Contraception: Four syllables, so much to say. Contraception prevents pregnancy, of course, and as a term, it’s technically interchangeable with “birth control.” But contraception gives women control over many areas of their lives. It’s a critical aspect of a woman’s overall health—full stop.

Research shows contraception boosts physical and mental health and allows women to become financially stable. Plus, when people have access to contraceptives early on, it predicts better outcomes for children’s health and well-being later. 

“As healthcare providers, we tailor a woman's birth control to align perfectly with her unique health requirements, lifestyle preferences, future family planning goals, and her comfort level with potential side effects,” says Marin M. Honore, M.D., an obstetrics and gynecology specialist practicing in Atlanta, Georgia. “Our objective is to minimize any drawbacks and discover the most suitable contraceptive method for each patient, empowering her to maintain agency over her body, health, and overall well-being.”

Dr. Honore works for Women’s Health Associates, one of many ob/gyn clinics within Lodus. Collectively, we have consulted about contraception with over 1.6 million patients in the past year alone. So, let’s just say we know from contraception—and we want to share all the important info with you! Whether you’re just beginning your journey with contraception or want to get ahead of family planning, the first step is learning about your options. Let’s start there.

What exactly is contraception?

Contraception is the intentional prevention of conception, or pregnancy, whether through external or internal methods. While birth control has existed for centuries—primitive condoms date back to about 3000 BCE—it is broadly considered a modern phenomenon. The big advancement came in 1960, when—along with JFK’s election and the publishing of To Kill a Mockingbird—the FDA first approved the use of the contraceptive pill. 

The pill remains the most prescribed form of birth control in the United States, having been used by over 300 million women worldwide. In the United States alone, 65% of reproductive-age women use some form of contraception each year, and nearly all women will use contraception at some point in their lifetime, according to the CDC. Although the Affordable Care Act requires most insurance plans to fully cover prescription contraceptives, more than a third of women ages 18-49 aren’t aware of this, so be sure to discuss it with your provider.

The most common uses of contraception

Of course, contraception is primarily used to avoid unwanted pregnancy. But it’s also a key means for reducing the risk of sexually transmitted infections, and some forms can provide other health benefits. In fact, nearly one in five women say they have used contraception solely to prevent sexually transmitted infections or manage a medical condition, per a recent survey conducted by the Kaiser Family Foundation. 

In another survey, a full 70% of pill users say they use it for noncontraceptive health reasons. Indeed, there’s lots of data backing the additional benefits of combined hormonal birth control (the type that contains both estrogen and progesterone—more on that later). These include:

• Lessening pain from menstrual cramps

• Managing menorrhagia (heavy menstruation or prolonged menstrual periods)

• Managing amenorrhea (the absence of menstruation during reproductive years)

• Regulating symptoms associated with PMS or PMDD ( a more intense form of PMS)

• Reducing the frequency or severity of menstrual migraines

• Minimizing acne and unwanted hair growth

• Managing endometriosis by slowing the growth of endometrial-like tissue

• Slowing the growth of uterine fibroids

• Improving bone mineral density in older women

• Lowering the risk of endometrial, ovarian, and colorectal cancers

• Supporting transgender men in ceasing menstrual cycles 

What are the main forms of birth control?

“It's wonderful that the United States offers women so many choices for contraception,” Dr. Honore says. So that just leaves… Which one should you pick? 

The right contraceptive depends on your health history, lifestyle, and desire to have children—all factors to discuss with your provider. These things might change as you age, meaning the birth control that’s best today may not be in a decade. “During the early stages of a woman's reproductive years, our discussions regarding birth control revolve around her pregnancy plans, and the potential for a quick reversal should her circumstances change,” says Dr. Honore. 

As people get older, their priorities change, and they may become more susceptible to health issues, which can impact the choice of birth control. “Consequently, we must prioritize their well-being by considering their health history and other medications,” Dr. Honore says. “These conversations often center on exploring options with low or no estrogen and transitioning to non-hormonal methods of contraception.”

Before we get into the common forms of birth control, a few things to remember: None of them prevent pregnancy 100% (though a few get close!), and most do not protect against sexually transmitted infections. And while it may sound obvious, you’ve got to use birth control correctly and consistently for it to work properly. 

Ok! Here we go. There are six main types of contraceptives: barrier, hormonal, permanent, emergency, and lifestyle. 

Barrier methods of birth control

Like any barrier, this type of birth control puts up a physical obstacle—in this case, to prevent sperm from reaching the egg, and you from becoming pregnant. Barrier methods include condoms, diaphragms, cervical caps, and the contraceptive sponge. 

Why go the barrier route? For one, it gives you enhanced control over your body, notes Dr. Honore. Plus, she says, “These methods offer the advantage of avoiding hormonal side effects, eliminating the need for frequent monitoring, and bypassing required visits with a physician.” 

That said (and while this true for all contraceptives), let us repeat ourselves: Because these methods must be physically, manually, put on or in, they must be used—and used correctly— every time you have sex. For each contraceptive below, we’ve included the “efficacy rate,” which is the reported estimate of how effective a method is at preventing pregnancy. Here are the options.

• Condoms: Because they create a physical barrier between you and your partner, condoms are the only birth control method that also protect against HIV and sexually transmitted infections. Male condoms are available over the counter at drugstores and are the most widely used type. Internal (female) condoms are available online or through a physician. 
• Efficacy rate: 82% for male condoms; 79% for female condoms

• Vaginal barrier methods: These devices are inserted into the vagina, where they cover the cervix—think of them like a stop sign for sperm. They’re also receptacles for holding spermicide, a gel that (as its suffix suggests) kills or harms sperm so that it can’t reach an egg. There are three main types of cervix-covering contraceptives.
  • Diaphragm: A dome-shaped prescription device, diaphragms look like small basins, at just under 3 inches (on average). Made of latex, they are soft and reusable, and can stay in the body for up to 24 hours. Following childbirth, check with your physician to ensure you are still using the right size diaphragm. 
  • Efficacy rate: 88% when used with spermicide.

• Cervical Cap: Smaller than a diaphragm, made of silicone, and resembling a mini sailor hat, a cervical cap can be left in for up to 48 hours. A physician will prescribe the size that’s right for you. Because the shape and size of your cervix changes with childbirth, cervical caps are more effective for people who have not given birth.
• Efficacy rate: 83% for people who have not given birth; 77% for people who have given birth vaginally
  
  
   
• Contraceptive Sponge: This 2-inch round, soft plastic foam looks kind of like a mini doughnut. There’s just one brand available in the U.S., called the Today Sponge, and it’s available at drugstores without a prescription. As with a cervical cap, it doesn’t work as well for women who have given birth.
• Efficacy rate: between 76% and 77%

If you’re interested in barrier options, you and your doctor will discuss which one makes the most sense for you. But Dr. Honore’s top choice is the condom. “It gives the dual benefit of birth control and protection from STIs,” she says. “In contrast, I tend to avoid prescribing diaphragms and cervical caps or suggesting use of the sponge. These methods have several drawbacks, including the reliance on user compliance, they do not protect from STIs, and are less effective at preventing pregnancy. There are other birth control methods that are more efficient.”

Short-acting hormonal birth control

Barrier methods throw up a “do not enter” sign for sperm as it nears the cervix. Hormonal contraceptives get to work earlier, aiming to stop ovulation from occurring in the first place. They contain various concentrations of reproductive hormones, which upset the naturally occurring ones that prepare your body for pregnancy. In essence, hormonal birth control “tricks” your ovaries into not releasing an egg.

But hormonal birth control also puts up roadblocks, should an egg appear: It thickens cervical mucus, making it more difficult for sperm to reach an egg. And it thins the uterine lining, barring a fertilized egg from attaching itself. 

“Typically, short-acting methods are the first step a woman takes into hormonal birth control,” says Dr. Honore. “She is unsure about how soon she may desire to become pregnant and wants to take control of her own contraception.”

There are a variety of hormonal birth control options, and each requires a prescription. Ideally, they should be taken at the same time, every day, month, or three months as directed. “Short-acting hormonal contraception goes into action within days of starting them. Once you stop, they also take a shorter amount of time to exit your system,” explains Dr. Honore.

• Birth control pills: Commonly referred to as “the pill,” this oral contraceptive is a tiny pill that’s taken daily. There are two main types of birth control pills, which differ in the hormones they contain. Consult with your doctor to determine which best suits your needs. 
• Combined pill: Also called a “combination pill,” this contains both estrogen and a form of progesterone (progestin). “Combined hormonal contraceptives closely mimic a woman’s natural menstrual cycle, providing flexibility in case she forgets a pill and reducing the likelihood of experiencing unwanted side effects,” says Dr. Honore. This makes them a good option for women just starting birth control. 
• Mini pill: A progestin-only version, often prescribed for people who have an increased risk of blood clots, notes Dr. Honore. “The mini pill is very sensitive however and requires adherence in taking it at the same time every day, within a window of only one hour,” she explains. “Deviating from your scheduled dose may lead to spotting.” 
• Efficacy rate for both types: 91%
  
   
• Birth control ring (NuvaRing, EluRyng, Annovera): The birth control ring is a flexible, plastic ring that you insert into the upper vagina (something you do at home—no need to visit a doctor). It releases estrogen and progesterone into the vaginal lining. Two ways to use the ring: 1) Wear it for 21 days and remove it for seven, during which time your period comes. 2) Insert a new ring every 21 days, which means you won’t get your period. 
• Efficacy rate: 91%

• Birth control injection (Depo-Provera): The depot-medroxyprogesterone shot contains progestin and is typically given in the upper arm or buttocks. Each injection lasts for up to 13 weeks. “This method is very effective for young adults who may not be sexually active yet, but can’t predict when they might be,” says Dr. Honore.” It’s super low maintenance, and only requires a visit to your physician every three months for your next dose.” The birth control injection may result in a temporary delay in fertility (an average of 10 months) after you stop using it. 
• Efficacy rate: 94%

• Birth control patch (Xulane, Twirla): Also known as a transdermal contraceptive, the patch releases estrogen and progestin through your skin. It’s a small square that adheres to your arm, upper back, buttocks, or abdomen, and must be changed every seven days. Some women skip week 4 of the patch to have a period, while others use it continuously for no period. Your physician will help guide you on what will work best for you. 
• Efficacy rate: 91% 

Long-acting reversible contraceptives (LARC)

LARCs include intrauterine devices (IUDs) and contraceptive implants and get their name because they last for several years. Of all reversible contraceptive methods, they also happen to be the best pregnancy-blockers—with an over 99% efficacy rate. LARCs are prescribed and administered by your healthcare provider, can be removed anytime, and have not been shown to impact future fertility.  

“Long-acting contraception is ideal for individuals seeking effective pregnancy prevention over an extended period of at least 12 months,” shares Dr. Honore. “She knows that her fluctuating schedule may prohibit her from taking her pill everyday or doesn’t want the responsibility for changing monthly patches or rings. These are also among the safest and most effective forms of birth control.”

• Hormonal intrauterine device (Mirena, Skyla, Liletta, Kyleena): This plastic, T-shaped device, about the size of a quarter, is inserted into the uterus, where it releases progestin to prevent eggs from being fertilized. Depending on the IUD brand, it remains in place for three to eight years. 
  
   
• Copper intrauterine device (ParaGard): Similar in shape and size to a hormonal IUD, a copper device delivers a small amount of copper into the uterus. The copper interferes with a sperm's ability to move, making it difficult to enter the uterus. Because this device is hormone free, it’s a good long-term option for people who want to avoid hormones or have pre-existing medical conditions that could interact with hormones. A copper IUD can last 10 years. 
  
   
• Birth control implant (Nexplanon, Implanon): This is a flexible, plastic, matchstick-sized rod implanted just beneath the skin of the upper arm. It releases progestin into the body, stopping ovulation and thickening the mucus of the cervix. You can keep an implant in for up to three years, and—with a 99.9% efficacy rate—trust that it’s got your back.

Permanent methods of birth control

And we do mean permanent: Female tubal sterilization and male vasectomy should be carefully considered, taking into account both your current wants and potential future desires. Becoming pregnant after sterilization is rare, can be costly, and often comes with additional risks.

• Tubal sterilization: This surgical procedure for women closes off or removes the fallopian tubes. Because an egg can’t continue its trek down the tube, it never meets up with any sperm. 
• Efficacy rate: Fewer than 1% of women will get pregnant within a year following tubal sterilization. 
  
   
• Vasectomy: In this surgical procedure for men, the vas deferens (the tubes carrying sperm) are tied, cut, clipped, or sealed to prevent sperm from being released into the semen. 
• Efficacy rate: 99.8% 

Emergency contraception 

Emergency contraception is like contraceptive 911. It’s for emergencies—a.k.a., after having unprotected sexual intercourse, or if a condom breaks, when you don’t want to become pregnant. It is not intended to be a primary method of pregnancy prevention and should not replace your regular birth control method. But it is there for you if needed.

There are two types of emergency contraception: the copper intrauterine device (IUD) and emergency contraception pills. Both must be employed within a certain time frame after sex, and neither works if you’re already pregnant.

• Copper IUD: This device makes it difficult for sperm to fertilize the egg. When used within five days (120 hours) of having unprotected sex, the copper IUD is the most effective form of emergency contraception.  A healthcare professional must prescribe and administer the IUD.  
• Efficacy rate: 99%
  
   
• “Morning after pills”: There are two types of pills known as the “morning after pill,” both of which delay or prevent ovulation. They are:
• Levonorgestrel pill (Plan B One-Step): Conversationally referred to as just “Plan B,” this progestin pill must be taken within three days (72 hours) of unprotected sex. It’s available over the counter at drugstores.
• Efficacy rate: 96.9% 

• Ulipristal (Ella): This pill contains a steroid ingredient, ulipristal acetate, and requires a prescription. But you’ve got more time to take it after unprotected sex (within five days) and it’s slightly more effective than Plan B. More specifically, studies have shown that the odds of pregnancy among users of ulipristal were 42% lower in the first 72 hours, and 65% lower in the first 24 hours following sex when compared to users of levonorgestrel. Why? Ulipristal is able to disrupt ovulation even after the luteinizing hormone surge has begun (when your ovary releases a mature egg), something the progestin-only pill can’t do.
• Efficacy rate: 97.9%

• Combined birth control pills: Birth control pills containing both estrogen and progestin can be used as emergency contraception. In this case, they’re taken in higher-than-usual amounts within five days of having unprotected sex. Your doctor will guide you through the right dosage to delay ovulation. 
• Efficacy rate: 96.5% 

Additional methods of contraception
And the list goes on! There are a few other ways to prevent pregnancy, which rely not on pills or devices, but lifestyle actions.

• Fertility awareness-based birth control: There are only certain points of the month when a woman can get pregnant. By tracking the menstrual cycle, you can determine the most fertile time frame, and avoid having sex then. This method is not recommended for women with irregular menstrual cycles.
• Efficacy rate: 76% 

• Withdrawal method: Also known as "pulling out," the withdrawal method is when a man removes his penis from the vagina before ejaculation. It’s not foolproof, though, as some sperm can enter the vagina pre-ejaculation. 
• Efficacy rate: 78%

What are the side effects and risks of birth control?

Contraception is considered safe for healthy women, and serious complications are rare. And, as Dr. Honore points out, “Generally speaking, using birth control is considered a lower-risk option when compared to the side effects and risks associated with pregnancy and childbirth.”

Still, there can be side effects. Your doctor can offer a complete picture of potential risks, and balance those with your needs. And remember that everyone’s body is different, so what a friend experienced with a certain type of birth control might not be your experience.

It’s always a good idea to listen to your body and discuss any worries or new symptoms with your physician. But in general, these are a few of the most common concerns with hormonal (pills, patches, rings), injected, or implanted birth control:

 

• weight gain
• nausea
• sore breasts
• headache
• menstrual changes (breakthrough bleeding and missed periods with the injection; irregular or missed periods for IUDs)
• mood changes

A few additional things to keep in mind:

• Hormonal birth control: Some forms of hormonal birth control can marginally increase the risk for heart attack, stroke, and blood clots (1 in 1,000), as well as slightly increase the risk of breast and cervical cancer. Women over the age of 35 who smoke are at a higher risk. Hormonal birth control is not recommended for anyone with a history of breast cancer, blood clots, diabetes, migraine with aura, stroke, or heart disease. On a positive note, studies show that taking the combined birth control pill or using the hormonal IUD may help reduce the risk of ovarian and endometrial cancers. 
• Methods that touch the skin: The patch, condoms, barriers that women insert—there can be skin irritation or an allergic reaction. 
• IUDs: Some people feel cramps upon insertion.
• Injection: There’s a risk of bone density issues with the injection.
• Diaphragm, cervical cap, or sponge: There is a rare occurrence of toxic shock if left in for more than 24 hours. 

Top questions to ask at a contraceptive appointment

Clearly, there’s a lot to consider when deciding on the right birth control for you. But rest assured: Your doctor will be with you every step of the way. 

To make the most of your appointment, we've created a checklist of questions to think about and talk through with your provider. Be honest: It will help you make an informed decision, and your doc isn’t there to judge.

1. What reasons are you using birth control?  

-To prevent pregnancy? 

-To manage nagging symptoms or a health-related condition?

2.How foolproof do you need your contraception to be?

-Are you likely to stick to a schedule when taking or administering birth control?

-What level of pregnancy risk are you comfortable with?

3.Do you want to have children in the future? How soon?

4.Are you in a monogamous relationship? 

5.Does your birth control also need to protect against sexually transmitted infections?

Ready to see a healthcare provider who can help you get started with contraception or transition to a different type?