Illustration by Emma Günther
Which birth control is right for me?
Your guide to birth control
Top things to know about choosing a birth control
There are a variety of options when it comes to choosing a type of birth control
Some birth control options have hormones and others don’t
It’s best to choose the birth control you’ll use correctly and consistently
If you’ve decided you’re ready for birth control, you’ve definitely got options. But choosing the type of birth control that’s right for you can be overwhelming. Don’t worry—we’re here to help.
Birth control can be taken for a variety of reasons, including managing unpredictable periods, reducing period cramps, or skipping periods altogether. For the purposes of this article, we’re going to be talking about birth control used to prevent pregnancy.
Here we’ll outline all of your birth control options, along with their efficacy rates. Researchers often measure how well a birth control method works in two ways: typical use and perfect use rates. You can learn more about what they mean and how they’re calculated here.
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Picking the right birth control for you
Choosing the birth control that’s right for you involves a few factors. When considering your options, ask yourself these important questions to help guide your decision:
Do you want to have monthly periods?
Do you want a method you can quit any day (like the pill) or one you can commit to (like the implant)?
Do you want a method you don’t have to think about?
Do you plan on becoming pregnant any time soon?
Do you need to hide your birth control use from anyone?
Do you want to address other cyclic issues like menstrual pain or heavy bleeding?
Each birth control method listed above has different risks and benefits. If you’re still not sure which one you’d prefer, go over your answers to these questions with your healthcare provider. You can use Clue to track your monthly bleeding and other cycle-related experiences before your visit to give your provider an overall picture of your cycle.
Birth Control without a prescription
Most forms of birth control require a prescription from a healthcare provider. But, when you need to be discreet or pick up some pregnancy prevention in a hurry, these options are available at most pharmacies without a prescription. Birth control options available without a prescription are all non-hormonal.
Condoms
External/male
Unintended pregnancy in the first year of use:
Typical use: 13 out of 100 couples
Perfect use: 2 out of 100 couples (1)
Internal/female
Unintended pregnancy in the first year of use:
Typical use: 21 out of 100 couples
Perfect use: 5 out of 100 couples (1)
Condoms are thin tubes of latex, plastic, or other materials that cover the genitals to act as a barrier to bodily fluids. Male/external condoms are very effective when used consistently and correctly (1). If you’re using condoms to prevent pregnancy, make sure both you and your partner know how to use them. As a bonus, consistent and correct use of condoms can also significantly reduce your risk of contracting sexually transmitted diseases (STIs), including human immunodeficiency virus (HIV) (1). Although internal/female condoms are less popular, they’re also effective at preventing pregnancy and reducing the transmission of STIs (1).
Spermicide creams, foams, and suppositories
Unintended pregnancy in the first year of use:
Typical use: 21 out of 100 couples
Perfect use: 16 out of 100 couples (1)
Spermicides are considered some of the least effective forms of birth control but are still better than using no protection at all (1). You can use spermicides in cream, foam, or suppository form alone or with condoms, the cervical cap, or the diaphragm to make each method more effective (1). They work by immobilizing or destroying sperm (1). Spermicides have the added benefit of working as a lubricant (1). They can be applied up to one hour before having sex, and additional doses can be applied for multiple acts of sex with the same partner (1,2). Spermicides don’t protect against STIs (1).
Contraceptive sponge
Unintended pregnancy in the first year of use:
Typical use: Ranges from 32-16 out of 100 couples
Perfect use: Ranges from 9-20 out of 100 couples (1)
The contraceptive sponge is filled with spermicide and placed in the vagina before sex so that it rests against the cervix (the opening of the uterus from the vagina) (1). The contraceptive sponge is not widely available. To be effective, the sponge must remain in the vagina for six hours after sex (2). The sponge is more effective if you’ve never given birth (1). It works the same way spermicide does, but it has the added benefit of absorbing ejaculate, so less enters the uterus (2). The sponge doesn’t protect against STIs (2).
Fertility Awareness Methods
Unintended pregnancy in the first year of use:
Typical use: Ranges from 2 to 23 out of 100 couples depending on method
Perfect use: Ranges from less than 1 to 5 out 100 depending on method (1)
Fertility Awareness-Based Methods (FABMs or FAMs) can be used both to become pregnant and prevent pregnancy. FAMs are designed to predict when a person will ovulate to avoid sex when the fertilization of an egg is possible (1). There are a variety of FAM methods, and each has a different efficacy rate. Some methods require more attention and effort than most other birth control methods.
Lactational amenorrhea is an effective form of birth control for postpartum people who exclusively breastfeed/chest feed. This method required breastfeeding/ chest feeding (not pumping) every four hours during the day and every six hours at night (1). You can read all about other forms of non-hormonal birth control, including outercourse and fertility awareness here.
Your prescription birth control options
These forms of birth control require a visit with a healthcare provider (either online or in-person) to obtain a prescription. The good news is that you can get a prescription that lasts from a year (for pills) to ten years (for the copper IUD), so you won’t have to worry about it again for a while unless you want to make a switch. Remember that none of these forms of birth control protect against STIs.
Hormonal birth control
Hormonal methods of birth control contain—you guessed it—hormones. Hormonal birth control options include the implant, the intrauterine device (IUD), the shot, the pill, the ring, and the patch. They contain either progestin (a synthetic form of progesterone) or a combination of both progestin and estrogen (1).
Most hormonal birth controls prevent pregnancy by inhibiting ovulation so there’s no egg to fertilize, or by thickening cervical mucus to make it harder for sperm to enter the uterus and fertilize the egg, and most do both (1). The hormonal IUD works differently, though. It mostly thickens cervical mucus and sometimes prevents ovulation but not always (2).
The pill
Unintended pregnancy in the first year of use:
Typical use: 7 out of 100 couples
Perfect use: Less than 1 out of 100 couples (3 out of 1000 couples) (1)
Oral contraceptives, or “the pill,” are the most common form of hormonal contraception in the United States (2). There are three types of pills with different combinations of hormones, including the combined oral contraceptive (COC), the extended-use COC pill, and the progestin-only pill (POP), which is estrogen-free (2). Choosing a type of pill involves deciding on a few factors, including how often you want to have a withdrawal bleed and if you are breastfeeding (1). Your provider can walk you through the best options for you. Birth control pills need to be taken every day to be effective (2), which can be a deterrent for some people.
The patch and ring
Unintended pregnancy in the first year of use:
Typical use: 7 out of 100 couples
Perfect use: Less than 1 out of 100 couples (3 out of 1000 couples) (1)
The patch and ring both contain estrogen and progesterone (1). Instead of taking a pill every day, however, the patch and ring can both be applied or inserted and left for a while. The patch is made of thin plastic and looks similar to a small bandage (1). It delivers hormones through the skin and needs to be replaced weekly for three weeks, and removed for the fourth week (1). During this fourth week, you’ll experience a withdrawal bleed (1). The ring is a circular piece of plastic that’s placed in the vagina and left for three weeks, then removed for the fourth week (1). During the fourth week, you’ll experience a withdrawal bleed (1).
The shot
Unintended pregnancy in the first year of use:
Typical use: 4 out of 100 couples
Perfect use: Less than 1 out of 100 couples (2 out of 1000) (1)
The shot, or injectable contraceptive, contains progestin. One dose lasts three months, at which point another shot must be administered (1). Because you only have to administer the shot once every three months, some people find this method very convenient. It’s also discrete and doesn’t require cooperation from sexual partners (1). Typically, bleeding may be unpredictable for the first several months and then no monthly bleeding (1). There may be a temporary delay in the return of fertility after stopping the shot therefore, your healthcare provider may recommend you discontinue the shot 12–18 months before the time pregnancy is desired (2)
The implant
Unintended pregnancy in the first year of use:
Far less than 1 out of 100 couples (1 out of 1000 couples) (1)
The hormonal implant is the most effective form of hormonal birth control and contains only progestin (1). The implant is a thin rod that is inserted under the skin in the upper arm (1). It lasts for three years, at which point you can return to a clinic to have a new rod implanted (1). It’s convenient and also discrete. Insertion of the implant is an in-office procedure that can cause some swelling, bruising, and pain in the arm where it is inserted (1).
Hormonal IUD
Unintended pregnancy in the first year of use:
Less than 1 per 100 couples (2-8 per 1000 couples) dependent on dose (1)
The IUD is a small T-shaped implant placed inside the uterus. The IUD is highly effective, convenient, discreet, and has high satisfaction rates among people who use it (2). There are a few different kinds of hormonal IUDs with varying doses of hormones. Depending on the dose, you can use one IUD for three to eight years (2,3). Your healthcare provider can help you pick the dose that works for you. The IUD requires an in-office insertion procedure that can cause some cramping. Unpredictable bleeding and spotting are common in the first few months of use, with improvement after three months (2). Hormonal IUDs are associated with a reduction in monthly bleeding loss, or bleeding may stop altogether (2).
Non-hormonal birth control
The non-hormonal birth control options you can get from your provider include the copper IUD, Phexxi vaginal gel, and sterilization.
Copper IUD
Unintended pregnancy in the first year of use:
Typical use: Less than 1 per 100 couples (8 per 1000 couples)
Perfect use: 6 per 1000 couples (1)
The copper IUD is hormone-free and can be used for 10 years (1). The IUD is a T-shaped plastic frame wrapped with a thin copper wire that releases copper ions. These ions generate an inflammatory response, creating an inhospitable environment for sperm (2). The copper IUD might increase menstrual pain and bleeding in some people, so it’s good to ask your provider if it’s the right option for you (2).
Diaphragm and cervical cap
Unintended pregnancy in the first year of use:
Typical use: 17 per 100 couples (includes the use of spermicide)
Perfect use: 16 per 100 couples (includes the use of spermicide) (1)
A diaphragm is a soft latex cup that covers the cervix and is used with spermicide. Cervical caps are smaller than diaphragms and fit tightly around the cervix (1). Diaphragms must be left in place at least 6 hours after ejaculation, but no longer than 24 hours (1). Both are available in the US by prescription (2). Most diaphragms come in different sizes and require fitting by a healthcare provider (1). Only use water-based spermicides or lubricants when using a diaphragm and a cervical cap (2). The diaphragm and cervical cap don’t protect against STIs (1).
There is also a one-size-fits-all diaphragm, Caya. A healthcare provider may have you insert Caya during the visit and then perform a pelvic exam to make sure that it was placed in the right position (4). Water-based spermicide should also be used with Caya (4)
Phexxi vaginal gel
Unintended pregnancy in the first year of use:
Typical use: 14 out of 100 couples
Perfect use: 7 out of 100 couples (5).
Phexxi is a new non-hormonal birth control method available by prescription. It’s a vaginal gel and works by lowering the pH in your vagina (5). This makes it hard for sperm to move, which lowers the chance that sperm and egg meet (5). Phexxi comes in pre-filled applicators and is applied inside the vagina before sex (5). It starts working right away and is effective for up to one hour (5,6). Phexxi can be combined with other methods of birth control like condoms, diaphragms, or hormonal options like the pill or patch to increase effectiveness (5,6). Phexxi cannot be used with the ring, however (5,6).
Sterilization
Tubal occlusion/removal
Unintended pregnancy in the first year of use:
Less than one out of 100 couples (5 out of 1000 couples) (1)
Vasectomy
Unintended pregnancy in the first year of use:
Less than 1 out of 100 couples (1.5 out of 1000 couples) (1)
Permanent sterilization is the most effective form of birth control, but it’s only for people who don’t ever want to have more children. Both vasectomy (male sterilization) and tubal occlusion (female sterilization) require surgery, although it’s usually an outpatient procedure (2). Recovery from both procedures is usually quick.
