Finding the best birth control method

Written by Brendan Levy

Let's review all the birth control methods, including condoms, IUDs, pills, and more!

There are so many different birth control methods available today - which is great, because over 98% of women in America will use birth control at some point in their lives! - but it can also be a bit daunting to choose the right one for you. A lot of people ask us which type of birth control is the best, and the short answer is that each method has its own advantages and disadvantages, and so there is no single, best method for everyone. Each type varies in terms of effectiveness, ease of use, cost, medical risks, or additional benefits like menstrual cycle regulation.

If you're trying to decide which method is right for you, take a moment to think about what the most important factors are for you.

Your primary-care doctor, OB-GYN, or an online Doctor here at HeyDoctor can also help you decide.

Note: Keep in mind that most types of birth control don’t protect against sexually transmitted diseases (STDs), so you still need to think about an STD prevention strategy in addition to preventing unintended pregnancy. More on that later.

IUDs and Implants

In terms of effectiveness, these are our favorite methods - they are called long-acting reversible contraceptives (LARCs). These are great because while you are using them you are extremely unlikely to get pregnant (there’s less than 1 pregnancy out of every 100 women per year), and because you’re not having to remember to take a pill every day, there’s very little room for user error. Just like the name suggests, they are also reversible, so when you are ready to get pregnant you just have the device removed.

Intrauterine devices (IUDs) are small, t-shaped devices that a doctor inserts in your uterus during a procedure that is like a much more crampy pap smear. Depending on the type of IUD you choose, it can remain in your uterus and effectively protect against pregnancy for up to 10 years!

Some types of IUDs (Skyla, Mirena) have hormones like birth control pills . These hormones may help reduce period bleeding and cramping. The other type of IUD (ParaGard) uses copper and doesn't have hormones. This type is safer for people for whom hormones might increase clotting or other risks.

Implants (Nexplanon) are tiny plastic rods that are inserted right under the skin of the arm. It's a quick procedure that is less weird than it may sound. They use hormones to prevent pregnancy and need to be replaced every four years. These implants are also excellent highly effective options.

Pills

Birth control pills are very common and there are a huge number of brands to choose from. For the purposes of this article, we’ll break it down into two types: combination pills and progestin-only pills. We’ll go into more detail about all the different brands within those categories in a future post.

Combination pills contain an estrogen and a progestin. This pill is great for regulating your menstrual cycle and can be used for things like skipping periods. They also tend to have a lower risk of mild side effects like acne. The big downside is that estrogen can increase risk of things like blood clots or stroke, especially if you have certain risk factors like high blood pressure.

Progestin-only pills (POP) just have a progestin. They are great because they are lower risk for serious side effects like blood clots. It is especially important with progestin-only pills to take them at the same time every day - an easy way to do this is by setting an alarm on your phone, or take them first thing in the morning or right before bed. Progestin-only pills can cause some spotting initially but usually make your period lighter over 3-6 months.

NuvaRing

The Nuvaring is like a small jelly bracelet that you put into your vagina. The plastic contains the hormones that prevent pregnancy and they are slowly released over the month. The ring is extremely flexible, making it easy to insert into your vagina. Some women may find it strange at first, but it’s easy to get the hang of (kind of like inserting a small tampon) and once it’s inserted most people don’t notice it at all.

The risks of the Nuvaring are similar to a combination pill because it contains the same hormones but with a different delivery mechanism. Overall it’s a great and effective method, especially because you only need to change it every three weeks.

The Patch

The patch used to be called Ortho Evra, but the company that made it changed and now it is called Xulane. It is the same patch with the same ingredients. The patch delivers hormones that are just like the pill, but instead of taking the pills orally, the medicine is delivered slowly through your skin.

The risks of the patch are very similar to a NuvaRing or combination pill because it is using the same hormones but with a different delivery mechanism. The nice thing about the patch is that you only have to think about it once a week when you change it, as opposed to having to remember to take a pill every day.

Natural Family Planning or Fertility Awareness

There are also people who track their natural fertility cycle and use that to decide when to have unprotected sex. The nice part of this method is you don't need to take any medicine. There are different methods of tracking, and people use a combination of indicators including temperature, cervical mucus, bleeding, and other signs, to help determine when they are more or less likely to get pregnant from unprotected sex.

You can track this using a calendar or journal, but there are also new apps like Glow and Clue that can help people be more accurate and reliable in keeping track of their fertility indicators. The apps help you track your cycle, record when your periods occur, and can even remind you to enter your body temperature, etc.

The biggest risk with this method is that a lot of people have have irregular cycles, so it’s harder for them to reliably know when they might get pregnant from unprotected sex. It’s also easy with this method to mess up the tracking or forget to record information. On average, this method results in 12-24 pregnancies out of every 100 women per year. This method also would not protect you from STDs.

Abstinence from Sex

This method is 100% effective and pretty self explanatory. It's great for some people but definitely not for everyone. It’s also important to remember some things like heavy petting can still transmit certain STDs, and often strategies like 'just the tip’ don't go as planned.

Pull-out method (Withdrawal)

This method is when one partner pulls their penis out of the vagina before ejaculation, making sure that no semen/ejaculate goes inside or near the vagina. This is one of the less-effective methods for preventing pregnancy (it is only about 75% effective), in part because it's difficult to use this method perfectly every time. This method isn't effective for protecting against STDs either. We recommend combining this method with another method of birth control like the pill or condoms.

Condoms

Condoms are always a great addition for safer sex. Not only do they help reduce the risk of unintended pregnancy, they also help prevent transmission of many STDs (including HIV). If they’re used perfectly they do a good job of preventing pregnancy, but in reality, the statistics aren’t great: there are about 18 pregnancies out of every 100 women per year. Condom use often leads to accidental pregnancies because they’re hard to use perfectly in the moment. That’s why we usually recommend combining them with another method to help get the benefits of both methods.

Female Condoms

Many people aren't aware of it, but an improved version of the female condom was just introduced to the market. It is something women can control and use if male partners don't want to use a male condom.

Just like a male condom, it isn't the best option for birth control alone (31 pregnancies out of 100 women per year), but it is a great thing to use alongside birth control and can dramatically reduce the risk of STD transmission.

STD Testing

Lastly, don't forget to consider adding regular STD testing of you and your partner or partners into the mix. Safer sex is better sex!

Next Steps

You can discuss any of these options with your doctor in-person or with your medical team at HeyDoctor. While we don't offer all of them (like IUDs or implants) we can always offer advice. Most of the other types of birth control we are able to prescribe, and we can send them to your door or to a local pharmacy of your choice! Take a look at our Birth Control page for more information.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.