How to Find the Best Birth Control for You
Oral contraceptives contain both estrogen and progestin, and taking the pill once a day, every day, suppresses ovulation, stopping the ovaries from releasing an egg, according to the Mayo Clinic. These pills also spark changes in the cervical mucus and your endometrium (the lining of the uterus), in order to prevent sperm from joining an egg.
Pros: It's easily reversible—as soon as you stop taking the pill, your fertility may return to normal. The theory that it takes a while for the pill's effects fertility effects to wear off is an old wives' tale, says Justin Shelton, an OBGYN at Albert Einstein Medical Center in Philadelphia. The pill is also known to help with acne and heavy or irregular periods and reduce the risk for ovarian and endometrial cancers, reports the Mayo Clinic.
Cons: There's room for human error, which alters its effectiveness. You're also at an increased risk of blood clotting due to the higher levels of estrogen, Shelton says, so those with a history of deep vein thrombosis (DVT) or pulmonary embolisms should avoid this form of birth control.
Efficacy Rate: Shelton says you should take the Pill at the same time every day for it to be the most effective. Taken appropriately, the pill can be up to 99 percent effective.
Best for: Someone who doesn't mind taking a pill every day, and doesn't have a history with the health considerations commonly associated with negative side effects of this type of birth control. The pill is not recommended for smokers over age 35, women with a history of breast cancer and heart disease, and those who suffer from migraines.
The NuvaRing, the only vaginal hormonal contraceptive that's approved by the FDA and available in the U.S., is also a combination hormonal birth control. The flexible, plastic vaginal ring is placed in the upper vagina and releases estrogen and progestin that is absorbed through vaginal tissue, according to the American Congress of Obstetricians and Gynecologists (ACOG). To insert the ring, you fold it and place it in the vagina, where it stays for 21 days. Then you remove the ring and wait 7 days (when you'll get your period) before inserting a new ring.
Pros: You don't need to remember to take a pill every day and the ring can be removed at any time. (You don't need to take it out during sex.) The Mayo Clinic says the side effects commonly associated with all types of combination hormonal birth control—spotting and possible weight gain, for example—are less likely to occur when using the ring because it delivers a smaller amount of hormones.
Cons: Side effects are similar to that of the pill and include breast tenderness, nausea, and headaches. The ring could also fall out, which the Mayo Clinic says can sometimes happen during tampon removal, sex, or a bowel movement. That said, you have a three-hour window to reinsert the ring without any problems. Longer than that and you should use a backup method of contraception for a week.
Efficacy Rate: According to the U.S. Department of Health & Human Services (HHS), 9 out of 100 women who use this method may get pregnant each year.
Best for: Someone who doesn't want to worry about a daily pill, is familiar with their female anatomy, and is comfortable placing the vaginal ring every three weeks.
This contraceptive skin patch (think birth control's version of the smoking cessation nicotine patch) is a combination hormonal drug called Xulane. You simply slap it on (usually on the arm, abs, or butt) so estrogen and progestin can be absorbed through the skin. Swap it for a new one each week for three weeks, then take it off for the fourth week, which is when you'll get your period.
Pros: You don't have to remember to take a daily pill, just to replace your patch weekly. And nope, you don't have to remove it to shower, swim, or exercise.
Cons: Shelton says that if you weigh more than 198 pounds, the failure rate of the patch starts to increase. The patch also has the highest risk of blood clots compared to any other form of combined hormonal contraceptives, he says. And if you have a family history of endometrial or breast cancer, talk to your doctor before using the patch as it can increase your risk for both. If the patch falls off (either fully or partially) and can't be reapplied, you'll need to replace it with another patch immediately. If you can't get a new one on within 24 hours, use backup contraception for a week, suggests the U.S. National Library of Medicine. Same goes if you're late swapping out your weekly patches.
Efficacy Rate: Less than 1 out of 100 women will get pregnant each year if the patch is used correctly, according to the Mayo Clinic.
Best for: "Women who want the benefits of combined contraception but don't want to take a pill every day, are at a healthy weight, and are comfortable with the potential risk of developing a blood clot," says Shelton.
Nicknamed the mini-pill, progestin-only meds, including Micronor, Nora-BE, Nor-QD, and Ovrette, work similarly to combination pills, but they don't contain any estrogen, there are no "inactive pills" and the amount of total progestin is lower than in a combination pill. Its main job is to thicken the cervical mucus while thinning the lining of the uterus to keep sperm from reaching the egg. It sometimes suppresses ovulation, too, says ACOG.
Pros: These are safer for smokers, diabetics, people with heart disease, and those at risk for blood clots because there's no estrogen. Because it stops ovulation for about 60 percent of women, according to ACOG, it's likely to lighten your period or stop it altogether.
Cons: There's little-to-no wiggle room for error here—if you don't take the pill at the exact same time every day, then you'll need to use a backup method for two days. (You have a tiny three-hour window where it won't cause problems.) "If you don't take it within that time-sensitive period, it's almost like you didn't take the pill at all," says Shelton. Additionally, research shows that women who become pregnant while taking the mini-pill are at an increased risk of experiencing an ectopic pregnancy, which is when the fertilized egg implants outside the uterus, usually in the Fallopian tube. Ectopic pregnancies are dangerous if left untreated, and the fertilized egg won't be able to survive.
Efficacy Rate: Taken correctly, Shelton says the mini-pill can be 91 percent effective. However, The Mayo Clinic reports that as many as 13 out of 100 women can get pregnant while using this form of birth control.
Best for: Women with health concerns due to increased estrogen, and those who are able to adhere to a fairly strict daily routine.
IUDs, also known as Mirena, Skyla, ParaGard, fall under long-acting forms of reversible contraception (LARC), which ACOG calls the most effective forms of reversible birth control currently on the market. There are hormonal IUDs (Mirena and Skyla), which release progestin and can be left in for up to three to five years, and a copper IUD (ParaGard), which doesn't release any hormones and can be used for 10 years. Both are T-shaped devices that are surgically inserted into the uterus, and they both prevent fertilization between the sperm and egg, says ACOG. The hormonal IUD thickens the cervical mucus to make it harder for sperm to enter the uterus while thinning the lining of the uterus so that it's less likely a fertilized egg will attach. The copper, on the other hand, "produces an inflammatory reaction in the uterus that is toxic to sperm" to prevent fertilization, says the Mayo Clinic.
Pros: Aside from the fact that you don't have to do anything once it's inserted, the IUD can be used basically anytime (even after a miscarriage, childbirth, abortion, or while breastfeeding), and most women are able to use one form or the other. The hormonal IUD can also help ease menstrual symptoms, like cramping, and lighten up periods. (What You Know About IUDs May Be All Wrong.)
Cons: IUDs can be painful to insert, so cramping and bleeding can happen. Experts suggest taking an anti-inflammatory, like ibuprofen, two hours before the procedure to help minimize the pain. And even though it's rare, it is possible for an IUD to pierce the uterine wall during insertion (it happens with about 1 in every 1,000 insertions), or for the IUD to come out of the uterus (about five percent of cases). Women with an IUD are also at a slightly increased chance for pelvic inflammatory disease (PID) during the first 20 days after insertion, says ACOG. PID is an infection of the uterus and Fallopian tubes that can cause scarring and make it more difficult to get pregnant later.
Efficacy: The IUD is nearly 100 percent effective and is in the same success range as that of sterilization! "Over the long term, LARC is 20 times more effective than birth control pills, the patch, or the ring," reports ACOG.
Best for: People who can't remember to take a pill every day, and are sexually active with a partner they know is not putting them at risk for sexually transmitted infections.
Birth Control Implant
Another form of long-acting reversible contraception, Nexplanon is an implant about the size of a matchstick and is surgically placed under your skin by a doctor (without making any incisions) on your upper arm. It releases a low, incisions) on your upper arm. It releases a low, steady dose of progestin to help prevent pregnancy and oftentimes stop periods, too.
Pros: There's no pill to take or patch to replace, and it typically provides relief from menstrual pain and pelvic pain caused by endometriosis. It lasts for up to three years.
Cons: ACOG says the most common side effects are unpredictable bleeding and bloating for the first three to six months but that can improve over time. Other reported side effects include mood changes, headaches, acne, and depression.
Efficacy Rate: Just like the IUD, less than 1 out of 100 women are likely to get pregnant when using an implant as the main form of contraception for a year.
Best for: Women who don't want to get pregnant within the next three years and don't want to take a pill every day.
Diaphragms, including Milex Wide Seal, Semina, SILCS, are a barrier type of birth control, meaning it works to keep sperm from entering the uterus. It's a small, reusable latex or silicone cup that's shaped like a dome, and should be placed deep into the vagina (to cover the cervix) only when you're about to have sex. The flexible rim should sit snugly behind your pubic bone, and it should always be used with spermicide, which contains chemicals that stop sperm from moving.
Pros: There are no hormones at play, so there aren't any side effects to consider. Plus, anyone can use it (even breastfeeding women, starting six weeks after childbirth), unless you've previously been diagnosed with toxic shock syndrome (TSS).
Cons: This is not a one-size-fits-all situation. You'll need to get it fitted by your OBGYN, and if you lose or gain weight (more than 10 pounds, according to the McKinley Health Center at the University of Illinois at Urbana-Champaign), then you'll probably need to get refitted. You also need to wash it after every use with warm, soapy water. Using a diaphragm can increase your risk of TSS if it's left in for more than 24 hours, but it must be left in for six hours post-sex to be effective, according to ACOG. Diaphragms and spermicide can also boost your odds of getting a urinary tract infection (UTI) or having an allergic reaction to either the latex or the spermicide.
Efficacy Rate: According to the Mayo Clinic, an estimated 21 out of 100 women will get pregnant in a year of using a diaphragm. Without spermicide, that number bumps to 29. Experts say there's a lot of room for error, as it's possible to still get pregnant if the diaphragm dislodges itself from the cervix or if you remove it too soon.
Best for: Women looking for a second form of contraception and do not have bladder or prolapse issues.
Much like a diaphragm, a female condom, which can be called Dominique, Femy, Protectiv, or Reality, is a barrier method birth control that you insert deep in the vagina, over the cervix. It's a loose-fitting pouch with a ring on either end, one of which holds the condom in place while the other remains outside the vagina to help with removal.
Pros: Unlike the diaphragm, it helps protect against STDs. Another bonus? You don't need a prescription to get one, and it can be inserted up to eight hours before sex.
Cons: It may feel uncomfortable when you insert it, and the Mayo Clinic says it could even cause a burning sensation, itching, or a rash.
Efficacy Rate: According to the Mayo Clinic, 21 out of 100 women could become pregnant within a year of use. There's also a higher failure rate than male condoms, as it's possible for the penis to slip between the vagina and the outer surface of the female condom, the outer ring could slip into the vagina during sex, or the condom could slip out of the vagina altogether.
Best for: Women who don't want to or cannot take a hormonal pill, those who also want protection from STDs, and/or don't want to rely on a partner for birth control.
Male condoms, (think Trojan, Durex, LifeStyles) are probably the first form of protection you heard of—a thin sheath of latex or polyurethane that's rolled over an erect penis just before sex. It's another barrier method of birth control used to keep sperm from entering the uterus.
Pros: Condoms are one of the few types of birth control that protects against STDS, they're easy to use and widely available, a package of them is relatively inexpensive, and they're sold over the counter.
Cons: You're still at risk for getting pregnant or contracting an infection if the condom breaks or falls off during intercourse. Some people can also suffer allergic reactions to latex, symptoms of which include rash, hives and, in severe cases, tightening of the airways. Look into latex-free alternatives.
Efficacy rate: If used correctly every time, Shelton says they're about 80 percent effective, with an 18-21 percent failure rate.
Best for: Everyone! (Try one of these 5 Condoms That Make Sex Better.)
You've probably heard of the Rhythm method, Standard Days method, or BBT method. Fertility awareness revolves around "knowing and recognizing when the fertile time occurs in the menstrual cycle," says ACOG. In other words, knowing when you're most likely to get pregnant, and then having—or not having—sex, depending on your end goal (a lot of women use this method when trying to get pregnant, but some use it as a preventative measure as well).
Pros: There's no medicine involved, and it's extremely cost effective (usually just the cost of a tracking app, if there is any or ovulation tests).
Cons: There's no form of protection against STDs, and if you want to have sex during your ovulation period, you'll need to use a backup method of contraception.
Efficacy Rate: ACOG says fewer than 1 to 5 women out of 100 will become pregnant when using fertility awareness perfectly. Unfortunately, most do not (often due to inconsistency with tracking), increasing those odds to between 12 to 24 out of 100 women.
Best for: Those who want to practice birth control without the intervention of medicine or external barriers, sometimes for religious or spiritual reasons, says Shelton. This method should also only be used by women who have regular, predictable menstrual cycles, because "if they are irregular, this method will not work the way it's designed to," says Shelton. "You have to be very in tune with your own menstrual physiology."
Emergency contraception goes by Plan B One-Step, Take Action, Next Choice One-Dose, My Way, and Ella. Dubbed "the morning after pill" for good reason, this type of birth control is to be taken after having unprotected sex as a form of "backup" birth control. It's most commonly needed when a woman forgets to take several birth control pills in a row, when a condom breaks or falls off, or when no protection was used at all. Usually, a woman will take a form of emergency contraception (though the copper IUD is also considered a highly effective form of emergency contraception), either Ulipristal (Ella) or progestin-only (Plan B).
ACOG says ulipristal is the most effective pill form of EC, and it works by changing the way progesterone works in the body, often delaying ovulation or preventing pregnancy if taken within five days of having unprotected sex. Progestin-only EC delays ovulation and is most effective when taken within three days.
Pros: You only need to take one pill.
Cons: Ulipristal is only available by prescription, whereas progestin-only can be purchased over the counter to women 18 years and older, depending on your state regulations. After you take ECs, you may experience irregular bleeding or spotting for the next week, and your next period may not occur at the expected time, says ACOG.
Best for: Women who had unplanned or unprotected sex and are at risk for pregnancy.