Everything you always wanted to know about preventing pregnancy
The array of contraception options can be dizzying. When you’re deciding on a birth control method, Planned Parenthood suggests you keep these seven considerations in mind: lifestyle fit, convenience, effectiveness, safety, affordability, reversibility and protection against sexually transmitted infections. We’ll add an eighth: You may need to make this decision a few times throughout your childbearing years; no one method will suit you for your entire life.
So sit back and let us guide you through the choices.
Abstinence. The only form of birth control that is 100 percent effective: Abstinence (also known as not having sex). Pregnancies (per 100 women): 0.
Cervical Cap. Similar to a diaphragm, but smaller, a cervical cap slips into place over the cervix, blocking sperm’s entry into the uterus. It is used in conjunction with spermicide. Cervical caps can stay in place for 48 hours, giving them a thumb’s up on the spontaneity front. Cervical caps must be fitted by a physician, and they provide no STI protection. They also can’t be used during your period. Pregnancies (per 100 women): 11 to 16 (women who have never had children); 22 to 32 (women who have had children).
Condom (female). A thin rubber sheath with one closed end, the female condom was first introduced in 1994. Version two (quieter than the first version, which users complained squeaked) was released in 2009. In addition to being a contraceptive, the female condom also provides protection from sexually transmitted infections (STI). Like the male condom, the female condom is designed for one-time use. Unlike the male condom, an erect penis is required to use the female condom. Pregnancies (per 100 women): 20.
Condom (male). Condoms, latex, lambskin or polyurethane shields, have been around for a least 400 years. To use it, roll it over an erect penis. Sounds simple, but a 2012 report from the Kinsey Institute found an unexpected number of adults use condoms incorrectly Designed for one-time use, latex and polyurethane condoms also protect against STIs. Latex condoms are weakened by oil-based lubricants. Pregnancies (per 100 women): 11 to 16.
Diaphragm. A rubber dome that is placed over the cervix before sex, a diaphragm is used with a spermicide. A diaphragm is relatively inexpensive and lasts about two years. But it must be fitted by a doctor, doesn’t provide STI protection and can’t be used during your period due to a risk of toxic shock syndrome. If you gain significant weight, you may need to be refitted. Pregnancies (per 100 women): 11 to 17.
Emergency Contraception. Plan B, Plan B One-Step and Next Choice (a generic form of Plan B) is an option if you didn’t use birth control or your usual method failed. Also called the morning-after pill, all three options contain a high dose of a hormone found in many birth control pills and must be used within 72 hours of unprotected intercourse. Ella, a non-hormonal emergency contraception drug, requires a doctor’s prescription regardless of a woman’s age and can be taken up to five days after sex. Emergency contraception doesn’t work if you are already pregnant Pregnancies (per 100 women): 1.
Implanon. Introduced in 2006, Implanon is a matchstick-sized rod implanted beneath the skin of a woman’s upper arm. Implanon lasts three years and can be used by breastfeeding women. It is expensive ($400 to $800 for exam, implant and insertion), and it is not as effective for overweight or obese women. It may cause irregular bleeding and heavier periods. There is no STI protection. Pregnancies (per 100 women): less than 1.
IUD. An intrauterine device (IUD) is a T-shaped plastic device inserted into the uterus. Both types (ParaGard, a copper IUD, can last as long as 12 years; Mirena, a hormonal IUD, must be replaced after five years) make it difficult for sperm to fertilize an egg. Once an IUD is in place, you can ignore it. It may cause irregular or heavier periods. Pregnancies (per 100 women): less than 1 for both types.
NuvaRing. A flexible, plastic ring inserted into the vagina, NuvaRing releases low-dose progestin and estrogen over a three-week period. It is easy to insert and remove and has low estrogen-related side effects, such as nausea and breast tenderness. Breastfeeding women will have to use another form of birth control; NuvaRing can’t be used while breastfeeding. Pregnancies (per 100 women): less than 1.
The Patch. Introduced to the market in 2002, the patch is a small progestin-only square worn stuck to the body like a band-aid for three-week periods. It is convenient and easily reversible. Possible side effects include bleeding between periods, a risk of blood clots and changes in desire. Pregnancies (per 100 women): 5.
The Pill. The most common form of birth control pill uses a combination of estrogen and progestin taken for 21 days to prevent ovulation. The pill does more than prevent pregnancy; it also provides some protection against acne, and endometrial and ovarian cancers. Breastfeeding moms can take the progestin-only mini pill, but to be effective, the mini pill must be taken at the same time every day. The pill does not, however, prevent STIs, and it could increase your risk for spotting, breast tenderness, higher blood pressure and blood clots. Pregnancies (per 100 women): 5 to 8.
Rhythm Method. Also called fertility awareness and natural family planning, the rhythm method tracking body temperature and cervical mucus and avoiding sex when a woman is most fertile. It is non-hormonal and noninvasive, but relying on this method requires keeping close track of “safe” days. The rhythm method may not work for women with irregular periods or women who are breastfeeding. Pregnancies (per 100 women): None if done correctly (but note that 25 percent of typical users get pregnant).
Shot. Depo Provera is a shot of the hormone progestin that prevents ovulation for three months. Though Depo also provides some protection against cancer in the lining of the uterus, long-term use has been linked to loss of bone density. Requiring four injections each year, Depo can be pricey (about $240/year). It doesn’t protect against STIs, and some women report breakthrough bleeding, especially during the initial months of use. Pregnancies (per 100 women): less than 1.
Spermicide. A chemical that kills sperm, spermicide can be in foam, jelly, cream or film that is placed inside the vagina before sex. Some types must be inserted 30 minutes before sex. Frequent use may cause irritation, increasing the risk of infections and STIs. Pregnancies (per 100 women): 30.
Sponge. Introduced in the early ’80s, the sponge is a soft, spermicide-covered polyurethane disc inserted into the vagina against the cervix up to 24 hours before intercourse. You don’t need a prescription for the sponge, which has been on and off the market because of company woes, not medical concerns. But it can be difficult to insert and remove. The sponge also doesn’t provide protection against STIs, and, like the diaphragm and cervical cap, it can’t be used during your period. Pregnancies (per 100 women): 11 to 16 (women who have never had children); 22 to 32 (women who have had children).
Tubal Ligation. If your baby-making days are over (or you know you don’t want to have children), you can have your tubes tied. This permanent form of birth control is a surgical procedure where a physician closes off the fallopian tubes. A newer procedure inserts silicone (Adiana) or metal (Essure) implants into the fallopian tubes non-surgically. Scar tissue grows around the implants, blocking the tubes, and it is effective in about three months. Neither form of tubal ligation provides protection against STIs, and young women may have difficulty convincing doctors to perform the procedure. Pregnancies (per 100 women): less than 1.
Vasectomy. At the moment, a vasectomy—surgically closing the vas deferens (the tubes that carry sperm from the testicles)—is the only form of birth control besides condoms available to men. After the permanent procedure, which is cheaper than tubal ligation, sperm won’t be released, but a man will still ejaculate. There is no protection against STIs with a vasectomy. Pregnancies (per 100 women): less than 1.
Withdrawal. Surprisingly, about six in 10 women in this country say they use the withdrawal method (known as “pulling out”), where a man removes his penis from a woman’s vagina before ejaculating. It’s free and hormone free. To prevent pregnancy it must be done correctly every time. There is no protection against STIs. Pregnancies (per 100 women): 4 when done correctly; typically 18.
Need help making a choice? Planned Parenthood and WebMD have online tools to help women sift through the options