialmente en el primer año de uso.

Published failure rates are usually based on the 'Trussell table',³ based on failure rates in the USA; the figures below are from the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS) and take other UK-based guidelines and reviews into account.

Cuestiones a considerar al discutir la elección de anticonceptivos

• The individual woman's preferences and choice. A woman who comes in asking for 'the pill' may indeed have done her research and decided that the pill is the right thing for her. It is also however possible that she is using the phrase 'the pill' to mean 'any form of contraception' and would benefit from having other options, including LARC, explained to her.

• Education. Make sure that she is aware of all appropriate options and fully informed. Address any misconceptions.

• Comorbilidad. Considere las condiciones que pueden descartar ciertas opciones como elecciones.

• Medication. Consider concurrent medication which may affect choice - in particular, the use of enzyme-inducing medication significantly narrows options to only the injection and intrauterine device.

• Age and parity.

• Historial de tabaquismo y peso.

• Planes familiares. La necesidad de anticoncepción a corto o largo plazo afectará la elección.

• Protección contra infecciones de transmisión sexual. Fomentar el uso de preservativos además del método anticonceptivo elegido, cuando sea apropiado.

• Excluir embarazo.

• Ethical issues: consider consent and safeguarding when prescribing for girls aged under 16 or women with learning difficulties.

Anticoncepción y grupos especiales

Varios grupos de mujeres tienen requisitos especiales. Por ejemplo, se puede necesitar atención adicional al considerar:

• Women aged over 40.

• Mujeres que están amamantando.

• Fumadores.

• Mujeres más jóvenes.

• Mujeres que tienen diabetes.

• Women with obesity.

Vea también el separado Anticoncepción y grupos especiales, Anticonceptivos de emergencia y Cuestiones etnoculturales en la anticoncepción articles. The small increased risks of meningioma and breast cancer are now discussed; other risks are given in the sections on specific methods.

Contraception and meningioma⁴

• In 2024 and 2025, papers were published linking various progestogen containing contraceptives with a risk of intracranial meningioma requiring surgery.

• Meningioma is a rare and benign tumour, with an incidence or 19 per 100,000 over the age of 40 and 0.16 per 100,000 under the age of 20. The main risk factors are age and being female.

• The odds ratios and numbers needed to harm are given in the table below where available. The absolute risk is low, due to the low background incidence of meningioma.

• The CoSHR advises that specialist advice should be sought before starting or continuing any hormonal contraception in individuals with a current or past history of meningioma.

• For those without such a history, they should be counselled about the increased risk before starting any method containing cyproterone acetate, nomegestrol acetate, desogestrel or medroxyprogesterone acetate.

• There is no data for etonogestrel (used in the contraceptive implant) but it is the active metabolite of desogestrel, so it would be sensible to seek advice for patients with a current or past history of meningioma who have an implant in situ.

Contraception and breast cancer

• There is a small increased risk of breast cancer in women who use hormonal contraception - previously this has been thought to only affect CHC, but a 2023 study found that the magnitude is similar in women using progestogen only contraception.

• The absolute risks are low and estimated at an extra 8 cases per 100,000 women aged 16 -20 and 265 cases per 100,000 women aged 35 - 39.

• This should be considered against the significant reduction in ovarian cancer for women using CHC (50% after 10 years of use) and women should be counselled accordingly.

Brief summaries of reversible contraceptive methods are shown below. Sterilisation for men and women, although technically reversible, should be viewed as permanent. Reversal is not always successful and not usually available on the NHS. They are covered in the separate Sterilisation (vasectomy and female sterilisation) artículo.

Combined hormonal contraception (CHC)^{5 6}

For more comprehensive information, see the separate articles Combined oral contraceptive pill (first prescription), y Combined oral contraceptive pill (follow-up and common problems).

The combined pill (COC) is a highly effective form of contraception and is the most commonly used method of contraception in the UK.⁷

The COC contains a combination of synthetic oestrogen and a progestogen. They have been classified into first-, second- and third-generation preparations reflecting their hormonal content and period of development. All current brands contain 20-35 micrograms of oestrogen. The hormonal combination is also available as a transdermal patch, Evra®, and a contraceptive vaginal ring, NuvaRing®. Both have approximately similar efficacy to the COC. Collectively, these methods are known as CHC.

Modo de acción

La píldora COC previene la concepción actuando sobre:

• The hypothalamic-pituitary-ovarian axis, to suppress synthesis and secretion of follicle-stimulating hormone and the mid-cycle surge of luteinising hormone, thus inhibiting the development of ovarian follicles and ovulation. (Primary method of action).

• Cervical mucus to prevent penetration of sperm. (Thickens cervical mucus).

• The endometrium to inhibit blastocyst implantation. (Reduces endometrial receptivity).

Beneficios

• Altamente efectivo, fácil de revertir y conveniente de usar.

• Useful to treat abnormal uterine bleeding, pre-menstrual syndrome, and endometriosis.

• Reduces incidence of benign breast disease, ovarian cysts, ovarian cancer (50% reduction if the combined pill is used for 10 years), and endometrial cancer.

Problemas

• Efectos secundarios - por ejemplo, sangrado intermenstrual, sensibilidad en los senos, cambios de humor.

• Increased risk of tromboembolismo venoso (VTE) - this varies with the type of progestogen, as per the table below.⁶

• Increased risk of myocardial infarction and stroke; the absolute risks of both of these is small, given the very low background risk in young women. For women with risk factors the baseline risk and absolute increased risk will be greater. Stroke risk is increased significantly by the presence of migraine with aura, which is an absolute contraindication to the use of CHC.

• Posible pequeño aumento del riesgo de cáncer cervical; sin embargo, esto puede estar relacionado con otros factores, por ejemplo, el número de parejas sexuales, el uso de métodos no barrera durante las relaciones sexuales, la exposición al virus del papiloma humano (VPH).

• CHC containing certain progestogens is linked to a small increased incidence of meningioma requiring surgery - see the section on this below.

Progestogen-only contraceptive pill (POP)⁸

For more comprehensive information, see the separate article Píldora anticonceptiva solo de progestágeno.

The contraceptive progestogen-only pill (POP) is particularly used when combined hormonal contraception is contra-indicated, for example for women who have a history of VTE, or have migraine with aura, although for some women it may be a first choice.

There are three types of POP. The 'traditional' pills are rarely used now and will not be discussed further. They generally contain norethisterone or levonorgestrel, do not reliably inhibit ovulation and have to be taken within 3 hours of the same time each day. The most commonly used POP contains desogestrel, but a relatively recent addition to the market contains drospirenone - the rest of this leaflet will discuss just these two options.

Modo de acción

• Ovulation is inhibited in the majority of cycles for desogestrel and drospirenone.

• El transporte del óvulo está retrasado.

• El moco cervical se vuelve más viscoso e impenetrable para los espermatozoides.

• El endometrio se vuelve inadecuado para la implantación.

Beneficios

• Es confiable si se toma correctamente, es fácilmente reversible y conveniente de usar.

• Evita los riesgos cardiovasculares del estrógeno.

• A menudo puede ser utilizado por muchas mujeres con contraindicaciones para la píldora COC. Pocas condiciones médicas restringen el uso de la POP.

• It can be used during breastfeeding at any point, whereas CHC has restrictions on use in breastfeeding in the first six weeks post-partum.

• Se puede usar hasta los 55 años.

Problemas

• Menstrual problems such as amenorrhoea and breakthrough bleeding. These are less common in drospirenone pills than in desogestrel pills.

• A desogestrel pill is considered missed if it has not been taken within 12 hours of the time when it would usually be taken; this is less than the missed pill window for combined and drospirenone pills, which is 24 hours.

• There is increased risk of functional ovarian cysts.

• It has previously been considered that if pregnancy occurs on the POP, it has a slightly higher risk of being ectopic. The overall risk of ectopics is much lower than background, as the overall number of pregnancies is lower. The majority of data underpinning this comes from the traditional pills which do not reliably inhibit ovulation and so it may be less of an issue with desogestrel and drospirenone pills.

Levonelle® is also used as a progestogen-only anticoncepción de emergencia.

Anticonceptivos inyectables solo de progestágeno⁹

For more comprehensive information, see the separate article Anticonceptivos inyectables solo de progestágeno.

Una inyección solo de progestágeno es un anticonceptivo de acción prolongada y reversible. Una progesterona sintética, o progestágeno, se libera lentamente en la circulación sistémica tras una inyección intramuscular o subcutánea.

Actualmente hay tres formas de inyección depot disponibles en el mercado del Reino Unido:

• Depo-Provera® es acetato de medroxiprogesterona en depósito (DMPA) suspensión acuosa de 150 mg en 1 ml para inyección intramuscular profunda.

• Sayana Press® es DMPA 104 mg MPA en 0.65 ml para inyección subcutánea.

• Noristerat® is norethisterone enantate (oenanthate) 200 mg in 1 ml in an oily liquid. This is only licensed for short-term use - eg, for women whose partners have undergone vasectomy, until the vasectomy is effective. It is rarely used in the UK.

Modo de acción

• Su principal mecanismo de acción es suprimir la ovulación.

• También hace que el endometrio sea inadecuado para la implantación si ocurre la fertilización.

• También aumenta la viscosidad del moco cervical, haciendo que el moco sea menos fácilmente penetrable por los espermatozoides.

Beneficios

• Very effective and convenient. Provided that the injections are given on a regular basis (every 13 weeks for Depo-Provera® and Sayana Press®, every 8 weeks for Noristerat®), there is a very low failure rate.

• Se puede usar durante la lactancia.

• La amenorrea es común, lo que puede ser una ventaja para las mujeres con menorragia o dismenorrea.

• Self-administration can be used for Sayana Press®; women can be taught to inject by a practice nurse when they have the first injection, or via a video on the manufacturer's website.

Problemas

• No es rápidamente reversible.

• There is an associated small loss of bone mineral density and possibly a subsequent increased fracture risk, which recovers after stopping. The Medicines and Healthcare products Regulatory Agency (MHRA) and the Faculty for Sexual and Reproductive Healthcare (FSRH) advice is therefore:

  • Las inyecciones anticonceptivas no deben ser utilizadas por mujeres menores de 18 años a menos que no haya otra opción adecuada.

  • Los riesgos y beneficios deben revisarse cada dos años.

  • Considere otras opciones anticonceptivas en mujeres con otros factores de riesgo para la osteoporosis.

• Menstrual irregularities common in women using this method, with irregular bleeding being a common reason for stopping. Amenorrhoea commonly develops with time, however, and women should be counselled before use about the possibility of early bleeding and encouraged to persevere. It is sensible not to start the depot injection in women for whom irregular bleeding in the first three months would be particularly problematic.

• Weight gain year may occur. A higher initial BMI (≥30 kg/m²) hace esto más probable, particularmente en mujeres menores de 18 años.

• Retorno retrasado de la fertilidad de hasta un año después de detenerse.

Implante subdérmico solo de progestágeno¹⁰

For more comprehensive information, see the separate article Implantes subdérmicos solo de progestágeno.

The progestogen-only subdermal implant (SDI) is a long-acting reversible contraceptive. Etonogestrel (a progestogen) contained in a rod is released slowly into the systemic circulation following subdermal insertion in the upper arm.

Nexplanon® is now the only contraceptive implant on the UK market. It is a 4 cm flexible rod containing 68 mg etonogestrel. Nexplanon® must be removed after five years when it can then be replaced.

Modo de acción

El principal mecanismo de acción de Nexplanon® es inhibir la ovulación. También espesa el moco cervical, inhibiendo el paso de los espermatozoides al útero, así como adelgaza el endometrio, previniendo la implantación si un óvulo fuera fecundado.

Beneficios

• Highly effective with very few pregnancies reported. The main reason for 'failure' is incorrect timing of insertion, conception prior to insertion and failure of insertion.

• Larga duración de acción.

• Reversible. No hay evidencia de retraso en el retorno a la fertilidad tras la extracción de Nexplanon®.

• It is very convenient, only needing replacement every five years.

• Reducción de problemas menstruales como la dismenorrea.

Problemas

• Sangrado irregular; común en el primer año, pero disminuye después.

• Se han reportado cambios en el peso, el estado de ánimo y la libido; sin embargo, no se ha encontrado una asociación causal..

Intrauterine contraceptive device (IUD)¹¹

For more comprehensive information, see the separate articles Dispositivo intrauterino anticonceptivo y Dispositivo intrauterino de levonorgestrel.

The IUD is a safe and effective method of contraception with a very low failure rate. There are two types of IUD - the copper IUD (Cu-IUD) and the levonorgestrel IUD (LNG-IUD). The latter was previously known as the intrauterine system (IUS) and some educational materials may still use this terminology.

IUDs have a monofilament thread to permit checking of presence and to allow removal. Women should be counselled to check for their threads at least monthly and to attend for a check (and use alternative contraception) if they cannot feel them. If the healthcare professional cannot see or feel the threads then a pelvic ultrasound should be done - if the device is present, the woman can be reassured, but she may need a hysteroscopy to remove the device. If the ultrasound does not show the device, an abdominal x-ray should be done to check that it has not perforated the uterus. If no device is present in the abdominal cavity then it has fallen out and alternative long-term contraception should be arranged.

Modo de acción

Cu-IUD:

• La fertilización se previene por el efecto del cobre en los óvulos y el esperma.

• Penetración reducida de espermatozoides debido al efecto del cobre en el moco cervical.

• Reacción inflamatoria endometrial que produce un efecto anti-implantación.

LNG-IUD:

• Esto se logra principalmente reduciendo el crecimiento endometrial y previniendo la implantación. Hay atrofia endometrial dentro de un mes de la inserción.

• Los efectos progestagénicos sobre el moco cervical reducen la penetración de los espermatozoides.

• La ovulación generalmente no está inhibida.

Beneficios

All IUDs:

• Altamente efectivo, reversible y conveniente.

• Ningún efecto demostrable en la densidad ósea.

• No significant interaction with other drugs - can be used in women taking enzyme-inducers.

Cu-IUD only:

• Efectivo directamente después del ajuste.

• Puede usarse como anticonceptivo de emergencia.

• No se involucran hormonas, reduciendo el potencial de riesgos y efectos adversos.

• Efectivo por hasta 10 años.

LNG-IUD only:

• Reduce la pérdida de sangre y la dismenorrea.

• It may reduce the risk of PID compared with normal IUDs, because of thickening of cervical mucus.

• 52 mg devices can be used for 8 years for contraception; see below for individual brand lengths of use.

• 52 mg devices an also act as the progestogen component of hormone replacement therapy, making it a useful method for women aged over 40 - for this indication it must be changed at 5 years.

Problemas

All IUDs:

• La inserción puede ser incómoda, pero se puede usar anestesia local.

• Displacement or expulsion: 1 in 20 women, most commonly in the first three months after insertion.

• Increased risk of PID - around 1% in the first three weeks after insertion.

• Uterine perforation: approximately 1-2/1,000 insertions (higher in breastfeeding women).

• Ectopic pregnancy: absolute risk very low; however, in pregnancies which occur with an ID in place, up to half of them may be ectopic.

Mainly affect Cu-IUD:

• Increased blood loss and longer and more painful periods are common.

Mainly affect LNG-IUD:

• Spotting and bleeding between periods is common in the first six months.

Considerations when choosing a brand of IUD

There are a large number of brands of Cu-IUD - a full list can be found in the CoSRH guidance.¹¹ A brand with at least 300 mm² of copper should be used to allow a 10 year lifespan - if fitted after the age of 40, such an IUD can stay until the menopause. IUDs with less copper can be slightly smaller and therefore easier to fit (particularly in a nulliparous woman) but will have a shorter lifespan.

There are five brands of LNG-IUD available in the UK, shown in the table below with their licenses and with CoSRH guidance on their use.

Diafragmas y capuchones¹²

For more comprehensive information, see the separate Métodos anticonceptivos de barrera para mujeres artículo.

La popularidad de los diafragmas y capuchones como formas de anticoncepción ha disminuido con la disponibilidad de métodos más efectivos y con la conciencia de la necesidad de protegerse contra las infecciones de transmisión sexual.

Diaphragms are thin, dome-shaped devices made of latex or silicone. They come in a range in sizes and types of spring. Diaphragms should lie diagonally between the posterior fornix and behind the pubic bone. Caps are smaller than diaphragms, fitting closely over the cervix. Both should be used with espermicidas.

Modo de acción

Los diafragmas y capuchones forman una barrera física, impidiendo la entrada de espermatozoides al cuello uterino.

Beneficios

• En comparación con el momento de uso requerido por los condones, la inserción de diafragmas o capuchones antes del coito puede permitir más espontaneidad.

• Sin efectos secundarios graves y sin efectos hormonales.

Problemas

• Las mujeres deben estar bien motivadas y ser cuidadosas en su uso.

• No es tan efectivo como algunos de los métodos anteriores.

• Los espermicidas pueden causar una reacción local.

• Poca evidencia de protección contra infecciones de transmisión sexual, a diferencia de otros métodos de barrera.

• La incidencia de infecciones del tracto urinario puede aumentar con el uso de diafragmas.

• It can be difficult to find a practitioner who is trained to fit one, even within sexual and reproductive health services.

Condones femeninos¹²

El condón femenino (Femidom®) ha estado disponible en Gran Bretaña desde 1992. Está hecho de poliuretano suave y flexible, pre-lubricado y con dos anillos flexibles.

Modo de acción

Este es un método de barrera.

Beneficios

• No se conocen efectos secundarios.

• Ayuda a prevenir infecciones de transmisión sexual y posiblemente reduce el riesgo de carcinoma cervical.

• Puede insertarse antes del coito.

• No se requiere ajuste.

Problemas

• Requiere una inserción cuidadosa.

• Puede ser empujado hacia la vagina o evitado.

• Puede ser incómodo o ruidoso, o interferir con la sensación.

• No es tan efectivo como algunos de los otros métodos anticonceptivos mencionados anteriormente.

Condones masculinos¹²

La única contraindicación para el uso de condones de látex es para personas con sensibilidad o alergia a las proteínas del látex, ya que los riesgos generalmente superan los beneficios. Hombres y mujeres con sensibilidad al látex pueden usar condones de poliuretano masculinos o femeninos o condones masculinos de látex desproteinizado.

Modo de acción

Este es un método de barrera.

Beneficios

• Disponibilidad inmediata.

• Protege contra infecciones de transmisión sexual y puede proteger a las mujeres contra el cáncer de cuello uterino.

Problemas

• They are relatively expensive if purchased, but are usually available for free at sexual and reproductive health clinics.

• Es necesario planificar con antelación.

• Carece de espontaneidad.

• Requiere la cooperación de ambos socios.

• Puede reducir la sensibilidad.

• Pueden romperse o deslizarse, aunque la investigación muestra que las fallas debido a roturas o deslizamientos disminuyen con el aumento de la experiencia de uso.

• Eficacia relativamente baja.

Planificación familiar natural¹³

Several methods are available, including calendar, temperature, observation of cervical mucus, and palpating the cervix. Mobile phone apps and dipsticks to measure hormone levels in urine can be used. Failure rate however remains high.

The lactational amenorrhoea method (LAM) is also an effective natural family planning option for breastfeeding mothers. For LAM to be effective, a woman must be fully breastfeeding, have amenorrhoea and a baby who is less than 6 months old. The failure rate for LAM is around 2%, higher than many other methods, so it is perfectly reasonable for a woman who fits the LAM criteria to also use another method.

Beneficios

• No hay efectos secundarios.

Problemas

• Se requiere un compromiso considerable de ambas partes.

• Poco fiable con ciclos impredecibles.

• Menos efectivo que algunos otros métodos descritos anteriormente.