As a modern woman, birth control is something you’ll consider from the first time you become sexually active. Because there are so many birth control options, choosing the best birth control for you may be difficult. Your weight, health concerns, schedule, allergies and even religious beliefs will affect your decision, so it’s important to do your research.
Below is a comprehensive list of birth control methods, their rates of failure and other information you may want to take into consideration when deciding on a contraceptive method for you and your partner.
BEHAVIORAL BASED BIRTH CONTROL
Birth control methods that rely on your own behavior can serve as a last resort if you do not have access to other forms of birth control. However, you should use them with some care.
- Abstinence is the only way to avoid pregnancy entirely. Without any sexual contact, you will prevent transmission of STIs, too. However, even non-penatrative sexual contact can spread specific STIs, as can kissing, oral and anal sex, so you may still want to use a condom if you’re having anal sex.
- Fertility awarenessrequires you to track your cycle to determine the days when you are most and least likely to become pregnant. If you’re trying to conceive, this same method can help you do so. WebMD recommends that your doctor train you to measure your cervical mucus and temperature. However, this method works best if your cycle is regular. Fertility awareness fails approximately 25% of the time.
- Pulling outis exactly as it sounds. Your partner will stop penetrating you before orgasm. However, pulling out has a much greater typical failure rate of 27%. Pulling out, when combined with fertility awareness, can decrease the risk of pregnancy better than either behavioral method alone. However, pulling out can be hot and lead to pearl necklaces.
If you rely on your own behavior to prevent pregnancy, you’ll have to be vigilant. You don’t want to gamble with your sex life.
You’re probably familiar with condoms. In fact, most people use condoms as their primary source of birth control and STI transmission prevention. You can find latex condoms at the pharmacy or the corner store for less than $15, and condoms may have special features such as ridges or warming lube. You can easily carry condoms on your person or in your purse if you anticipate a hookup, and condoms are recommended if you plan to have a threesome.
According to the CDC, latex condoms have the the lowest average failure rate of all condoms at 18%. They’re also capable of preventing transmission of HIV and other sexually-transmitted diseases. Latex condoms can cause an allergic reaction for people who have latex allergies. One alternative is polyurethane condoms, which results in a 9-percent failure rate after a six-month study, and is also effective against STIs.
Polyisoprene condoms are the newest condom material on the market. It offers the same benefits of latex condoms without risk of allergic reaction. Some users report that polyisoprene condoms feel more natural than latex condoms.
Natural condoms, which are typically made from lambskin, are another hypoallergenic option. Like the natural condom, the female condom is made of hypoallergenic materials. It has a slightly greater failure rate than latex condoms — 21% according to the CDC. Lambskin condoms do not protect against STIs, and the female condom may be less effective at protecting against STI transmission than latex condoms.
Condom efficacy can be increased by using a spermicide to kill the sperm. Spermicide can cause irritation like an allergy, however.
OTHER BARRIER METHODS
Although less common than condoms, diaphragms, cervical caps and sponges all provide physical barriers between your partner’s sperm and your uterus. You insert one of these devices into your vagina so that it sits against your cervix. Your doctor will have to properly fit a cervical cap or diaphragm, and he or she can instruct you to properly insert them.
One of the benefits of barrier contraceptives like these is that they can be placed before sexual activity, so you don’t have to interrupt foreplay to unroll a condom. great option You can wear a diaphragm for up to 24 hours, and you must keep it in place for up to 6 hours after having intercourse. The same is also true of the sponge, which can be worn for up to 30 hours.
Cervical caps, which are sold under the name FemCap, are similarly made of silicone and inserted before sex. They must remain in place for six hours but you can keep them inserted for up to 48 hours according to Planned Parenthood. Both cervical caps and diaphragms can be reused. However, the Today Sponge should be discarded after a single use. You can keep a diaphragm in place to have sex multiple times if you add more spermicide.
These barrier methods of birth control can also be used with spermicide to increase their efficacy. Diaphragms and cervical caps are as effective as latex condoms according to the CDC. The sponge is more effective for women who have not yet had a child — about 12% failure rate — than women who have given birth before — 24% failure rate.
THE BIRTH CONTROL PILL
Since 1960, the FDA has approved various birth control pills for use as a contraceptive. Never before did women has so much agency over their sexual health and bodies, which is why birth control pills remain one of the best birth control methods today.
Birth control pills rely on hormones to regulate your menstrual cycle. According to Planned Parenthood, the most type of birth control pill is the combination pill, which has both estrogen and progestin. These pills prevent ovulation, so your eggs never leave your ovaries. Combination pills also increase the thickness of cervical mucus, which prevents sperm from passing to your uterus.
The typical round of birth control pills includes three weeks of active medication and one week of placebo or iron pills, during which you’ll have your period. You can still get pregnant during this week, so using condoms is a good idea. Birth control pills should be taken every day around the same time to be most effective. Birth control pills are 99% effective when used correctly. However, typical use has a 9% failure rate.
The pill can be made less effective by other medication. This includes the antibiotic rifampin and griseofulvin, an antifungal medication. St. John’s Wort, which has a variety of uses, and some HIV medication can also decrease effectiveness of combination pills.
Another type of pill only contains progestin, and it’s known as the POP (progestin-only pill) or minipill. Your doctor may recommend this pill if your body doesn’t deal well with the increase of the hormone estrogen. There is no placebo week with the minipill. POPs have an even smaller window to take to remain effective and they have a 13% failure rate.
Both combination and minipills can create side effects, especially during the first several months as your body acclimates to the pill. Common symptoms of birth control pills include:
- Spotting between periods
- Breast tenderness
- Weight gain or loss
- Decrease in sexual interest
Birth control pills share many of these symptoms with other hormonal birth control methods.
Emergency contraception is a type of birth control you can use after having sex to prevent pregnancy. EC, as it’s known, isn’t the same as having an abortion. There are two types of EC.
- The morning after pillcontains a concentrated amount of hormones and can be taken up to 5 days after unprotected sex.
- ParaGard, the copper IUD, can be inserted up to five days after sex and continues to protect against pregnancy for 12 years.
The morning after pill is available in two brands: Ella and Plan B. Ella is more effective for heavier women; although, it becomes less effective if you have a BMI over 35. Plan B is most effective when used three days or less after sex and is less effective for women with a BMI over 25. Both of these methods can cause a heavier or earlier period and nausea or vomiting are common side effects.
Because of the symptoms caused by the heavy dose of hormones in EC pills, some women prefer the IUD option. However, ParaGard must be inserted by a doctor and is much more costly than morning after pills. Plan B can be acquired from most pharmacies without a prescription, while Ella requires a doctor’s prescription.
HORMONAL BIRTH CONTROL METHODS
There are a number of other birth control methods that use hormones like the pill, but you don’t take them orally.
- The implant— Implanon or Nexplanon — is surgically implanted into your arm by your doctor to release progestin over a period of three years. The implant has an incredibly high rate of success — 99.5%. It’s safe to use while breastfeeding but is not appropriate for women who have had breast cancer.
- The shot — Depo-Provera — requires a visit to your doctor every three months to prevent pregnancy. It has a 6% failure rate, and women often experience lighter periods or spotting when on the shot.
- The patch— Ortho Evra — is worn on the abdomen, butt or upper body for three weeks out of the month. During your period, you won’t wear the patch. The patch has a 9% failure rate, but is less effective for women who weight over 198 pounds.
- The ring— NuvaRing — is a silicone ring inserted into the vagina like a diaphgram. It’s worn for three weeks at a time like the patch, and then removed for the week of your period. NuvaRing contains both estrogen and progestin.
Hormonal birth control typically comes with the same side effects as the pill, and it can take two to three months for those symptoms to level out. Similarly, your body may require several months to return to its normal state after you stop taking birth control. Medication that would make the pill less effective have the same effect on other hormonal contraceptives.
Intrauterine devices, also known as IUDs or IUCs, are small, T-shaped devices that your doctor inserts into your uterus. There are three brands available in the United States- Mirena, Skyla and ParaGard. However, more brands of IUDs are available in Europe, and they come in a wider variety of shapes.
IUDs offer the longest form of birth control when compared to other barrier and hormonal birth control methods. Skyla is the smallest option available and is effective for up to three years. You can use Mirena for up to five years, and ParaGard prevents pregnancy for 12 years! Each of these IUDs can be removed at any time before the expiration if you decide you want children.
Both Skyla and Mirena emit hormones into your body in the form of progestin, which can help to reduce the intensity of your flow and cramps during your period. Many women experience no periods when using hormonal IUDs, and spotting is common. Mirena has an effectiveness rate of 99.8% according to the CDC.
ParaGard doesn’t use hormones for birth control, but remains over 99% effective. Symptoms can include more severe bleeding and cramps because the IUD contains no hormones. ParaGard is not the best birth control option for someone with an allergy to copper or users with Wilson’s Disease.
Other disadvantages of IUDs include the possibility of them slipping out of your uterus, which can lead to pregnancy, uterine infection and perforation of the uterine wall. Most of these risks can be minimized when your doctor properly trims the strings on your IUD during insertion. Monthly checking of your IUD ensures it’s stayed in place.
PERMANENT BIRTH CONTROL (STERILIZATION)
Permanent birth control is any type of birth control that surgically alters your reproductive system. These methods are 99% effective at preventing pregnancy, but won’t protect against STIs. Out-of-pocket costs can be thousands of dollars if your insurance doesn’t cover permanent birth control; however, it is a one-time cost. Depending on the type of sterilization, recovery can take up to three weeks.
Tubal ligation or having your “tubes tied,” is typically an outpatient procedure that requires 2 – 4 days for recovery.
Transcervical sterilization, where small rods, called Essure, are inserted into your fallopian tubes, causes scar tissue to form. Essure prevents eggs from traveling down the tubes, but the process should be used with another form of birth control during the first three months. Essure is an outpatient procedure, and some women return to normal activities on the same day.
A hysterectomy is complete removal of the uterus, and is typically recommended to correct other health problems and not just for birth control. You will no longer have periods, and your body’s creation of hormones may change. Recovery time may take up to six weeks.
A vasectomy is a man’s option for permanent birth control. A vasectomy surgically closes the vas deferens, which carry the sperm.
Permanent birth control should be considered carefully. Anyone who may want a biological child should consider another form of birth control before sterilization or vasectomy because reversal cannot be guaranteed, and any attempts are expensive.
WHAT’S THE BEST BIRTH CONTROL METHOD FOR ME?
Efficacy alone doesn’t necessarily mean that a certain type of birth control is the ideal way for you to prevent pregnancy. For example, if you subscribe to a more traditional religion such as Judaism that forbids the use of barriers contraceptives, including condoms, then hormonal birth control may be your only option. But hormonal birth control won’t protect against STI transmission.
The varying cost of birth control can also prevent you from using the best birth control for your needs. Condoms are readily available and relatively affordable — even free from some family planning clinics – but the IUD can cost near $1,000 in the United States if you lack health insurance.
Changes in life status, including, marriage divorce or moving to multiple partners, may also affect your decision. Even if you’re married, your future may involve different partners due to divorce or death, and those partners may have different preferences about birth control or may even change your mind about having kids. This is one reason why sex after divorce should cause you to rethink birth control.
Talking to your doctor may be necessary to get a prescription for birth control, but it’s a good idea even if you choose a non-prescription contraceptive. After all, a good education is an important part of taking control of your sex life.