Contraception

Finding the best birth control method for you may take some time and a bit of trial and error. Here’s a bit more about your various options:

Birth control pills (oral contraceptives)

How it works: “The pill” is available in two main forms, a combination pill or a progestin-only pill. Birth control pills are the most commonly prescribed form of contraception in the US. Both the progestin-only and the combined pill have a typical use failure rate of 7%, and they do not protect against STIs, according to the Centers for Disease Control and Prevention (CDC).  

The combination pill is the most popular. It releases the hormones estrogen and progestin (a synthetic form of progesterone) to prevent ovulation and thicken cervical mucus, making it more difficult for sperm to reach an egg. Combined pills are meant to be taken orally at about the same time each day and come in various pack sizes.

The progestin-only pill, also known as the minipill, contains—you guessed it!—progestin only. Since it contains a smaller dose of progestin than combination pills, there’s less margin for error and must be taken at the same time every day to effectively prevent pregnancy, per the Mayo Clinic.

Who it’s good for: Birth control pills work well for people who can remember to take a pill each day. You can also take them continuously (skipping the week of placebo pills in a pack and starting a new pack with active pills) to eliminate having a period. The progestin-only pill is a good choice for anyone who can’t take estrogen (more on that in a minute). In addition, some people experience lighter, less painful periods and reduced hormonal acne while taking oral contraceptives, according to The American College of Obstetricians and Gynecologists (ACOG). 

IUDs

How it works: An IUD is a small, T-shaped device that is inserted into the uterus by a trained health care provider. There are four leading hormonal IUDs available, as well as one non-hormonal option (the copper IUD). The progestin in hormonal IUDs thickens cervical mucus to help block and trap sperm; the hormones sometimes stop eggs from leaving the ovaries as well, per Planned Parenthood. The non-hormonal IUD is made with copper, which prevents sperm from moving and reaching an egg, per the ACOG.

The IUD is considered a set-it-and-forget-it birth control method, but it can be removed at any time depending on the type: The hormonal IUD is approved for up to three to seven years, and the non-hormonal IUD is good for up to 12 years. The hormonal IUD has a typical use failure rate of 0.1 to 0.4%, while the non-hormonal IUD has a typical use failure rate of 0.8%. IUDs do not protect against STIs. 

Worth noting: It’s common for people to experience pain during the IUD insertion process. You should have a conversation with your doctor if you’re concerned about this, so you can come up with a plan to manage any pain and help you feel more comfortable during the procedure.

Who it’s good for: An IUD is a great choice for anyone wanting a long-acting, progestin-only form of contraception that is still reversible. The copper IUD, in particular, is helpful for people who can’t use hormonal contraception, Kecia Gaither, MD, director of perinatal services and maternal-fetal medicine at NYC Health and Hospitals/Lincoln in the Bronx, tells SELF.

Birth control implant

How it works: The birth control implant is a flexible plastic rod the size of a matchstick; it is inserted by a health care provider, most commonly under the skin of a person’s upper arm, per the NLM. It releases the hormone progestin, which prevents ovulation, thickens cervical mucus to make it harder for sperm to reach an egg, and thins the lining of the uterus to prevent embryo implantation. The implant delivers the hormone over a three-year period. Dr. Gaither says it is almost 100% effective (with a typical use failure rate of only 0.1%). The implant does not protect against STIs. It can also be removed at any time.

Who it’s good for: The implant is ideal for anyone who wants a highly effective, progestin-only LARC that only needs to be replaced every few years. Since this device is quickly implanted under the skin—a procedure that is done using local anesthetic—it’s also a good option for people who prefer to avoid IUD insertion or vaginal ring placement.

Vaginal ring

How it works: The vaginal ring is a plastic device that the user places in the upper vagina; it releases estrogen and progestin. Once in place, the ring can stay there for 21 days. After removal, you must wait seven days before inserting a new one. During this week, you will likely have a period. Alternatively, you can insert a new ring every 21 days for a continuous-dose form of birth control—meaning you take it without stopping to avoid getting a period, according to the ACOG. The typical use failure rate for the ring is around 7% and it does not protect against STIs. 

Who it’s good for: The ring is worth considering if you want a combination birth control method that does not require remembering to take a daily pill. That said, you need to be comfortable inserting and removing it yourself monthly. 

Birth control shot

How it works: The birth control shot contains progestin, which suppresses ovulation and thickens cervical mucus, per the ACOG. The injection is given by a health care provider every three months, and a person typically receives it in the upper arm or buttocks. The shot has a failure rate of 4% to 6% and it does not protect against STIs.

Something to keep in mind if you plan to get pregnant: It takes an average of 10 months to get pregnant after stopping the use of the birth control shot, which is longer than other LARCs. Some people also experience more side effects with the birth control shot compared to other forms of hormonal contraception.  

Who it’s good for: The shot works well for people who want a progestin-only birth control method. It’s also a good choice for anyone not wanting to take a daily pill, replace a patch, or insert a device into the vagina. That said, it’s crucial to receive your shots on time for maximum efficacy.

Birth control patch

How it works: The transdermal contraceptive patch is an external form of birth control you place on your body to prevent pregnancy. It releases the hormones progestin and estrogen through your skin to stop ovulation. These hormones also thicken cervical mucus, according to Planned Parenthood. The birth control patch should be placed on areas that don’t experience much friction, like your upper arm, lower abdomen, or upper body. It must be replaced each week on the same day for three weeks in a row for maximum efficacy, per the Mayo Clinic. 

The typical use failure rate for the patch is around 7% and it does not protect against STIs. Additionally, the ACOG says the patch is less effective in people who weigh more than 198 pounds. 

Who it’s good for: The patch works well for anyone who wants a combination birth control method that lasts more than a single day but no longer than a month. It does not require insertion into the vagina and you won’t need to remember to take a daily pill.

Condoms

How it works: Condoms are a barrier method. They are available for people with penises (also called an external condom) and people with vaginas (also called an internal condom). An external condom goes over the penis to catch the sperm after ejaculation, whereas the internal condom is placed in the vagina to prevent sperm from entering. 

The external condom has a typical use failure rate of 13% and it does help protect against STIs. The internal condom, on the other hand, has a typical use failure rate of around 21%. It also helps protect against STIs. This is largely because external condoms can slip off or break during sex; an internal condom can also break or become displaced or twisted during sex, per the Cleveland Clinic.

Who it’s good for: Condoms are a great option for anyone who needs a one-time-use barrier method. They are effective on their own or in addition to other forms of birth control like an IUD, diaphragm, or birth control pills to help protect against STIs and prevent pregnancy. They are also a good choice for people who want a non-hormonal form of contraception. People who have latex allergies should opt for latex-free condoms.

Diaphragm

How it works: The diaphragm is a single-use barrier method that helps prevent pregnancy by covering the cervix with a flexible, shallow silicone cup to prevent sperm from accessing an egg. It has a bendable rim that allows you to insert it into the vagina. The diaphragm requires applying spermicide—a foam, gel, or cream that kills sperm—before sex. You can leave the diaphragm in for 24 hours, but if you have sex more than one time, you need to put more spermicide in your vagina, per Planned Parenthood. You’ll need to leave it in for six hours after sex to prevent sperm from making their way to an egg. The diaphragm has a typical use failure rate of 17% and it does not protect against STIs. 

Who it’s good for: This is an option for anyone who wants an immediate-acting non-hormonal birth control method. It’s also good for people looking for temporary contraception that is also portable (it fits easily in a bag). It does require a prescription and sometimes a fitting from your physician or primary care provider. Once you have a prescription, you can get it filled at any pharmacy.  

Birth control sponge

How it works: The sponge is a single-use contraceptive method that is inserted into the vagina up to 24 hours before sex and left in for six hours after sex. It covers the cervix to create a barrier, preventing sperm from reaching an egg. The sponge is small and made of soft, squishy plastic and contains spermicide. The sponge does not protect against STIs. If you’ve never been pregnant, the sponge has a typical use failure rate of 14%. If you’ve given birth, that number increases to a failure rate of 27%. 

Who it’s good for: If you want a temporary, non-hormonal birth control method that does not require a prescription or a visit to the doctor’s office, the sponge is worth considering. However, you need to be comfortable inserting it yourself or having a partner do it. 

Spermicide

How it works: Spermicide is a chemical-based birth control method that works by killing sperm. It comes in gels, creams, films, suppositories, and foams. You should wait at least 10 to 15 minutes to have sex after inserting spermicide, according to the ACOG. You also need to leave it in place for six to eight hours after having sex. Spermicides need to be used correctly; on their own they have a typical use failure rate of 21%. 

Who it’s good for: Spermicide is good for people using a diaphragm, and it’s also a smart addition to condoms. Spermicide is only effective for one hour after placing it in the vagina, so it works best for people who have access to it and plan on having sex immediately. 

Emergency contraception

How it works: Emergency contraception (EC) is used after having sex with the goal of reducing the chance of pregnancy. EC works by preventing pregnancy from occurring, according to the ACOG. It will not work if you are already pregnant. There are currently two types: EC pills (ulipristal, progestin-only pills, or combination pills) and the copper IUD. You may need a prescription for some EC pills, while others are available over the counter at a pharmacy or online. The ACOG says the copper IUD is the most effective form of emergency contraception.

Who it’s good for: People who do not use or have access to a reliable form of birth control while having sex might benefit from having EC on hand or seeing their doctor immediately after having sex. It’s also a good choice if you missed a pill, a condom breaks, or you have concerns about the effectiveness of your current contraceptive method. 

Other methods of contraception to be aware of

Contraception goes beyond over-the-counter products and prescription devices. There are also methods like fertility awareness, tubal ligation, and vasectomy. 

Fertility awareness, also called natural family planning, relies on knowing and recognizing a fertile time in the menstrual cycle, which is typically done via a tracking method. According to the ACOG, once you know your fertile period, you must avoid sexual intercourse or use a barrier method to prevent pregnancy.

During a vasectomy, the vas deferens in the scrotum is tied off and cut apart, according to Dr. Gaither. “This surgical procedure is almost 100% effective, but it doesn’t prevent STIs, and it is considered permanent,” she adds. 

Another permanent method is bilateral tubal ligation. During this procedure, the fallopian tubes are cut or removed. Dr. Gaither says it is almost 100% effective, but keep in mind that it also does not prevent STIs. 

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Using contraception is a safe way to prevent pregnancy, but the “safest” method for you will depend on your health history. Barrier methods, like a condom or diaphragm, are generally safe for anyone. Temporary devices like the sponge also carry a low risk of health complications. 

Hormonal birth methods, particularly those that contain estrogen, slightly elevate a person’s risk of blood clots or stroke and may not be recommended for people who already have a higher risk of these complications. That said, Dr. Singer says contraceptives like combination birth control pills are safe for most people, especially since the dose of estrogen and progesterone in these pills has become very low since the pill first hit the market. 

Hormonal birth control offers the highest risk for potential side effects, which can include but are not limited to:

• Menstrual cycle changes, like spotting or breakthrough bleeding
• Temporary breast soreness, tenderness, or swelling
• Bloating
• Headaches
• Weight fluctuations
• Abdominal cramping
• Nausea
• Pelvic pain (in the case of IUDs)
• Mood changes

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Though there are plenty of contraception choices, some birth control methods fare better than others when it comes to effectiveness. 

Irreversible contraception (like tubal ligation) is still a highly preferred contraception method in the US, and these options are extremely effective, Dr. Singer says. However, he says LARCs are now popular among people who do not wish to undergo surgery and prefer a long-term option that is both safe and highly effective. In fact, LARC methods, like an IUD or implant, are 20 times more effective than birth control pills, the patch, or the ring, according to the ACOG.

The hope, Dr. Singer says, is that as LARCs become more available and affordable, the rate of unplanned pregnancies will go down. Learning the pros and cons of each method will help you determine the most effective option that works seamlessly with your lifestyle, so you can take control of your sexual and reproductive health.

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