When it comes to birth control, women have more options than ever. But more choices mean there’s a lot more to consider. So how can you choose which pregnancy prevention method is right for you?
The most important step is to weigh your options with your doctor. You’ll want to find out how each form of birth control will affect your health. Factors like high blood pressure, your smoking habits, and a history of breast cancer should all have an impact on your pick.
The most popular forms of birth control in the United States, according to the National Center for Health Statistics, are oral contraception, tubal ligation (having your tubes tied), and condoms. While no one method is foolproof, oral contraception can do a pretty good job of preventing pregnancy: For every 100 women who are using oral contraception, nine will become pregnant.
The cost of birth control depends on your insurer and your method. Many plans currently don’t require you to pay anything for your prescription, but there are some that do. Without insurance, oral contraception can cost around $50 a month; a vaginal ring $80. A IUD can cost up to $1,000 if you’re not covered.
Before you meet with your doc to discuss what plan is best for you, take a look at our list of pros and cons for 11 birth control methods.
Birth Control Pills Do More Than Prevent Pregnancy
There are a slew of birth control pills for women to choose from, including ones that use only progestin or a combination of estrogen and progestin.
Pill Pros: If you pop the pill flawlessly, the failure rate can be as low as 1 percent. Combination birth control pills can also lead to less painful menstrual cramps, lighter periods, and fewer symptoms of premenstrual syndrome.
The pill may also provide protection against pelvic inflammatory disease, endometrial cancer, and ovarian cancer. Progestin-only pills (known as “minipills”) are safer for women who have a history of blood clots or have uncontrolled high blood pressure. Both types of contraception help regulate your periods, as well.
Pill Cons: In reality, the pill has an 8 percent failure rate — and that’s because it’s hard to remember to take it regularly. If you’re on a progestin-only pill, it’s especially important to take it at the same time every day.
Birth control pills can cause spotting, breast tenderness, nausea, and low sex drive. Combination pills carry a risk of blood clots and increase your risk of stroke if you smoke. Condoms Keep You Safe in More Ways Than One
There’s a reason that condoms are a birth control mainstay: They’re the only option that not only prevents pregnancy, but diseases and infections, too. If there is any risk your sexual partner could pass on an STD (sexually transmitted disease), condoms are a must.
Today there are both male and female condoms to choose from, though male condoms are by far the most popular. A spermicide foam, cream, jelly, or film can be used with barrier methods like condoms. But spermicide alone only prevents pregnancy for about 71 percent of women.
Condom Pros: Condoms are inexpensive and offer the best protection from STDs and HIV. Female condoms help give women even more control because they place it themselves.
Condom Cons: Male condoms are only about 82 percent effective for preventing pregnancy, and female condoms 79 percent effective. Because of the high failure rate, We suggests using condoms with another form of birth control. Some women also complain that female condoms are awkward to place and can create funny sounds
Diaphragms and Other Barrier Methods Are Hormone-Free
These are barrier methods of birth control. The diaphragm is a flexible cup that you place in your vagina to block sperm from entering your uterus. It’s most effective when used with spermicide.
You will have to be fitted for a diaphragm by your doctor, and it’s a good idea to replace it after a year. You’ll have to examine it occasionally, as well, to make sure there are no holes, tears, or thinning of the latex. If you’ve recently gained or lost weight, you’ll also want to have it checked for fit.
The cervical cap is similar to the diaphragm. You’ll have to be fitted for one by a healthcare professional, and it’s best to use it with spermicide. You place it in your vagina, where it keeps sperm from entering the cervix. It should also be replaced yearly.
The sponge is soft foam coated with spermicide. The device looks like a donut, and covers the cervix when you insert it into your vagina.
Pros: All of these items are hormone-free. You can insert your diaphragm or cervical cap anywhere from just before sex up to six hours before intercourse. They’re both great options if you have medical conditions, such as breast cancer, that make it unsafe to use hormones for birth control. Unlike those methods, the sponge is an over-the-counter item.
Cons: To be most effective, diaphragms and cervical caps should be used with spermicide and left in place for at least six hours after having sex. With diaphragms, this may increase your risk for urinary tract infections, but urinating after sex can help you avoid them. With cervical caps, there are risks for bladder infections.
While it is extremely rare, all three methods may cause toxic shock syndrome. So don’t leave a diaphragm in for more than 24 hours, and don’t leave a cervical cap in for more than 48 hours.
If you are at risk of HIV infection, these two methods should probably be avoided because an ingredient used in spermicides can increase your risk of getting HIV from your partner. The diaphragm is only 88 percent effective for preventing pregnancy, as is the sponge in women who have not yet had a baby. Cervical caps are at best 86 percent effective.
The Patch and the Ring Free You From Pills
The patch and the ring are both hormonal methods of contraception containing estrogen and progestin, like the pill, but neither of these require a daily routine.
The patch is a small piece of plastic that sticks on your stomach, buttock, arm, or torso and is replaced weekly. The ring is a small, flexible device that is placed inside the vagina and left for three weeks at a time, but is taken out for one week of the month in order for you to have a period.
Pros: Both of these birth control options share all the benefits of combination pills — they’re just more convenient. Plus, the ring can be used continuously to allow you to skip periods. Like the pill, they’re 91 percent effective for preventing pregnancy, and can be even more effective if used exactly as instructed.
Cons: The patch can cause skin reactions in some women. And like the pill, both the patch and the ring can cause side effects, such as spotting, headaches, bloating, and breast tenderness. You shouldn’t use them if you’re predisposed to blood clots, have uncontrolled high blood pressure, or get migraines with aura. The ring has additional possible side effects of vaginal discharge or irritation.
Hormone Shots Protect You for Three Months at a Time
A shot of progestin in the arm offers women pregnancy prevention for three months at a time. It blocks ovulation, and also makes it more difficult for sperm to travel because of an increase in cervical mucus.
Hormone Shot Pros: When the hormone shot is administered properly by a healthcare worker, and is received every three months on the dot, fewer than 1 in 100 women will get pregnant. And hey, you don’t have to think about birth control every day, every week, or even every month.
The shot may also reduce risk of uterine cancer and protect you from pelvic inflammatory disease, according to the American Congress of Obstetricians and Gynecologists.
Hormone Shot Cons: You’ll have to go to your doctor to get the shot, and the shots tend to cause more irregular bleeding than the pill, patch, or ring, particularly during the first three to six months.
Also, prolonged use can lower your bone density, so you should get a bone density test if you use this contraception method for five years continuously. Bone loss is reversible once you stop using the hormone medication.
If you plan to become pregnant in the future, you’ll have to plan ahead if you’re using hormone shots — It can take an average of 10 months to conceive after stopping them.
IUDs Are the Most Effective Birth Control Device
An IUD, or intrauterine device, is a T-shaped device that’s inserted into the uterus by your doctor. You’ll need to choose between one that contains copper or the synthetic hormone progestin.
IUD Pros: The IUD is a very effective contraception option — pregnancy occurs in less than 1 in 100 women who use one. It is invisible from the outside, and you don’t need to use spermicide with it. Copper IUDs can be left in for 10 years, and an IUD containing hormones can be left in for three to five, depending on the brand.
The copper IUD can even be used for emergency contraception if it’s inserted within five days of unprotected sex. Another benefit of the IUD is that although long-term, it’s reversible, and you can become pregnant after having it removed.
IUD Cons: Copper IUDs tend to cause heavier bleeding during your period, while those with hormones tend to make it lighter. Both types (though particularly copper) can cause an increase in cramping. If you have a sexually transmitted infection at the time it’s inserted, your risk for pelvic inflammatory disease increases.
Hormone Implants Protect You for Three Years
A piece of plastic about the size of a matchstick, this long-term form of contraception contains progestin. It is inserted by your doctor just under the skin of the upper arm and prevents pregnancy for three years.
Hormone Implant Pros: You won’t have to worry about birth control for three whole years. The method is also invisible. And it’s as effective as an IUD — less than 1 in 100 women will get pregnant with a hormone implant in place. If you plan on having a baby, you can still become pregnant after having the implant removed.
Hormone Implant Cons: Most women will experience irregular bleeding throughout the first year, but eventually women stop getting periods on this method. If irregular bleeding is a problem, estrogen can be given to counteract it.
Fertility Awareness May Work for Committed Couples
Know your cycle well? All you may need to do is use a barrier method, such as a condom, during the days that you’re fertile. Preventing pregnancy through fertility awareness can be done by tracking your cycle on a calendar, monitoring your cervical mucus, and taking your body temperature.
Fertility Awareness Pros: You can forget about prescriptions, devices, and taking hormones with this natural birth control approach.
Fertility Awareness Cons: You’ll need to make a strong commitment to monitor your cycle. Even with careful attention, there’s still a large margin of error because women can ovulate on a different day of every cycle. And because sperm can stay alive for up to six days after sex, you have to use a barrier method for six days before you ovulate. The failure rate for using a combined method of checking your body temperature, monitoring cervical mucus, and watching the calendar is high, about 25 percent.
Abstinence, Alas, Is the Only Foolproof Method
Ever considered ceasing sexual activity altogether? Practicing abstinence is one birth control option that can’t fail. Some people practice periodic abstinence.
Abstinence Pros: Totally refraining from sex is the only foolproof way to prevent pregnancy.
Abstinence Cons: Refraining from sex is certainly not feasible for everyone — nor is it easy. “We’re all human beings and we all have a sex drive,”. If abstinence is your only plan, you should always have a backup contraception on hand, such as condoms.
Vasectomies Are Permanent and Nearly 100 Percent Effective
Tired of holding all the pregnancy-prevention responsibilities as a woman? If you’re done having children, you might consider sending your husband to the doctor. Vasectomy is a simple procedure: Through a tiny incision, a doctor closes the tubes that carry a man’s sperm, preventing them from leaving his body.
Vasectomy Pros: A vasectomy is almost 100 percent effective for contraception — the tubes grow back together only in about 1 in 1,000 men. This permanent form of birth control also carries few risks, requires only a few days of recovery, and has no effect on a man’s sexual function.
Vasectomy Cons: You’ll need to use a back-up birth control method, such as condoms, for three months after the surgery to be sure all of previously made sperm has been ejaculated. And remember: It is permanent, and there’s a very small chance that a vasectomy could increase the risk of prostate cancer. So you have to be sure that you don’t want more children before he has the procedure. Although the surgery can be reversed in some cases, it’s very expensive and success is not guaranteed.
Tubal Ligation Is Permanent, Too
There are permanent birth control options for women, too. Tubal ligation is also known as female sterilization, or having your “tubes tied.” It involves closing the fallopian tubes to prevent a woman’s eggs from being fertilized and pregnancy from developing.
Tubal Ligation Pros: Female sterilization is a generally safe form of contraception and doesn’t change your hormone levels. Sterilization is also nearly 100 percent effective. It may also lower your risk of having ovarian cancer later.
Tubal Ligation Cons: The operation involves anesthesia, and as surgery, has some associated risks: reactions to the anesthesia, damage to your bladder or bowel, and pelvic pain afterwards, notes the Mayo Clinic.
This birth control method is permanent, so you should be sure you don’t want more children before opting for this procedure. Like a vasectomy, reversing sterilization is expensive and not guaranteed.
Frequently Asked Questions
A review published in January 2014 in the Cochrane Database of Systematic Reviews analyzed 49 studies and found that going on the pill or using the patch made no significant difference in weight for most women; the largest notable weight gain found, when studies did find it, was nearly four pounds. In the 21 studies that provided data on why women stopped taking birth control, 0 to 5 percent of women said they stopped because of weight gain.
If you do experience weight gain, the researchers say it’s highly unlikely that your birth control is causing it. Unlikely, that is, unless you’ve had the birth control shot, which has been shown to increase weight in about one-quarter of the women who use it. If you’re on a different method than the shots, and you feel heavier, say experts, it’s probably water weight, and not an actual increase in fat.