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With so many choices when it comes to birth control, how to decide which is the safest and most reliable method?

The decision to use birth control and the method of choice is a personal one. There are many options. Most are highly effective when a person uses them correctly, but there is always a chance that it will not work.

Weighing the options with a doctor and partner is an important part of the decision making process.

Some things to consider when choosing a birth control method:

  • overall health
  • the desire to have children in the future
  • the frequency of sexual contact and number of sex partners
  • the safety and efficacy of the options
  • protection from sexually transmitted infections (STIs)
  • personal preference

In this article, we explore the safety, effectiveness, and side effects of different types of birth control, including natural and nonhormonal methods.

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Natural and nonhormonal methods of birth control are all reversible. The risk of side effects is low, but there is a higher chance of pregnancy than with hormonal or permanent methods.

It is not possible to predict the effectiveness exactly, but the following table gives some idea. The sections after the table give more detail about each type, including hormonal and permanent methods of birth control.

There are two ways of measuring how well a type of birth control prevents pregnancy. “Perfect use” involves using birth control correctly, on time, and without error. This is not always possible. “Typical use,” which is more realistic, reflects a person forgetting a pill or a ring accidentally falling out, for example. This can happen to anyone, and it can reduce the effectiveness of birth control.

Natural or nonhormonal methodAdvantages
Side effects and disadvantages
Effectiveness
Abstinence– free of charge
– reversible
– no protection from STIsIn theory, 100%, but it can be hard to maintain.
Fertility awareness– reversible
– requires some training and determination to abstain from intercourse on fertile days
– no protection from STIsIn theory, 99%; in reality, it may be around 89%.
Standard days– free of charge
– reversible
– requires some training
– no protection from STIsIn theory, 95%; in reality, it may be as low as 76%.
Withdrawal– free of charge
– reversible
– no protection from STIsResearch suggests around 78%.
Breastfeeding– free of charge
– convenient
– no protection from STIsIn theory, 98%; in reality, it may be 92.5%.
Outercourse– free of charge– no protection from STIsThere are no figures, but the risks are similar to those of withdrawal.
Male condom– low cost
– readily available
– some protection from STIs
– possible latex allergyIn theory 98%; in reality, it may be closer to 82%.
Female (internal) condom– some protection from STIs
– possible latex allergy
– irritation
In theory, 95%, but the OWH suggests 79% in reality.
Diaphragm– no hormones
– can insert before sex
– reversible
– allergic reaction
urinary tract infections (UTIs)
– vaginal irritation
– risk of toxic shock syndrome
In theory 92–96%, but it may be as low as 83% in reality.
Cervical cap or shield– no hormones
– can insert before use
– reversible
– allergic reaction
– risk of toxic shock syndrome
With correct use, effectiveness is 71–86%. The Office on Women’s Health (OWH) suggests it is 77%.
Contraceptive sponge
– no hormones
– no need for fitting
– safe during breastfeeding
– reaction to spermicide
– vaginal dryness and irritation
– risk of toxic shock syndrome
This is 88–91% effective in those who have never given birth and 76–88% effective in those who have.
Spermicide – easy to use
– safe during breastfeeding
– allergic reaction
– irritation
In theory, 82%, but in reality, it may be as low as 72%. The OWH suggests 79%.

Several methods of birth control require no device or medication, but they may be less reliable than other options.

Abstinence

In terms of pregnancy prevention, abstinence means avoiding any activity that could allow sperm to enter the vagina. Partners need to avoid penetrative vaginal sex and any other activity in which sperm could make contact with the vagina.

In theory, abstinence is 100% effective, but any activity in which the penis is near the vagina increases the chances of pregnancy. There are no physical side effects and abstinence is free. However, it can be difficult to maintain.

How does not having sex for a long time affect the body?

Fertility awareness

In the menstrual cycle, there are some days when pregnancy is more likely. For someone wishing to prevent pregnancy, fertility awareness — also known as natural family planning or the rhythm method — involves avoiding sex that could lead to pregnancy or using another method of birth control on these days.

For this to work, the person needs to:

  • have a regular, predictable cycle
  • be familiar with their cycle and know when pregnancy is most likely
  • use birth control or avoid sex on days when pregnancy could occur

Ways of checking for the “fertile window” include:

  • using a calendar
  • monitoring changes in cervical mucus during the month
  • checking for a spike in temperature, which tends to happen before ovulation

Used correctly, this method should be 99% effective, but statistics suggest that 1 in 9 females using it become pregnant a year, making the effectiveness closer to 89%.

This method requires a lot of motivation on the user’s part. It involves checking vital signs and cervical mucus first thing every morning and committing to abstinence or another birth control method on fertile days.

Learn more about how the menstrual cycle can indicate fertility.

Standard days method

This is similar to the rhythm method, and it requires a person to use another form of birth control or avoid sex that could lead to pregnancy on days 8–19 of the menstrual cycle.

Proponents of the standard days method (SDM) claim that it is 95% effective, indicating that 5 in every 100 people who use it become pregnant in the first year of use. There is no data to show its effectiveness with typical use, but research indicates that periodic abstinence, which SDM might involve, is 76–83% effective.

Organizations promoting the use of SDM include Cycle Technologies, a company that sells CycleBeads. This is a set of beads that helps a person keep track of their menstrual cycle.

As with fertility awareness, a person needs to check their vital signs and cervical mucus first thing every morning.

Withdrawal method

The withdrawal, or “pull-out,” method involves removing the penis from the vagina prior to ejaculation.

The OWH suggests that this method is 78% effective. Pregnancy can occur if pre-ejaculate enters the vagina or if semen is present around the vagina or on the hands.

Learn more about the pull-out method.

Breastfeeding

The chances of becoming pregnant are reduced while breastfeeding exclusively within 6 months of delivery — as long as periods have not started again. The reason is that hormone levels have not returned to their prepregnancy state yet, so ovulation does not occur, and there is no menstruation.

The technical term for this approach to birth control is the lactational amenorrhea method (LAM). It may offer up to 98% protection against pregnancy, but it is not a guaranteed method of contraception.

LAM only works if breastfeeding accounts for at least 85% of feeds, and some experts say that the infant needs to have no other method of feeding to delay ovulation sufficiently. This can be difficult to maintain, and one review suggests that LAM is ineffective in up to 7.5% of cases.

Also, a person usually does not know when ovulation has resumed because it happens before menstruation. As a result, it can be difficult to tell when pregnancy is possible again.

Most doctors recommend using another method alongside LAM if pregnancy prevention is a high priority.

Learn more about some pros and cons of breastfeeding.

Outercourse

There are two ways of defining outercourse. One is sexual activity that does not involve vaginal penetration. The other is sexual activity that involves no penetration — oral, anal, or vaginal.

Examples of outercourse without vaginal penetration include kissing, masturbation, manual stimulation, body-to-body rubbing, fantasy, sex toys, and oral and anal sex.

This method can be nearly 100% effective with perfect use, but this is difficult to achieve. If semen or pre-ejaculate is on the hands, a sex toy, or near the vagina, pregnancy may be possible.

Outercourse has the following benefits:

  • There are no physical side effects.
  • There is a reduced risk of fluid exchange.
  • It can encourage people to explore new relationships and sexual experiences.

The disadvantages include:

  • difficulty abstaining from penetrative sex
  • the possibility of accidental contact with sperm
  • no protection from STIs

Sex without fluid contact — learn more about dry humping here.

Some examples include condoms, the diaphragm, the cervical cap or shield, and sponges. A person may use them alone or alongside a natural method of birth control.

Male condom

A male, or external, condom made from latex, polyurethane, and polyisoprene can prevent pregnancy and offer protection from STIs. Natural or lambskin condoms can only prevent pregnancy. People can use condoms during vaginal, anal, and oral sex.

Male condoms are 98% effective at preventing pregnancy if people use them correctly every time. In reality, however, this figure may be closer to 85%. Using them with spermicide increases the level of protection. These condoms are inexpensive and widely available.

Some disadvantages involve the possibility of an allergic reaction to latex and a change in sexual sensation. Also, the user needs to put on the condom during sex, which can be briefly disruptive.

Learn more about the different types of condoms and how to use them.

Female condom

A female, or internal, condom can prevent pregnancy and may offer protection from HIV and other STIs. However, researchers have called for more studies to confirm how effective they are against specific infections.

Used correctly, internal condoms are 98% effective at preventing pregnancy. However, they can slip or tear, and both the Centers for Disease Control and Prevention (CDC) and the OWH suggest that the effectiveness may really be 79%.

They are suitable for use during anal and vaginal sex, and a person can use them with spermicide. Using a lubricant can keep the condom from slipping and tearing.

People should not use internal and external condoms at the same time, as this can cause tearing.

Find out more about female condoms.

Male and female condoms are available for purchase online.

Diaphragm

Diaphragms are shallow silicone cups used with spermicide. A person inserts the diaphragm into their vagina to prevent pregnancy.

When used perfectly every time, a diaphragm is 92–96% effective at preventing pregnancy. Realistically, however, the CDC suggests that the effectiveness is around 83%.

A diaphragm is safe during breastfeeding and does not affect hormone levels. One risk is that it may become dislodged during sex.

The diaphragm needs to stay in the vagina for at least 6 hours after sex to prevent pregnancy, but it should stay in the body no longer than 24 hours, to reduce the risk of infection. A person needs to use more spermicide if they want to have sex again and the diaphragm has been in place for more than 3 hours.

Side effects and complications include allergic reactions and irritation, and an increased risk of UTIs and toxic shock syndrome.

In the past, doctors needed to fit a diaphragm and refit if the person gained or lost more than 7 pounds. With newer types, however, this may not be necessary.

Find out more about diaphragms and how to use one.

Cervical cap or shield

Cervical caps and shields are silicone cups that fit over the cervix in the vagina. This method is safe while breastfeeding and does not affect hormone levels.

If a person has never given birth, the cervical cap is around 86% effective with correct use. If a person has given birth, the effectiveness falls to 71%. Using the cap or shield with spermicide will improve its effectiveness.

Caps and shields can be hard to put in place, and there is a chance of them dislodging. There are also risks of abnormal pap smears, an allergic reaction, and toxic shock syndrome.

A doctor may need to fit a cap or shield and refit one due to changes in weight or pregnancy.

A cervical cap must stay in place for at least 6 hours after sex and be removed within 48 hours.

Contraceptive sponge

A sponge is a plastic foam disk that contains spermicide, and a person inserts it into the vagina.

When someone who has never given birth uses a sponge perfectly, it is likely to be 91% effective at preventing pregnancy. After giving birth, it may be 80% effective with perfect use. In reality, however, figures suggest that sponges are around 88% effective for someone who has never given birth and 76% for someone who has.

The sponge does not affect hormone levels, there is no need for fitting, and it is safe to use when breastfeeding.

However, a person may have a reaction to the spermicide, and it may lead to vaginal irritation and dryness. Leaving the sponge in can increase the risk of toxic shock syndrome. Also, it can be hard to insert, and there is a risk of it breaking.

Sponges and other birth control products are available for purchase online.

Spermicide

Spermicides prevent pregnancy by killing sperm. They are available as foams, gels, creams, films, suppositories, and tablets. A spermicide can increase the effectiveness of barrier methods, such as condoms and diagrams.

If a person uses spermicide perfectly with no other method of birth control, it will be around 82% effective at preventing pregnancy. In reality, however, the figure is closer to 72%. This means that out of every 100 people who use it, 28 will become pregnant. For this reason, it is best to use spermicide with another method.

Spermicide is easy to use and widely available. It is also safe during breastfeeding and does not affect hormone levels. However, some people may have an allergic reaction or irritation.

There are various hormonal methods of birth control, including pills, patches, injections, intrauterine devices (IUDs), and vaginal rings.

Some may cause or increase the risk of adverse effects, including a heart attack, stroke, blood clots, high blood pressure, liver tumors, gallstones, and jaundice.

These risks are higher for people who:

  • are at least 35 years old
  • have obesity or are overweight
  • have a history of certain inherited blood-clotting disorders
  • have high blood pressure
  • have high cholesterol
  • are experiencing prolonged bed rest
  • smoke tobacco products
  • have a history of migraine with aura

A doctor can recommend a suitable contraceptive, taking into account the risk factors above. Hormonal methods do not protect against STIs, so it is a good idea to also use a barrier method of protection, such as a condom.

Pills

Birth control pills contain either a combination of the hormones estrogen and progestin or just progestin.

Used correctly, they are 99% effective. In reality, it may be closer to 91%, according to the OWH, and 93% according to the CDC. This could be due to forgetting a dose, having diarrhea, vomiting, or taking certain medications at the same time.

The pill may also help manage menstrual problems and premenstrual syndrome, better known as PMS, and it may improve acne. The pill may also offer some protection against endometrial and ovarian cancers.

However, it may cause adverse effects, such as breast tenderness, mood changes, and menstrual changes or spotting. It may also slightly increase the risk of breast cancer. The risks depend on the specific type of pill.

Learn more about the birth control pill’s side effects.

Patches

Hormonal patches prevent pregnancy by delivering specific hormones through the skin.

Used perfectly, a patch is likely to be 99% effective. In reality, however, the OWH estimates the effectiveness to be around 91%, while the CDC suggests that it is 93%. It is less likely to be effective in people who weigh 198 pounds or more.

A person wears a patch for 21 days, then removes it for 7 days.

Possible adverse effects include skin irritation, menstrual changes, mood changes, sore breasts, headaches, weight gain, an increase in blood pressure, and gastrointestinal problems.

Learn more about the patch.

Injections

Given every 3 months, Depo-Provera is an injectable form of birth control that uses the hormone progestin to prevent pregnancy.

According to the CDC, it is 96% effective when used correctly.

Benefits of injectable birth control include safety and convenience, uterine cancer prevention, safety during breastfeeding, and the fact that no estrogen is involved.

In the past, people had to have intramuscular injections in a doctor’s office. Now, however, the medication can be injected under the skin, and a person may learn to administer the injections themselves at home.

Side effects can include menstrual changes, weight gain, and a reduction in sex drive. The side effects can last as long as the person receives injections. There may also be a higher risk of osteoporosis in the long term.

After stopping the injections, it can take 1 year for fertility to return.

Learn more about the Depo-Provera shot here.

Vaginal rings

NuvaRing is a flexible plastic ring that a person inserts and leaves in their vagina for 3 out of every 4 weeks. It prevents pregnancy by releasing estrogen and progestin into the vagina. Used perfectly, it is over 99% effective. In reality, however, the effectiveness may be closer to 91%.

A newer option is Annovera, which a person can reuse for 13 cycles, which means that they do not have to return to the doctor for refills every few months. A 2019 study with 1,303 participants concluded that this method was 97.5% effective. Out of 38 participants who wished to become pregnant after the 13-month trial, 63% did so within 6 months.

Vaginal rings are easy to use, and fertility resumes soon after stopping use. Other possible benefits include lighter periods, improvements in acne, and a reduced risk of some cancers.

Some possible adverse effects include temporary bleeding and spotting, headaches, nausea, and breast tenderness.

Learn more about the NuvaRing.

Implanted devices are long-term forms of birth control.

IUDs

An IUD is a T-shaped device that a doctor inserts into the uterus. Currently, the following are available in the United States: Mirena, Skyla, Kyleena, and Liletta, which are hormonal, and Paragard, which is not. Paragard contains copper.

An IUD is 99% effective at preventing pregnancy. A person can leave a hormonal IUD in for 3–5 years and a copper IUD for 10–12 years.

With any IUD, there is a risk of:

Learn more about the possible adverse effects of an IUD.

An IUD provides long-term birth control, and hormonal devices may also help manage menstrual cramps and bleeding. In most cases, fertility returns soon after an IUD is removed.

An IUD may not be suitable for everyone, and a doctor can provide specific guidance.

How do IUDs work?

Implantable rod

Another form of implanted birth control is a small implantable rod, called Implanon or Nexplanon. It sits under the skin in the upper arm, can stay in place for 3 years, and is 99% effective at preventing pregnancy.

The implant requires no maintenance, and it does not contain estrogen. However, it may not be suitable for everyone.

Possible side effects include:

  • headaches
  • menstrual changes
  • weight gain
  • sore breasts
  • in some cases, difficulty removing the rod

How does the implant work?

Below are some options for permanent sterilization.

Tubal ligation

During a tubal ligation, a surgeon stops the fallopian tubes from being able to carry an egg from the ovaries to the uterus, preventing pregnancy. They may tie, cut, seal, clamp, or remove a portion of the tubes. This is more than 99% effective.

Can a person become pregnant after a tubal ligation?

Male sterilization

A vasectomy blocks or closes the vas deferens, which transports sperm. It does not affect erections or the ability to produce semen.

This is 99% effective at preventing pregnancy within 1 year, but fertility takes time to decrease. The person needs a semen analysis 12–16 weeks after the procedure and will need to use another method of birth control until results show that there are no motile sperm in the ejaculate. In 80% of cases, there is no motile sperm after 12 weeks.

The risks include bruising, infection, and, in rare cases, the tubes reconnecting.

A person can have surgery to reverse a vasectomy, but there is no guarantee that fertility will return.

Find out more about vasectomies.

Emergency birth control can help prevent pregnancy if conception may have occurred. There are two types of emergency birth control: the “morning after” pill and a copper IUD.

Morning after pill

In the U.S., a pill called Plan B, which contains levonorgestrel, can prevent pregnancy after a person has had sex without sufficient birth control.

This type of pill is 97.4% to 99.4% effective at preventing pregnancy within 72 hours, or 3 days, of sex. However, it may be less effective if a person has a body mass index of over 25.

Side effects include menstrual changes, headaches, and pain.

What is Plan B?

Copper IUD

Having a copper IUD fitted within 120 hours, or 5 days, of having sex without sufficient birth control can prevent pregnancy. Fewer than 0.1% of people who have an IUD as emergency birth control become pregnant.

Possible adverse effects include pain and a risk of infection.

Learn more about emergency birth control.

There are many types of birth control, and their effectiveness varies. Natural and barrier methods are less likely to cause adverse effects than hormonal methods, but they may be less effective at preventing pregnancy.

A doctor or another healthcare professional can advise about the best option, taking into account a person’s overall health, lifestyle, and preferences.