Birth control options: What’s out there and how do they work?

For thousands of years, people have tried to find ways to have more control over if and when they become pregnant.¹ Over the past 50 years, safer and more effective birth control methods have been developed than ever before.²

Read on to learn about options, including condoms, implants, pills and more.

In this article:

What birth control options are there?

“There’s no one perfect birth control method or one perfect way to choose it,³” says Melissa Kottke, MD, MPH, a gynecologist and director of the Jane Fonda Center for Adolescent Reproductive Health at the Emory University School of Medicine. “A method that is great for one person may not be good for another, and a method that was good for you at one point in your life may not be as good for you later.” 

When thinking about what option might be best, she recommends discussing reproductive priorities with a health care provider. They can help decide which categories may be a good fit. 

The main categories include the following: 

• Barrier methods. Physical devices like caps, condoms and diaphragms work by preventing sperm from reaching the egg.⁴ Spermicide, a chemical that impairs sperm, can be used with items in this category (except for the sponge, which already contains spermicide.)⁵
• Short-acting hormonal methods. The birth control pill is probably the most well-known option. But the patch and the ring also deliver hormones that make it harder for an egg to be fertilized.⁶
• Long-acting reversible birth control. Implants, injections (“the shot”) and intrauterine devices (IUDs) need to be delivered by a health care provider, but some work for years. Most implants and IUDs use hormones to help prevent pregnancy, but some IUDs contain copper to stop sperm from fertilizing an egg.⁷
• Permanent methods. Surgical options include a vasectomy for men and tubal ligation for women. These options are for people who want to avoid pregnancy indefinitely and should be considered irreversible procedures.⁸

Ultimately, there’s no one “best” method. “The right form of contraception is ultimately the one that you’re happy with and, most importantly, you will use consistently,” says Jennifer Pitotti, MD, MSc, board-certified OB-GYN at the University of Colorado Medicine Obstetrics and Gynecology, East Denver.⁹

Condoms, caps and barrier methods

Barrier methods are just what they sound like. They create a physical boundary, blocking the sperm from reaching the egg.¹⁰ Even with perfect use, the success rates are lower than hormonal birth control. As a result, many people pair a barrier method with a hormonal method. 

Barrier methods have a few bonuses. Most of them are available over the counter. Some types of condoms help prevent sexually transmitted infections (STIs) when used correctly every time during sex.¹¹ That said, they can be harder for some people to use consistently. 

“They require use with every act of sex, so they may not be as effective at preventing pregnancy for folks who cannot or do not use them every time,^12, 13” says Dr. Kottke. Again, success rates are lower than hormonal birth control even with perfect use. 

Barrier methods include the following: 

• Birth control sponges. A birth control sponge is a piece of sponge that contains spermicide. It’s placed deep in the vagina to cover the cervix during sex.¹⁴
• Condoms. Condoms are thin sheaths made of latex, plastic or lambskin that cover the penis during sex.¹⁵ “A significant benefit of condoms is that they are the only type of contraception that can prevent the transmission of many STIs,” Dr. Pitotti says.¹⁶ It’s important to note that lambskin condoms do not prevent the transmission of STIs.¹⁷ Read each product label for details and safety information. 
• Diaphragms or cervical caps. These are flexible cups that are inserted into the vagina to cover the cervix.¹⁸ They must be used with spermicide in order for them to work.¹⁹ Diaphragms and cervical caps require a prescription. Because they come in different sizes, they need to be fitted by a health care provider. It’s also recommended to wait six weeks after giving birth before using a diaphragm.²⁰
• Internal condoms. Sometimes referred to as “female condoms,” internal condoms work the same way but are worn inside the vagina. They can also help provide some protection against STIs.²¹
• Spermicide. While not a barrier itself, spermicide prevents sperm from moving well enough to reach the egg and blocks the entrance to the cervix. It can be used with a barrier method and inserted deep into the vagina. Spermicide can be bought without a prescription.²² Check the product label to determine how long before sex to insert the product. People should avoid using spermicide if they engage in intercourse multiple times a day. Repeated use throughout the day can cause vaginal irritation and increase the risk of STIs.²³

Long-acting reversible birth control

Long-term options are some of the most effective birth control methods out there. Sami Heywood, MD, OBGYN, a Complex Family Planning Fellow at the University of Illinois Chicago, calls these the “set it and forget it” methods.²⁴ She says, “IUDs and implants are highly effective at preventing pregnancy without any further user action.”^25, 26

These options are reversible, allowing a person to try for pregnancy at a later point in their life. 

Options include the following: 

• Birth control implant. This is a tiny rod placed into the upper arm by a health care provider. It helps prevent pregnancy by releasing a type of hormone called progestin.²⁷
• Birth control injection. An injection administered by a health care provider, “the shot” contains progestin and is effective for about three months. A person needs to get another shot every 12 to 14 weeks in order to stay current.²⁸ Keep in mind that it may take months to start ovulation after the last shot, so it may be beneficial to plan ahead. 
• Intrauterine device (IUD). A tiny device is placed into the uterus by a health care provider. Some IUDs can prevent pregnancy for up to 10 years. Hormonal IUDs help prevent pregnancy by releasing progestin. Copper IUDs use copper instead to inhibit the viability and movement of sperm.²⁹

Other hormonal birth control

Short-acting hormonal methods all use estrogen and/or progesterone. Synthetic versions of those two chemicals make it tough for the body to become pregnant. However, there’s a lot of variation in how these get delivered.³⁰ Remember to always follow the package instructions.

“There are many different formulations of shorter-term methods, so sometimes it takes some trial and error to find the best formulation for you,” says Dr. Heywood.³¹

Some of them include the following: 

• Birth control pill. Taken daily, “the pill” helps prevent ovulation and thickens cervical mucus to make it harder for sperm to reach the egg. Some pills use a combination of estrogen and progestin, while others use progestin only.³² Consult a health care provider about birth control pill options. In select states, pharmacists can prescribe birth control pills for eligible patients.³³ Additionally, an over-the-counter, progesterone-only option, Opill, is now available without a prescription. 
• Birth control patch. “The patch” is a small patch placed on the skin and left on as directed. It contains progestin and estrogen to prevent ovulation. It’s typically replaced once a week for three weeks followed by a patch-free week.³⁴
• Birth control vaginal ring. A small bendy circle, “the ring” is typically worn inside the vagina for three weeks at a time followed by a one-week rest. It contains both estrogen and progestin.³⁵ Similar to other hormonal birth control options, the ring works by preventing ovulation. 

Emergency contraception (also called the “morning-after pill”) can also be used to help prevent pregnancy following unprotected sex.³⁶ The length of time emergency contraception can be used after unprotected sex depends on the method. 

The over-the-counter version contains the hormone levonorgestrel, which helps prevent the release of the egg.³⁷ While they should not be a primary method of birth control, “having emergency contraception pills on hand can be a good idea because the sooner they are used, the better they work,” says Dr. Kottke.^38, 39

Learn more about the morning-after pill here.

Permanent birth control

“When you are sure you are not interested in having future children, permanent options can be a good choice,” says Dr. Heywood.⁴⁰ “These methods are same-day surgical procedures that are performed in a health care setting.”^41, 42

• Tubal ligation. Sometimes referred to as “getting tubes tied,” tubal ligation permanently blocks or removes parts of the fallopian tubes so eggs can’t be fertilized.⁴³ Tubal ligation should be considered permanent. 
• Vasectomy. “Vasectomy is safer and more effective than tubal ligation and can be completed in a clinic in just a few minutes,” says Dr. Heywood.⁴⁴ This simple procedure prevents sperm from leaving the body by modifying the vas deferens.⁴⁵ A vasectomy should be considered permanent.

How effective is birth control?

“Birth control options have a range of effectiveness,” Dr. Heywood explains. “While most types can be over 95 percent effective with perfect use, more realistic effectiveness is based on typical use.”⁴⁶

For instance, if hormonal birth control pills are taken exactly as directed, they are more than 99 percent effective. But in reality, people may occasionally miss a dose.⁴⁷

Here’s a look at the effectiveness of different methods:⁴⁸

• 99 percent effective: birth control implants, IUDs, tubal ligations and vasectomies 
• 96 percent effective: birth control shots 
• 93 percent effective: birth control patches, pills and rings 
• 87 percent effective: condoms 
• 86 percent effective (for people who have never given birth): cervical caps and sponges 
• 83 percent effective: diaphragms 
• 79 percent effective: spermicide and internal condoms 
• 78 percent effective (for people who have given birth): sponges 
• 71 percent effective (for people who have given birth): cervical caps 

(Note that some methods, such as the sponge or cervical cap, are more effective in people who have never given birth.) 

The percentages can increase when using a hormonal and barrier method together. “For people who prioritize delaying or avoiding pregnancy, using two methods at once can improve the overall ability to prevent pregnancy,” says Dr. Kottke.”^49, 50 Spermicides can also be used with condoms to increase efficacy.⁵¹

What are some birth control side effects?

Methods that contain hormones may have side effects. “They may increase the risk of blood clots, particularly in patients with certain other medical conditions like hypertension, clotting disorders or smoking,” says Dr. Pitotti.^52, 53 More common, but less serious risks include headaches, nausea, breast tenderness, mood changes and decreased libido.⁵⁴ Changes in menstrual cycle, such as unscheduled bleeding or spotting, can occur but are temporary.⁵⁵ Certain hormonal birth control is not advised for people with a history of breast cancer, clotting disorders and certain cardiovascular diseases, among others.⁵⁶

Barrier methods are considered to have relatively few side effects. Condoms may occasionally cause irritation, and people with latex allergies should choose non-latex options.⁵⁷ Devices that are inserted into the vagina, like diaphragms and sponges, can also lead to irritation in some people and to an increased risk of UTIs.⁵⁸ Repeated use of spermicides throughout the day can cause vaginal irritation and increase the risk of STIs. 

Permanent birth control methods (vasectomies and tubal ligation) often come with pain or discomfort following the procedure.^59, 60 In rare cases, this pain can persist for men with vasectomies.⁶¹ Similarly, IUDs can cause pain after insertion. IUDs can also lead to cramping and heavier periods. Less common side effects include pelvic inflammatory disease, ectopic pregnancy and uterine perforation.⁶² Make sure to review any risk with a health care provider and seek urgent care when necessary. 

To get a sense of all the pluses and minuses, talk to a health care provider. They can explain the risks and benefits of different options and help find the best solution. 

“Birth control is complicated, and so are people,” says Dr. Heywood. “Finding the method of birth control that works for you can take some time.”