Choosing the Right Birth Control for You

1. How Well It Prevents Pregnancy

Most people have one main contraceptive goal: to avoid getting pregnant (at least for now). About 85 percent of sexually active couples who do not use any method of birth control become pregnant within one year, according to the Guttmacher Institute.

All forms of birth control are measured by what’s known as a failure rate, which is the estimated percentage of women who become pregnant within a year of using the contraceptive. LARCs and sterilization are the most effective of the bunch, with a failure rate of less than 1 percent, according to the Centers for Disease Control and Prevention (CDC). Hormonal methods, while still highly effective, require remembering to regularly take medication, switch out the delivery system (like the ring or patch), or get a shot, resulting in slightly higher failure rates of 4 to 7 percent. Finally, barrier methods and fertility-awareness rhythm methods fail anywhere from 13 to 23 percent of the time.

Here’s a quick breakdown of the failure rates for each contraception option, from most to least effective, according to the CDC:

• Implant: 0.1 percent
• Levonorgestrel IUD: 0.1 to 0.4 percent
• Male sterilization: 0.2 percent
• Female sterilization: 0.5 percent
• Copper IUD: 0.8 percent
• Injection: 4 percent
• Pill, mini pill, patch, monthly ring: 7 percent
• Male condom: 13 percent
• Diaphragm: 17 percent
• Sponge: 14 percent (women who’ve never given birth) or 27 percent (those who’ve already given birth)
• Withdrawal: 20 percent
• Spermicides: 21 percent
• Fertility-based methods: 2 to 23 percent

“Methods that have the highest failure rate are things that require use with every sexual act, like condoms and natural family planning,” says Ashley Brant, DO, a family doctor who specializes in obstetrics and gynecology at the Cleveland Clinic in Independence, Ohio. “It’s due to a combination of not being used correctly or at all, or the method itself not being effective.”

But she also notes, “All of these are more effective than using nothing at all.”

2. Your Timeline for Having Kids

Thinking of starting a family soon? If that’s the case, you might want to use a short-term contraceptive. For example, even though the IUD and implant are highly effective and easy, they require a doctor’s visit for insertion and removal. That means you can’t immediately get off of them, notes Brant. “If you’re thinking you may have kids soon, it may not be worth the effort to get an implant or IUD,” says Dr. Brant. “And certainly if you plan on having any more kids at all we won’t talk about sterilization.”

Although vasectomies and tubal ligation are meant to be permanent, they are technically reversible. One warning: “Reversal procedures are not too successful,” says Dr. Dweck, so most couples have to go through IVF, which is rarely covered by insurance, if they want to get pregnant again.

The injection usually isn’t a good option either for women who are considering getting pregnant within the next year, says Brant, since the medication can take up to a year to wear off before conception is possible.

You can stop using the pill, patch, or ring whenever you want, and fertility usually resumes quickly after discontinuing their use. That said, for some it could take up to several months before ovulation begins again. With condoms, natural family planning, or withdrawal methods, on the other hand, there is no delay in fertility after stopping their use.

3. How Often You’ll Need to Use It

The implant, IUD, and sterilization are long-term, almost completely mistake-proof options. Once an IUD is inserted, you’re set for anywhere from 3 to 8 years (hormonal IUDs) to 12 years (copper IUDs), according to Planned Parenthood. The implant lasts up to 5 years, according to Planned Parenthood. Sterilization, meanwhile, lasts for life.

All other types of contraception need to be taken or applied more frequently. The pill needs to be taken every day, whereas the patch needs to be changed weekly. Vaginal rings are swapped or removed and cleaned once a month (depending on which version you’re using), and injections are given every three months by a healthcare provider.

Barrier methods, such as condoms, are applied every time you have sex. The rhythm method typically involves tracking your cycle daily by taking your temperature every morning, checking your cervical mucus, and/or charting your periods.

4. Ease of Use, Including Whether You’ll Need a Prescription

For now, all hormonal birth control methods (patch, pill, ring) as well as the diaphragm require a prescription from your doctor. You’ll also need to visit the doctor to get the IUD or implant. The injection is usually administered by your healthcare provider, which means you’ll have to schedule — and make time to visit — your doctor or clinic every three months to stay protected. It may be possible to self-administer a birth control injection at home, although it’s less common than having it done in-office, so ask your provider if this is an option. Lastly, sterilization, of course, requires surgery.

The upside to set-it-and-forget-it methods like the IUD, implant, injection, or yearly ring is that you won’t have to think at all about when to use it, aside from regular maintenance once every few months to years.

Male and female condoms and spermicides are sold at the drugstore without a prescription, but you’ll need to remember to keep them on hand and use them correctly every time, which isn’t always easy in the heat of the moment.

Device-free methods, such as natural family planning and withdrawal, require knowledge and precision. You’ll have to read up on natural family planning to understand how it works and carefully track your cycles every month so you can abstain from sex (or use a backup method like condoms) at certain times. Withdrawal requires accurate timing to ensure sperm can’t reach an egg.

5. If It’s Covered by Insurance — and if Not, How Much It Costs

Whether or not your preferred birth control method is covered by insurance depends a lot on your provider. Insurers base coverage on many factors, including the brand of contraception, the type of birth control being used, and a woman’s age, says Dweck.

“There are so many different insurance plans, it’s impossible to know what will be covered without checking your individual plan,” says Brant. The Affordable Care Act guarantees that at least one type of birth control in each category is covered — although some insurers are skimpy or don’t offer prescription coverage, she adds.

If you don’t have insurance or your insurer doesn’t cover prescriptions or a specific type of birth control, costs can vary widely. Planned Parenthood provides a list of the various costs without insurance.

6. Whether It Protects Against STIs

Only two forms of birth control have been shown to protect against STIs, according to the Office on Women’s Health: male and female condoms. While even condoms are not completely foolproof, they are very effective if used correctly and consistently. Planned Parenthood has an easy-to-follow guide on the right way to put on and use condoms.

According to the CDC, the latex condom is the most effective at protecting against STIs, including HIV/AIDS. Polyurethane is an effective alternative if you have a latex allergy, but lambskin condoms don’t protect against STIs because they’re porous.

7. If It Relieves Period Symptoms (Cramps, Heavy Bleeding, etc.)

Almost all hormonal birth control methods improve period symptoms a little, says Brant. Periods tend to be shorter, lighter, and less painful since hormones thin out the endometrial lining so there’s less to shed every month.

The birth control pill is often the most effective at helping cramping and long heavy periods, while hormonal IUDs greatly reduce the amount of bleeding many women experience, notes Jessica Shepherd, MD, FACOG, a gynecologist at Baylor Scott & White Health in Dallas. (The exception: Women tend to have longer and heavier periods with a copper IUD.)

8. Whether You Want to Skip Your Periods Altogether

It’s possible to avoid monthly bleeding altogether, if you want, by choosing a continuous form of hormonal birth control. These include the implant, IUD, or injection. You can also use the pill, patch, or ring without the placebo week.

“IUDs with progestin are often the most effective at taking away a period altogether, followed closely by the implanted rod,” says Dr. Shepherd.

Be aware that these options can cause irregular bleeding, although it’s usually minor and gets better after three to six months, says Dweck. Some women, though, continue to have irregular or unpredictable bleeding and can even experience persistent daily bleeding on the implant, Brant adds.

9. Its Potential Impact on Sexual Pleasure

Women are sometimes concerned that hormonal contraception will reduce their sexual desire. But the fact is that research on this is not clear. One review of research on the impact of hormonal contraceptives on female sexual function found that while some studies concluded that the pill, for example, might dampen sexual desire in some women, others found no negative effect on sex drive or function. The review noted that the research on hormonal contraception and women’s sexual function shows contradictory results, with some showing a negative effect, others showing no effects, and still others showing improvement. The authors also point out that sexual function is complicated and influenced by a multitude of factors, with hormonal contraceptives being only one piece of the larger picture.

The review concluded that it’s difficult to understand just how each type of birth control will impact someone’s sexual desire, and unfortunately, there just isn’t a whole lot of research on the topic. “Desire and orgasm are complex in women and [not due to] one factor,” Dweck says.

Bottom line, says Brant: “The research on this [subject] is really mixed, and the quality of the studies makes it difficult to draw conclusions. The majority of women report no change in sexual function. Some people report improvement, and some people report worsening.”

Even opinions on popular barrier methods can vary. For example, while condoms can reduce penile sensitivity in men, perceptions of just how much and whether it’s even a drawback vary widely, according to one study. In fact, some men credit the condom with helping to stretch their time to ejaculation.

And for some people, peace of mind can be an aphrodisiac. “All methods have the potential to increase sexual pleasure since women worry less about pregnancy while using them,” says Dweck.

10. Whether It Contains Hormones — and the Potential Side Effects of Those Hormones

Some women worry about the side effects of regularly taking hormones. But according to the American College of Obstetricians and Gynecologists (ACOG), hormonal birth control has been proven to be extremely safe for most women. The hormones are simply synthetic versions of the ones your body naturally makes.

Another plus: Many women find that hormonal birth control makes their periods shorter, regular, and lighter and reduces menstrual cramps, according to ACOG. Hormonal birth control has also been linked to a reduced risk of cancer of the ovaries, uterus, and colon, and it’s used to treat endometriosis and fibroids.

Contrary to what some people may think, hormonal birth control does not make you infertile. A review of 22 studies, which included 14,884 women who discontinued contraception, found that contraception methods, including hormonal contraception, didn’t seem to have a negative effect on women’s fertility after they stopped it, regardless of how long they used it.

Hormonal birth control contains varying levels of hormones. The mini pill, implant, IUD, and injection contain progestin only, while the pill, patch, and some types of rings also contain estrogen. The implant and IUD contain low levels of progestin, with the IUD releasing about one-fifth of the amount of the combination pill.

Until you try a type of contraception, there’s no way to know if you’ll experience side effects, which can vary from person to person. Common side effects of hormonal birth control include irregular cycles, mid-cycle spotting, acne, and mood changes, which may pass within a few cycles, according to ACOG. If they don’t, talk to your doctor about changing the level of hormones or trying another type of birth control.

According to ACOG, some women have reported weight gain while using progestin-only birth control methods such as the injection, though the research is conflicting. “There are other variables at play. Lots of young women start hormonal contraception during a life stage when weight gain is more common anyway, like when they start college,” says Dweck.

11. Any Associated Health Risks, in General or Particularly for You

Some people with certain preexisting health conditions shouldn’t use specific types of hormonal contraception. Talk to your doctor if you have a history of blood clots; a family or personal history of breast cancer, diabetes, high blood pressure, high cholesterol, deep vein thrombosis (DVT), migraine with aura, or heart disease; or if you’re over 35 and smoke. Also, be sure to discuss any medications you’re currently taking.

Blood clot, pulmonary embolism, and stroke are the most serious potential side effects of hormonal birth control, according to Brant, although these are relatively low in women who don’t have any risk factors. Even with risk factors, your doctor will be able to help you find an acceptable form of contraception, potentially one that does not contain hormones. “We can find a method that’s safe, effective, and works for their lifestyle,” says Brant.

12. Whether It Conflicts With Your Religious or Other Personal Views

If your religious or other personal views conflict with using hormonal or barrier birth control, there are other options.

“The rhythm method is pretty reliable for those who understand the premise and have a regular cycle,” says Dweck. (For women whose cycles are very irregular, the natural rhythm method can be hard to follow, says Shepherd.)

Even with the best planning, you may find that a particular birth control method just isn’t working for you. Don’t give up. Many unintended pregnancies happen because people abandon their contraception cold turkey, says Brant.

There are lots of options out there, and you’re bound to find one that works well for you, even if it requires a bit of trial and error. “If you get on birth control and realize you don’t like it, it’s fine to stop it and make an appointment with your doctor to find a new method,” says Brant. “Compare the risks and benefits of any type of birth control to how you’d feel about an unintended pregnancy.”