The best method of birth control will depend on individual needs and preferences. Methods vary widely in terms of reliability, ease of use, permanence, and other factors.
Deciding on a birth control method is a personal choice, and there are many options. Most are highly effective when people use them correctly, but there is always a chance that birth control will not work.
Weighing the options with a doctor and a partner is an important part of the decision making process.
Things to consider when choosing a birth control method include:
- a person’s overall health
- whether a person wants to have children in the future
- the frequency of sexual contact and number of sex partners
- the safety and effectiveness 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.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Learn more.
Natural and nonhormonal methods carry a lower risk of side effects but a higher chance of pregnancy than hormonal or permanent methods.
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 issues such as a person forgetting a pill or a ring accidentally falling out. This can happen to anyone, and it can reduce the effectiveness of birth control.
The table below provides information about natural and nonhormonal birth control methods.
| Natural or nonhormonal method | Advantages | Side effects and disadvantages | Effectiveness |
|---|---|---|---|
| abstinence | • free of charge • reversible | no protection from STIs | in theory, 100%, but that may not be feasible |
| fertility awareness | • reversible • requires some training and determination to abstain from intercourse on fertile days | no protection from STIs | in theory, 91% to 99%, but in reality, it may be around 89% |
| standard days | • free of charge • reversible • requires some training | no protection from STIs | in theory, 95%, but in reality, it may be around 88% |
| withdrawal | • free of charge • reversible | no protection from STIs | around |
| breastfeeding | • free of charge • convenient | no protection from STIs | in theory, |
| outercourse | free of charge | no protection from STIs | no figures are available, but risks are similar to those of withdrawal |
| male condom | • low cost • readily available • some protection from STIs | possible latex allergy | in theory, 98%, but in reality, it may be closer to 82% |
| female (internal) condom | some protection from STIs | • possible latex allergy • irritation | in theory, 95%, but in reality, it may be 79% |
| diaphragm | • no hormones • can insert before sex • reversible | • possible allergic reaction • urinary tract infections (UTIs) • vaginal irritation • risk of toxic shock syndrome (TSS) | in theory, 92% to 96% |
| cervical cap or shield | • no hormones • can insert before sex • reversible | • possible allergic reaction • risk of TSS | with correct use, 71% to 86% |
| contraceptive sponge | • no hormones • no need for fitting • safe during breastfeeding | • possible reaction to spermicide • vaginal dryness and irritation • risk of TSS | 78% to 91%, depending on previous birth history |
| spermicide | • easy to use • safe during breastfeeding | • possible allergic reaction • irritation | in theory, 82%, but in reality, it may be as low as 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.
Read about how celibacy affects the body.
Fertility awareness
During the menstrual cycle, there are some days when pregnancy is more likely. For someone who wants 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 those 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
- using a calendar
- monitoring changes in cervical mucus during the month
- checking for a spike in temperature, which tends to happen before ovulation
With correct use, this method should be 91% to 99% effective, but statistics suggest that 1 in 9 females using it become pregnant each year, which means the effectiveness is closer to 89%.
This method requires a lot of dedication. It involves checking vital signs and cervical mucus first thing every morning and committing to abstinence or using another birth control method on fertile days.
Learn more about how the menstrual cycle can indicate fertility.
Standard days method (SDM)
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 through 19 of the menstrual cycle.
Proponents of SDM claim that it is 95% effective, which indicates that 5 in every 100 people who use it become pregnant in the first year of use. Typical use may reduce the effectiveness to 88%.
One organization promoting the use of SDM is Cycle Technologies, a company that sells CycleBeads — 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 while following SDM.
Withdrawal method
The withdrawal, or “pull-out,” method involves removing the penis from the vagina before ejaculation.
The Office on Women’s Health suggests that this method is
Learn more about the pull-out method.
Breastfeeding
The chances of becoming pregnant are reduced while breastfeeding exclusively
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 is likely to work only if a person is exclusively breastfeeding their baby and not supplementing with formula or other breast milk. If a person has had a period since giving birth, LAM is unlikely to work.
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.
Outercourse
There are two ways of defining outercourse. According to one definition, it is sexual activity that does not involve vaginal penetration. According to another, it is sexual activity that involves no penetration at all — 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, on a sex toy, or near the vagina, pregnancy may be possible.
Outercourse has the following benefits:
- It has no physical side effects.
- There is a reduced risk of fluid exchange.
- It may encourage people to explore new relationships and sexual experiences.
It also has some disadvantages:
- People may have difficulty abstaining from penetrative sex.
- There is a possibility of accidental contact with sperm.
- It does not protect against STIs.
Examples of barrier methods include condoms, a diaphragm, a cervical cap or shield, and sponges. A person may use these methods 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 STI transmission. Natural or lambskin condoms can only prevent pregnancy. People can use these 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, the effectiveness may be closer to 82%. Using male condoms with spermicide increases the level of protection. They are inexpensive and widely available.
Disadvantages include 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 disruptive.
Learn more about 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,
With correct use, internal condoms are 98% effective at preventing pregnancy. However, they can slip or tear, and their effectiveness with typical use may be 79%.
Find out more about female condoms.
Diaphragm
A diaphragm is a shallow silicone cup that a person inserts into their vagina to prevent pregnancy. A person should use spermicide along with a diaphragm.
With perfect use every time, a diaphragm is 92% to 96% effective at preventing pregnancy. Realistically, however, the Centers for Disease Control and Prevention (CDC) suggests that the effectiveness is around
A diaphragm is safe to use 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. However, to reduce the risk of infection, a person should not leave the diaphragm in for longer than 24 hours.
Side effects and complications include allergic reactions, irritation, and an increased risk of UTIs and TSS.
Find out more about diaphragms and how to use one.
Cervical cap or shield
A cervical cap or shield is a silicone cup that fits over the cervix in the vagina. This method is safe to use 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 decreases to 71%. Using a cap or shield along with spermicide will improve its effectiveness.
Caps and shields can be hard to put in place, and there is a chance that they will dislodge. They may also pose a risk of abnormal Pap smear results, an allergic reaction, or TSS.
A cervical cap must stay in place for at least 6 hours after sex, and a person should remove it within 48 hours.
Contraceptive sponge
A sponge is a plastic foam disk that contains spermicide. 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 a person has given birth, it may be 80% effective with perfect use. However, in reality, 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 may experience vaginal irritation and dryness. Leaving the sponge in can increase the risk of TSS. Also, a sponge can be hard to insert and may break.
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 diaphragms.
If a person uses spermicide perfectly with no other method of birth control, it will be around 72% effective at preventing pregnancy. This means that out of every 100 people who use it, 28 will become pregnant. For this reason, it is best to use spermicide along with another method.
Spermicide is easy to use and widely available. It is also safe to use during breastfeeding and does not affect hormone levels. However, some people may have an allergic reaction or irritation.
Various hormonal methods of birth control are available, including pills, patches, injections, intrauterine devices (IUDs), and vaginal rings.
Some hormonal methods may cause or increase the risk of negative effects such as a heart attack, a stroke, blood clots, high blood pressure, liver tumors, gallstones, and jaundice.
These risks are higher for people who:
- are 35 years old or older
- have obesity or overweight
- have a history of certain inherited blood-clotting disorders
- have high blood pressure or heart disease
- have a history of breast cancer
- have diabetes-related complications
- have liver cancer or severe cirrhosis
- have gallbladder or bile duct problems
- smoke
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, such as a condom.
Pills
Birth control pills contain either a combination of the hormones estrogen and progestin or progestin alone.
With correct use, they are 99% effective. However, effectiveness decreases if someone forgets a dose, experiences diarrhea or vomiting, or takes certain medications at the same time.
The pill may help a person manage menstrual problems and premenstrual syndrome (PMS), and it may improve acne. The pill may also offer some protection against endometrial and ovarian cancers.
However, it may cause negative 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.
Patches
Hormonal patches prevent pregnancy by delivering specific hormones through the skin.
With perfect use, a patch is likely to be 99% effective. In reality, however, the effectiveness is around 91%.
A person wears a patch for 7 days before replacing it with a second patch for 7 days and then a third patch for another 7 days. The person then removes the third patch and does not wear one for 7 days.
Possible negative effects include skin irritation, menstrual changes, mood changes, breast soreness, headaches, weight gain, an increase in blood pressure, and gastrointestinal problems.
Learn more about the contraceptive patch.
Injections
Given every
According to the CDC, it is
Benefits of injectable birth control include safety and convenience, uterine cancer prevention, safety during breastfeeding, and the fact that no estrogen is involved.
Initially, a doctor may give the injections in their office, but after that, people may be able to give themselves injections at home.
Side effects can include menstrual changes, weight gain, and reduced sex drive. The side effects can last as long as a person receives the injections. There may also be a
Learn more about the Depo-Provera shot.
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. With perfect use, it is more than 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. This means they do not have to return to the doctor for refills every few months. A
Vaginal rings are easy to use, and fertility resumes soon after a person stops using a ring. Other possible benefits include lighter periods, improvements in acne, and a reduced risk of some cancers.
Possible negative 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 a person’s uterus. Currently, the following IUDs are available in the United States: Mirena, Skyla, Kyleena, and Liletta, which are hormonal, and Paragard, which is nonhormonal. Paragard contains copper.
An IUD is more than 99% effective at preventing pregnancy. A person can leave a hormonal IUD in for 3 to 8 years and a copper IUD in for up to 12 years.
With any IUD, there is a risk of:
- infection
- menstrual changes
- pelvic inflammatory disease
- infertility, in some cases
- uterine perforation
- uterine expulsion
- pregnancy problems, if pregnancy occurs
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 IUD removal.
An IUD may not be suitable for everyone, and a doctor can provide specific guidance.
Learn more about the possible negative effects of an IUD.
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
The implant requires no maintenance and does not contain estrogen. However, it may not be suitable for everyone.
Possible side effects include:
- headaches
- menstrual changes
- weight gain
- breast soreness
- difficulty removing the rod (in some cases)
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, or clamp the tubes or remove a portion of the tubes. This is
Learn about pregnancy 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
The risks include bruising, infection, and, in rare cases, reconnection of the tubes.
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 the copper IUD.
Morning-after pill
In the United States, 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 95% effective at preventing pregnancy within 24 hours after sex. This effectiveness decreases to 58% effectiveness if a person takes it within 49 to 72 hours after sex.
Possible side effects include menstrual changes, headaches, and pain.
Copper IUD
A copper IUD can prevent pregnancy if a person has one fitted within 120 hours (5 days) of having sex without sufficient birth control. Fewer than 1% of people who receive an IUD as emergency birth control become pregnant.
Possible negative effects include pain and a risk of infection.
Learn more about emergency contraception.
There are many types of birth control, and their effectiveness varies. Natural and barrier methods are less likely to cause negative 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.
