Practicing safer sex is a vital part of reproductive health and some of the best tools to support safer sex are contraceptives. There is a wide variety of types of birth control and different options suit different lifestyles best. For example, for people who want to prevent pregnancy with a low maintenance option, an implant or IUD may be a good option. Embrace Sexual Wellness has compiled an overview of contraceptive options, with information such as efficacy, pros and cons, side effects, and more. We hope this guide will aid you in figuring out which method will work best for you. Keep in mind that condoms and dental dams are the only form of contraceptive that protects against STIs and should be paired with another method to ensure the most effective protection against pregnancy and STIs. We recommend using at least two methods, one of which should protect against STIs, to ensure the maximum amount of protection.
Note: all efficacy rates refer to perfect usage of the method and with those that require manual maintenance, human error may diminish efficacy rates
Overview
Efficacy: 99% effective
STI Protection: Does not protect against STIs
How it’s used: inserted by a doctor. No manual maintenance required
Types
Copper (Paragard)
How it works
A copper IUD is a plastic body with copper wrapped around it. Copper changes the way sperm cells move so they can’t access the egg.
Benefits
High efficacy at preventing pregnancy
Lasts up to 12 years but can be removed at any time by a doctor
Can be used as emergency birth control if inserted within 5 days of unprotected sex
Does not need manual maintenance
Drawbacks
Insertion can be uncomfortable
Initial side effects can be unpleasant but for most, should subside after the first 6-12 months
Does not provide STI protection
Hormonal (Mirena, Kyleena, Liletta, and Skyla)
How it works
Hormonal IUDs release a small amount of progestin which mimics the hormone progesterone that bodies naturally make. These hormones both make the cervical mucus thicker to block sperm from accessing the egg and the hormones can also stop ovulation, meaning there’s no egg present to be fertilized
Benefits
Long-lasting
Mirena: up to 7 years
Kyleena: up to 5 years
Liletta: up to 7 years
Skyla: up to 3 years
For some, lightened periods and cramps
Can potentially manage symptoms of endometriosis and polycystic ovarian syndrome (PCOS)
Drawbacks
Insertion can be uncomfortable
Initial side effects can be unpleasant but for most, should subside after the first 6-12 months
Hormones may worsen or complicate pre-existing mental and reproductive health conditions
Does not provide STI protection
How to Access It
IUDs have to be inserted by a doctor, most commonly an OB/GYN or a clinic like Planned Parenthood.
Potential Side Effects
Longer and heavier periods and cramps for the first 6-12 months
Irregular periods and spotting between periods
Works Best For
People who want to “set and forget” their birth control.
People who, for whatever reason, can’t or don’t want to use hormonal birth control (copper only)
People who are interested in birth control that has the potential to lighten or get rid of periods (hormonal IUDs only)
Contraindications
Conditions that cause pain from vaginal penetration such vaginismus
Mental illness (not for all; case by case basis)
People who want a regular, natural period
Overview
Efficacy: 91% effective
STI Protection: Does not protect against STIs
How it’s used: Oral ingestion once a day at the same time
Types
Combination (estrogen and progestin)
How it works
The hormones in the pill prevent ovaries from releasing an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.
The last week of the pack is hormone-free to allow a period to happen. For those interested in skipping their periods, consult your healthcare professional about not taking the hormone-free week of pills.
Benefits
Less strict time window for taking the pill, though it’s recommended to take it around the same time everyday to help stick to the routine
Drawbacks
Does not protect against STIs
Progestin only
How it works
The hormones in the pill prevent ovaries from releasing an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.
Benefits
For those who want to lighten or eliminate their period, hormonal birth control may help
Drawbacks
Must be taken in the same 3 hour window every day to be effective
Does not protect against STIs
How to Access It
Must be prescribed by a healthcare professional
Potential Side Effects
Spotting or bleeding between periods
Sore breasts
Nausea
Headaches
Weight gain
Works Best For
People who can remember and stick to a scheduled daily routine
Contraindications
If you’re prone to blood clots and strokes
Any condition involving regular vomiting and/or diarrhea, as the pill will not work following these functions
Overview
Efficacy: 99+% effective
STI Protection: Does not protect against STIs
How it’s used: implanted in arm by a healthcare professional under local anesthetic. No manual maintenance required
Type
Nexplanon
How it works
Releases progesterone to prevent the release of an egg each month and thickens cervical mucus to block sperm cells.
Benefits
Long lasting (up to 5 years)
Highly effective
Drawbacks
Does not protect against STIs
Requires minor doctor’s office procedure
How to Access It
Must be inserted into arm by healthcare professional, most commonly an OB/GYN
Potential Side Effects
Irregular bleeding especially in the first 6-12 months
Headaches
Breast pain
Nausea
Temporary bruising around insertion area
Works Best For
People who want low maintenance birth control
People who can’t use estrogen-based contraception
Contraindications
If you’ve had or do have breast cancer
Overview
Efficacy: 94%
STI Protection: Does not protect against STIs
How it’s used: Injected in a doctor’s office once every 3 months
Type
Depo-Provera
How it works
Releases progesterone which prevents ovulation, thickens cervical mucus to block sperm, and thins lining of womb to lessen likelihood of egg implantation.
Benefits
May reduce heavy, painful periods
Less maintenance than the pill
Drawbacks
Ability to get pregnant may not return for up to one year after ceasing injections
Does not protect against STIs
Medium maintenance - requires doctor’s visit every 3 months
How to Access It
Injections must be performed in a doctor’s office
Potential Side Effects
Changes to period
Bleeding more than usual
Spotting
Lack of a period
Nausea
Weight gain
Depression
Sore breasts
Works Best For
Those who cannot use estrogen-based birth control
Those who need a discreet method of birth control
Contraindications
If you want to be able to get pregnant soon after ceasing birth control
If you struggle with mental illness (case by case basis)
Overview
Efficacy: 85% effective
STI Protection: Yes, when used correctly, condoms protect against STIs
How it’s used: worn on the penis to prevent sperm from entering the vaginal canal (external condom) or inserted into vaginal canal (internal condom)
For an extensive overview of types of condoms and tips for usage, read this Embrace Sexual Wellness article
Diaphragm and Spermicide
Overview
Efficacy: 88% effective
STI Protection: No, they do not protect against STIs
How it’s used: the shallow, bendable cup is inserted into the vaginal canal and covers the cervix to block sperm from entering. Must be used in conjunction with spermicide
Parts
Diaphragm
How it works
Creates physical barrier between cervix and sperm
Benefits
Non-hormonal option
Not as intrusive as more long term contraceptives like IUDs
Effective immediately after it’s inserted
Few side effects
Drawbacks
Less effective than other options
Efficacy may be affected by human error
Must stay inside vaginal canal for 6 hours after sex but not more than 24 hours
Learning curve for inserting it
Spermicide
How it works
Chemicals stop sperm movement, held in place by the diaphragm
Benefits
Increases efficacy of diaphragm
Drawbacks
May cause irritation and/or UTIs
If you have sex again after applying it, you still must apply it again
How to Access It
Must be prescribed by your healthcare practitioner
Potential Side Effects
Frequent UTIs
Irritation from spermicide can make vaginal canal more susceptible to STIs
Works Best For
Those who cannot use hormonal birth control
Those who don’t mind a high maintenance option
Contraindications
If you can’t commit to consistently using the diaphragm properly
If you’re allergic to silicone, latex, or spermicide
If you have vaginal abnormalities that disallow a proper fit or placement
Overview
Efficacy: 99% effective
STI Protection: Does not provide STI protection
How it’s used: Must be stuck to either the belly, buttocks, back, or upper outer arm (latter option for Xulane only) and replaced once a week
Types
Xulane
How it works
The patch transdermally introduces the hormones estrogen and norelgestromin, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.
Benefits
Potentially may help acne and make periods lighter
High effectiveness
Only needs to be replaced once a week
Possible to get pregnant immediately after ceasing use
Drawbacks
Only works effectively for those with a BMI below 30
Patch may be susceptible to falling off
Twirla
How it works
The patch transdermally introduces the hormones estrogen and levonorgestrel, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.
Benefits
Potentially may help acne and make periods lighter
High effectiveness
Only needs to be replaced once a week
Possible to get pregnant immediately after ceasing use
Drawbacks
Only works effectively for those with a BMI below 30
Patch may be susceptible to falling off
Requires manual maintenance
How to Access It
Must be prescribed by a healthcare professional
Potential Side Effects
Nausea
Headache
Skin irritation around patch
Works Best For
Those with a BMI under 30
Those who want a less invasive contraceptive that doesn’t require as frequent maintenance as the pill
Those who are not regularly submerged in water because it may compromise the adhesion of the patch
Contraindications
People with a BMI over 30
Smokers over the age of 35
Overview
Efficacy: 99%
STI Protection: The ring does not protect against STIs
How it’s used: The ring needs to be inserted into the vaginal canal. The NuvaRing needs to be replaced every 5 weeks while ANNOVERA lasts a full year.
Types
NuvaRing
How it works
The NuvaRing releases a continuous low dose of the hormones etonogestrel and ethinyl estradiol to prevent pregnancy
Benefits
Has the potential to reduce acne and make periods lighter
High effectiveness
Option to skip period altogether
Drawbacks
Requires remembering to replace the ring
Possible for ring to fall out
Cheaper options than ANNOVERA ring
ANNOVERA
How it works
The ANNOVERA releases a continuous low dose of the hormones segesterone acetate and ethinyl estradiol to prevent pregnancy
Benefits
Lasts a full year
Has the potential to reduce acne and make periods lighter
High effectiveness
Option to skip period altogether
Drawbacks
More expensive than NuvaRing because no generic exists currently
Cannot be used while breastfeeding
How to Access It
Must be prescribed by a healthcare professional
Potential Side Effects
Headaches
Nausea
Sore breasts
Works Best For
Those who want total control over their birth control but don’t want the frequency of maintenance of the pill
Those who want a less long term hormonal option than the IUD
Contraindications
Smokers over 35
Breastfeeding people
It may take a few tries to find the best contraceptive method for your life. If you’re still unsure of where to start, try this Planned Parenthood quiz about what types of birth control might work for you. Make sure to consult your healthcare professional about the pros and cons of different contraceptives within the context of your life. Remember to use at least two contraceptive methods with one that protects against STIs every time you have sex. Sex can never be 100% risk-free but contraceptives greatly increase safety for everyone involved.
