As with all health topics, there’s a lot of information online about birth control, particularly on social media.
Some of what’s out there is accurate medical content, but a lot of it is false or misleading.
That’s why the best way to choose a birth control method is with your doctor or healthcare provider, who will work closely with you to determine what approach works best for your life and goals.
“Most patients have a good idea of what their priorities are,” says UNC Health OB-GYN Jes Morse, MD, MPH. “Is pregnancy prevention the No. 1 concern or managing your heavy periods? Do you want a method you don’t have to think about once it’s placed?”
Prescription Birth Control Options
Birth control comes in several forms, but in all cases its job is to prevent pregnancy. These are the most common types you can get with a prescription from your provider.
- Pills
Birth control pills use hormones—typically estrogen and progestin—to prevent ovulation so you can’t get pregnant. They’re very effective when taken as directed, but you need to take one every day, Dr. Morse says. Oral contraceptives can help improve acne and relieve heavy menstrual bleeding and painful period cramps. It’s a myth that it takes months after stopping the pill for fertility to return; some women get pregnant immediately. - IUDs
Intrauterine devices, or IUDs, are small t-shaped objects that sit in the uterus and prevent pregnancy. You can choose between a hormonal IUD or one with no hormones that is wrapped in a bit of copper, which incapacitates sperm before it can fertilize an egg. There’s an increasing understanding in gynecology that some women find IUD insertion painful, so providers are offering pain management options including numbing and sedation, Dr. Morse says. Once placed, IUDs are effective for years, some longer than a decade. - Vaginal ring
This flexible, bendy ring is inserted into the vagina once a month; you do it at home and remove it three weeks later to start your period. Like the pill, the ring releases hormones that prevent ovulation. As soon as you stop using the ring, you can become pregnant. - Implant
A doctor will insert the implant—a thin rod about the size of a matchstick—into your upper arm. Sold as Nexplanon, the implant releases progestin that thickens the mucus in your cervix to prevent pregnancy. It’s extremely effective, but some women experience unpredictable menstrual bleeding, Dr. Morse says. Nexplanon is good for up to five years but can be taken out early if you wish; pregnancy is possible immediately. - Shot
If you opt for a birth control shot, marketed as Depo-Provera, you’ll see your provider every three months for an injection in your arm or butt. The shot contains progestin to prevent ovulation. Many women on the shot don’t get a period at all after the first several injections, which is a benefit for some. Unlike many other methods, the shot is associated with delayed fertility for several months after you stop using it, but it has no impact on your fertility in the long run. - Patch
The birth control patch releases estrogen and progestin through the skin to prevent ovulation. You place the small, sticky piece of material, like a bandage, on your butt, stomach, back or upper outer arm. You need to use a new patch each week; the fourth week of your cycle, you don’t use a patch and you get your period. Like the pills and ring, once you stop using the patch, pregnancy is possible.
The Most Effective Contraception Methods
Sometimes, patients ask Dr. Morse which birth control method is most effective. The answer is that while prescribed options are very effective if used as directed, they are not 100 percent guarantees.
Human beings don’t always use them perfectly, either. That’s a big reason why set-it-and-forget-it methods, such as IUDs and the implant, have the highest success rates for reversible methods.
But that doesn’t mean you need to be nervous about your pill, Dr. Morse says. “If you’re taking your pill about the same time every day, it’s going to work.”
Permanent birth control, or sterilization, is nearly 100 percent effective. A man can have a vasectomy, an outpatient procedure in which the vas deferens, which deliver sperm to the semen, are cut and sealed. It’s important for men to know that they must return to their provider two or three months after the procedure for testing to make sure their semen does not contain sperm anymore. Until that confirmation, you must use protection if you want to prevent pregnancy.
For women, sterilization is achieved with a surgery called a salpingectomy, in which the fallopian tubes are removed. A more common term, tubal ligation, or “getting your tubes tied,” refers to a surgery that cuts or bands a small segment of the tubes. Importantly, research has shown that having the tubes removed reduces the risk of ovarian cancer. This procedure is effective immediately and is sometimes done at the same time a woman is giving birth via C-section if she knows she doesn’t want to be pregnant again.
Condoms, Cycle Tracking and Other Methods
It’s hard to get more basic than condoms, which are hormone-free but must be used correctly every time. Although condoms can break, a major advantage is that—unlike other contraceptive methods—they protect against sexually transmitted infections. Pairing a condom with a hormonal method of birth control is a good strategy when you want STI protection and to be extremely confident that pregnancy won’t occur.
Fertility awareness methods, sometimes called natural family planning or the rhythm method, use different strategies to determine your fertile days so you can avoid unprotected sex during that window. Some women monitor their temperature, cervical mucus or use a calendar to monitor their cycles—or all three. These all-natural methods are not as effective as prescription birth control or condoms.
There is also an over-the-counter birth control pill that is progestin-only.
“This pill should be taken at the same time every day but you can easily get it at a pharmacy without seeing your healthcare provider if that works better for you,” Dr. Morse says.
Emergency Contraception
If your birth control method fails—maybe the condom broke, or you realize you forgot to put your ring back in or start your next pill pack—and you’ve had sex, emergency contraception is an option.
The most effective method is to get an IUD inserted within five days of unprotected sex. This is more than 99 percent effective as emergency contraception and will give you birth control moving forward.
Another option is the so-called “morning-after pill,” which is more effective the sooner you take it. These pills are available by prescription and over-the-counter. Ask your doctor or a pharmacist for help choosing a pill; some are less effective for women with a higher body mass index.
Questions about contraception? Talk to your doctor or find one near you.