What Are the Best and Worst Birth Control Options?

Birth control is everyone’s responsibility. We’ve got answers to your questions.

Medically Reviewed
woman holding up contraceptive birth control pills

Which type of contraception is right for you right now?

Plenty of people have sex with no intention of having a baby, and there are more options than ever to prevent a pregnancy.

According to CeCe Cheng, MD, a maternal fetal medicine physician in Texas and a fellow with Physicians for Reproductive Health, preventing pregnancy may not be the only or most important goal of birth control, either.

Contraception Is Not Just About Preventing Pregnancy

“Before jumping into efficacy, when we talk to patients about contraceptives, we first narrow down what they want out of it,” she says. In women, birth control can also help lighten heavy periods, regulate menstrual cycles, and clear up acne, according to the Office on Women’s Health.

That’s not to say that birth control should only be a concern for women. According to Meera Shah, MD, MPH, birth control is every partner’s responsibility.

“Everyone should be counseled on all methods of contraception,” she says, from birth control pills to vasectomies, regardless of their gender.

What Type of Contraception Is Right for You Right Now?

The form of birth control that’s right for each person is very personal, and may change down the line. According to Dr. Shah, you are never locked into one form of reversible birth control and can always switch to another. It’s your healthcare provider’s job to help you navigate each one and advise on how it might apply to your lifestyle, goals, and needs.

“It’s about finding the best method for the patient, not a doctor pushing an agenda of what they think is the best one,” she says. “If you need to change, even after a month, don’t feel bad about it. Sometimes it takes a few attempts to find something that folks are comfortable with.”

Here’s a quick and easy guide to birth control options, including the pros and cons of each.

Barrier Methods

Diaphragm birth control barrier contraceptive

There are two types of barrier methods: condoms and diaphragms.

Condoms are the only method of birth control that have the added protection of preventing sexually transmitted infections (STIs), and the traditional type, used on a penis, is not your only option.

“Condoms are an incredible method of contraception, it’s just that they aren’t always used,” says Shah, noting that if you don’t use one every time, it’s a good idea to have another method, like emergency contraception, on hand.

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Most condoms are made of latex, a type of rubber. It’s important to always use a water-based lubricant — instead of an oil-based lube — with latex condoms because oil-based products can damage the material and make it less effective, according to Planned Parenthood.

If one or more partners has a latex allergy, you can find condoms made of?non-latex plastic and lambskin. But keep in mind that lambskin condoms do not protect against STIs.

Classic condoms are designed to cover a penis and catch semen, as well as protect partners’ genitals from coming into direct contact.

Pros: Latex and plastic condoms protect against STIs and are easily accessible in stores and often free at clinics.

Cons: They're only about 85 percent effective at preventing pregnancy, in part because they can break.

RELATED: Is This the End of Roe v. Wade? What Would a SCOTUS Decision Mean for Reproductive Health?

Internal Condoms

You may have heard these colloquially called “female condoms.” Internal condoms sit inside the vagina and work the same way condoms worn over a penis do: They prevent sperm from coming into contact with an egg.

Pros: Made of soft plastic, they prevent STIs and pregnancy.

Cons: They're only 79 percent effective at preventing pregnancy.

Diaphragms and Cervical Caps

A diaphragm is essentially a shallow, bendable cup that sits in your cervix, kind of like a menstrual cup. Diaphragms aren’t condoms, so they don’t prevent STIs, but when used correctly, they do prevent sperm from reaching an egg. Cervical caps work in a similar fashion.

Pros: At 88 percent, diaphragms are more effective than condoms.

Cons: According to Planned Parenthood, for greatest protection, diaphragms should be used with a spermicide — more on this below.

Intrauterine Devices (IUDs)

intrauterine devices iud contraception birth control

An IUD is a small, flexible, T-shaped plastic device that’s placed at the bottom of the uterus. It's known for its ease of use and efficacy as a long-acting reversible contraception (LARC). There are two general types: a copper IUD and a levonorgestrel intrauterine system (LNG IUD), and five brands have been approved by the FDA. Some IUDs can stop you from getting a regular period.

According to Planned Parenthood, three brands of IUD — Paragard, Mirena, and Liletta — can also be used for emergency contraception if inserted within five days of unprotected sex.

Copper IUD

Paragard is a hormoneless IUD that’s wrapped in copper, and it produces an inflammatory reaction that’s toxic to both sperm and eggs, according to the Mayo Clinic. It can be effective for 10 to 12 years, but can be removed at any time.

Pros: It's more than 99 percent effective, long-lasting, and doesn’t require regular maintenance.

Cons: It may not be an option if you have uterine abnormalities like fibroids, and requires an appointment with your healthcare provider to get it out. It can increase cramping, heaviness of flow, and number of menstruation days.

Hormonal Intrauterine Device (IUD)

Levonorgestrel intrauterine system (LNG IUD)

LNG IUDs (Mirena, Kyleena, Liletta, and Skyla) release a small amount of progestin daily and last three to seven years, depending on the brand, though you can have it removed sooner.

Pros: It's more than 99 percent effective, lasts years, and doesn’t require regular clinic visits or prescription refills.

Cons: Having a device inside the body isn’t for everyone, and it’s a bit more involved to remove than, say, stopping the pill or taking out a ring. It may not be an option for those with uterine abnormalities.

Hormonal Contraceptives

Woman applying birth control patch hormonal contraceptive

Hormonal contraceptives use two hormones, estrogen and progestin, to keep ovaries from ovulating (releasing an egg), according to the Mayo Clinic. The hormones also thicken the cervical lining, notes Planned Parenthood, which blocks sperm from swimming up the cervix.

“For certain people, the estrogen in some hormonal contraceptives can increase risk of blood clots, high blood pressure, and stroke when combined with other risk factors like smoking or being above age 35,” says Dr. Cheng.

Birth Control Pill

There are tons of different options when it comes to the pill, but they all fall into two categories: combination pills, which contain both estrogen and progestin, and progestin-only pills. According to Planned Parenthood, combination pills are the most common, but you and your healthcare provider can determine which version is right for you. It’s also worth noting that although you have to take any type of birth control pill daily, some have to be taken at the exact same time every single day to be effective, says Shah.

Pros: The pill can regulate your menstrual cycle, reduce cramps, and even clear up acne. It's about 91 percent effective when used correctly.

Cons:?It offers no STI protection, and you have to commit to taking it around the same time every day.

RELATED: 10 Home Remedies to Relieve Menstrual Cramps

Birth Control Patches

There are two birth control patches approved by the U.S. Food and Drug Administration (FDA): Xulane and Twirla. Like the pill, patches contain hormones that keep you from ovulating, but in this case, you don’t have to remember to take a pill every day. Patches are worn on the arm, belly, or buttocks, and release hormones into your skin.

You wear three different patches throughout one menstrual cycle, swapping out the old one for a fresh patch every week, and then have a period during the fourth week.

Pros: It's?99 percent effective and can help regulate your cycle.

Cons: It does not prevent STIs, and you have to remember to fill your prescription every month.

Birth Control Rings

There are two brands approved by the FDA: NuvaRing and Annovera, which last slightly different amounts of time before needing to be replaced. Both are small, flexible rings that sit inside your vagina and continually release hormones until you take them out the week of your period. Importantly, you don’t take a ring out during sex.

Pros: It's?91 percent effective and can be more convenient than the pill, with the same effect on your cycle.

Cons: Products that contain silicone or oil can damage the Annovera ring, and neither product protects against STIs.

Birth Control Shots

The Depo-Provera shot, often called “Depo” for short, is an injection of progestin given once every three months.

Pros: It's?96 percent effective, according to the Centers for Disease Control and Prevention (CDC)?and it might be more convenient for some people than a pill or device. It's progestin-only, which may make it safer for some people. If you don’t want others to know you're using contraception, the shot is “invisible.”

Cons: It requires a healthcare center visit four times a year to get the shot, and it doesn’t prevent STIs.

Birth Control Implants

An implant is a thin rod that’s inserted under the skin of your upper arm and releases progestin over the course of three to five years, protecting you from pregnancy. If you’d like it out sooner, that’s always an option. Like IUDs, implants are long-acting reversible contraception (LARC), known for ease of use and efficacy.

Pros: It's 99.9 percent effective at preventing pregnancy. Because it's progestin-only, it may be safer for some people, and it lasts for three to five years.

Con: Not everyone wants a device implanted in their body, and it doesn’t prevent STIs.

Gels, Creams, and Spermicides

Gel cream spermicide contraceptive birth control

There are several types of nonhormonal gels and creams that use active ingredients to kill sperm or prevent it from reaching an egg in other ways, like changing the pH of the vagina. These are typically applied each time before sex.

Spermicide Gel, Cream, or Lube

By themselves, spermicides are only about 72 percent effective and are often used in tandem with another form of birth control, such as condoms or a cervical cup. Spermicides are available over-the-counter and contain chemicals that slow sperm down and make it harder for sperm to reach an egg.

Pros: It's available without a prescription or medical appointment.

Cons: It's only about 72 percent effective and best used with another form of birth control; it does not protect against STIs.

Contraceptive Gel (Phexxi)

Phexxi is not a hormone or spermicide, but a prescription gel that’s inserted into the vagina before sex. It makes the vagina more acidic, which makes it harder for sperm to move, and therefore harder for sperm to reach an egg, according to Planned Parenthood. If used perfectly as directed, it’s about 93 percent effective, but most people don’t, so it’s really about 86 percent effective at preventing pregnancy. It works best when you combine it with another form of birth control — just don’t use it with the ring.

Pros: It can be a good nonhormonal birth control option if that's important to you.

Cons: You need to have it with you so you can use it every time you have sex, and it requires a prescription. It does not protect against STIs. It works for only about an hour and then you have to reapply.

Birth Control Sponges

The Today Sponge is a small, round sponge made of soft, squishy plastic that’s inserted deep into the vagina just before sex and then removed after. The sponge contains a spermicide and acts as a barrier between an egg and sperm. Sponges can be used alone or as an insurance policy along with condoms, but they aren’t the most effective form of birth control.

Pros: It can be a good option for people who feel a device or medication is not right for them.

Cons: It's only about 76 to 88 percent effective and has to be used every time you have sex. It doesn't prevent STIs.

Emergency Contraceptives

emergency contraceptive birth control

For those individuals not on a long-acting form of birth control, “if not getting pregnant is the goal,” Shah says, “we recommend patients have a [morning after] pill on the bedside.” While most people may think of Plan B as the only form of emergency contraception after unprotected sex or condom failure, certain IUDs can be used that way now.

You should use emergency contraception within five days of unprotected sex, and the sooner you use it, the better. It also should be used only in emergencies — not as a regular form of birth control, according to Planned Parenthood. In cases of sexual assault, Shah says a medical clinic can provide emergency contraception.

If you or someone you know has been the victim of sexual assault, the national nonprofit RAINN can connect you with confidential support and resources in your area.?

Levonorgestrel Pill

Most commonly known as Plan B, levonorgestrel pills are available over the counter. Other common brands besides Plan B are One Step, Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, and EContra. If you're looking to keep some on hand, you can order morning after pills online from places like Wisp and Bedsider. If you need it immediately, your local pharmacy should have it. If taken within three days, the pills are 75 to 89 percent effective in preventing pregnancy.

Pros: It's available over the counter and by mail.

Cons: Research has suggested the standard dose of 1.5 milligrams (mg) may not be as effective if you weigh 155 pounds or more, which really limits who can rely on it, though there are other emergency contraception options; importantly, it's still safe for people of all weights. It can interact with other medications or herbs, including St. John’s wort and some HIV medications. It won’t protect against STIs.

Ella?

Ella works in a similar way but contains ulipristal acetate instead of levonorgestrel. It’s about?85 percent effective at preventing pregnancy and requires a prescription.

Pros: It can work retroactively to prevent a pregnancy after unprotected sex.

Cons: If you weigh 195 pounds or more, Ella might be less effective, according to Planned Parenthood. It also requires a prescription, but some insurance plans may cover it.

IUDs

According to Shah, three IUDs — Liletta, Mirena, and the copper Paragard — can be inserted within five days of unprotected sex as emergency contraception, and will continue to act as longer-term birth control.

Pros: It can work retroactively to prevent a pregnancy after unprotected sex.

Cons:?An IUD is a bigger commitment, requires an office visit, and won’t protect against STIs.

Surgical Options for Birth Control

Doctor consultation surgical contraceptive methods

Surgery is a permanent (in rare cases reversible) method of birth control that can be a great choice for people who are sure they do not want to get pregnant in the future.

Vasectomy

A vasectomy is an outpatient procedure that cuts the tubes that carry sperm to semen. A small incision is made in the scrotum so the tubes can be severed. The procedure is done under local anesthesia, which means you stay awake for it. A vasectomy doesn’t work immediately, but after 15 to 20 ejaculations, any remaining live sperm will be flushed from the system. After that, vasectomies are nearly 100 percent effective at preventing pregnancy.

According to Shah, it’s a bit of a misconception that vasectomies are reversible. “If there is any chance you want to get pregnant in the future, you may want to consider another form of birth control,” she says.

Vasectomy reversal is not always possible, and very few doctors are skilled in the procedure, says Shah. Some people may opt to preserve their sperm in a sperm bank for extra insurance.

Pros: It's virtually 100 percent effective at preventing pregnancy and is permanent, requiring no maintenance.

Cons: lt can’t always be reversed, which may be a con for some people.

Tubal Ligation

Tubal ligation, or having your “tubes tied,” is a permanent surgical birth control option for people with a uterus. It can be performed at any time, including during a cesarean section. It doesn’t affect your menstrual cycle, but the clamps inserted around the fallopian tubes do prevent an egg from traveling down from the ovaries, where it can be fertilized. Like a vasectomy, tubal ligation is an outpatient procedure, but it does require general anesthesia or a spinal block (if done during a C-section).

Pros: It's more than 99 percent effective at preventing pregnancy and is permanent, requiring no maintenance.

Cons: It’s permanent, which may not be the best option for everyone, and it requires surgery.

Alternative Methods

birth control contraception tracking fertility cycle

Fertility Awareness Methods (FAM)

In fertility awareness methods, you keep track of your cycle so you know when you’re ovulating and can get pregnant. “Tracking is one of the oldest forms of birth control, and some people like it because they are really in tune with their bodies,” says Shah. Tracking and understanding your cycle can help you plan a wanted pregnancy, avoid pregnancy, and notice signs of potential health problems.

It usually involves a combination of looking at your cervical mucus, also known as vaginal discharge, which changes in consistency throughout your cycle (Shah says cervical mucus around the time of ovulation is thicker and whiter), and tracking your cycle on a calendar. You can also use other signs of peak fertility, such as body temperature and cervical position, to inform tracking. (FAM can be really useful if you’d like to get pregnant quickly.)

Pros: The concept is free (though not all tools are) and doesn’t require a doctor’s visit. Learning about your cycle is empowering.

Cons: You have to be diligent in paying attention to your cycle; it may not work for people with irregular periods. It requires partner cooperation and doesn’t protect against STIs.

Withdrawal

With the withdrawal method, commonly called "pulling out," people have condomless sex until just before the person with a penis ejaculates. They “pull out” so they don’t ejaculate in the vagina.

According to Shah, withdrawal is about 70 percent effective at preventing pregnancy.

Pros: It's free and doesn’t require any medical visits or tracking.

Cons: It’s only 70 percent effective and requires a person to commit to pulling out before ejaculating every time they have sex.

Breastfeeding

When a mother breastfeeds every four to six hours, her body stops ovulating, and you can't get pregnant if an egg isn't released. According to Planned Parenthood, breastfeeding full-time (called lactational amenorrhea method, or LAM) is 98 percent effective at preventing pregnancy, but only if you’re feeding every four to six hours. “We see people get pregnant while breastfeeding all the time, but it certainly does decrease your chances,” says Shah.

Pros: It's free, and it may be something healthy that you’re doing anyway.

Cons:?It's reliable only for the first six months of a baby’s life, or until your period returns, whichever comes first.

Outercourse and Abstinence

Couple in bed abstinence outercourse

You can still have sex without vaginal penetration, and that can be the best birth control for some people. But if abstinence is your first line of defense, it’s a good idea to have another form of birth control on hand, just in case.

“Refraining from sex is certainly not feasible for everyone — nor is it easy. We’re all human beings and we all have a sex drive,” says Sara Newmann, MD, MPH, the medical director of the New Generation Health Center at the University of California in San Francisco. “If abstinence is your only plan, you should always have a backup contraception on hand, such as condoms.”

Pro: It’s free and 100 percent effective at preventing pregnancy.

Con: It’s definitely not the right choice for many people, and it can be extremely difficult for a person and their partner to commit to. While it can cut down on the likelihood of sexually transmitted infections, STIs can still?spread through oral sex, anal sex, and other intimate contact.

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