A modern guide to birth control options

Healthcare is constantly changing and evolving, and for us at the OB/GYN, that means even more birth control options than ever before. But sometimes all those options can seem dizzying, and we get that! It’s not always easy to get all the information, and options, out of an often-times 15-minute visit. We’ve compiled information, and common questions, about some of the most popular birth control methods out there. So breathe easy, we’ve got you.

Long-Acting Contraception

Long-acting contraception (aka “LARCS”) has been rising in popularity, and for good reason; these methods are over 99% effective at preventing pregnancy and have no responsibility on the user’s end. These “set it and forget it” methods include the IUD (both hormonal and non-hormonal) and the nexplanon (sometimes called the implant). Both methods are as effective as having your tubes tied, only they’re reversible and have no impact on future fertility. Because of these perks, it’s easy to see why LARCs are becoming the new “it” birth control. Let’s break down these super-effective options:

1. Hormonal IUD (Mirena, Kyleena, Liletta, Skyla)

What is it? IUD stands for “intrauterine device”, and it is a small, T-shaped device that is inserted (in-office) into the uterus.

What hormones are in it? Progesterone.

How does it work? The IUD works to prevent pregnancy in a number of ways. The progesterone in the hormonal IUD keeps the uterine lining thin and the cervical mucus thick, creating a not-so-ideal home for an embryo and not-so-ideal conditions for sperm.

How long do they last? 3-5 years.

What are common side effects? Irregular bleeding and cramping are common. Typically, these side effects resolve after the first 3-6 months (but not always). Most women also see a significant reduction in bleeding; it is common to have shorter, lighter periods, or no period at all while using this method (which can be a perk for many of us!)

What is insertion like? IUD insertion can be uncomfortable. It is typically performed in your OB/GYN office by a doctor or nurse practitioner. Many women feel a strong cramp during the insertion of the device (which typically only takes a few minutes); cramping usually improves immediately following placement. Some women experience mild to moderate cramping that may last for a few days following placement. Irregular bleeding is common following placement of the IUD and may last up to 3-6 months.

Any impact on future fertility? No.

What are the pros to this method? Very effective, good for up to 5 years, periods typically get lighter /shorter, or go away completely, reversible.

How effective is it? Over 99%.

2. Non-Hormonal IUD (Paragard or Copper)

What is it? A T-shaped device made from copper that is placed in the uterus.

What hormones are in it? None, this method is non-hormonal.

How does it work? Copper ions confuse sperm, inhibiting them from making it to the egg.

How long do they last? Up to 12 years.

What are common side effects? On average, periods last one day longer, and are heavier, than periods pre-Paragard.

What is insertion like? Insertion of the non-hormonal IUD is similar to that of the hormonal IUD.

Any impact on future fertility? No.

What are the pros to this method? Very effective, good for up to 12 years, non-hormonal, reversible.

How effective is it? Over 99%.

3. Nexplanon (sometimes called “the implant”)

What is it? The nexplanon is a small, toothpick-sized device that, when placed under the skin of your upper arm, emits hormone and prevents pregnancy for up to 3 years.

What hormones are in it? Progesterone.

How does it work? The progesterone in the nexplanon causes thick cervical mucus (inhibiting sperm travel) and a thin uterine lining (not ideal for pregnancy).

How long do they last? 3 years.

What are common side effects? Irregular bleeding is the most common side effect of the implant. Irregular bleeding is very common during the first 3-6 months following insertion, but may continue throughout the life of the device.

What is insertion like? Before inserting the device, a nurse practitioner or doctor will numb your arm with a shot of lidocaine, which may be a little uncomfortable. Once numb, the implant is inserted under the skin of the upper arm.

Any impact on future fertility? No.

What are the pros to this method? Very effective, good for 3 years, easy to insert, reversible.

How effective is it? Over 99%.

4. The Shot (Depo-Provera)

How often do I need to get a shot? Every 3 months.

What hormones are in the shot? The shot is progesterone only (no estrogen!).

What are common, not so ideal, side effects? Irregular bleeding is common, especially for the first 3-6 months; increased appetite (and possible weight gain), delay in return to fertility (can take up to a year after stopping injections before regular fertility and ovulation resumes), and changes in mood. It is important to remember that once you’ve gotten the shot, it’s not reversible– so any negative side effects may take a few months to wear off.

What are benefits? Easy to use, and, in some women, periods will stop completely.

Any impact on future fertility? Yes; it can take up to a full year for regular ovulatory cycles to resume.

How effective is it? 94% with typical use, but 99% with perfect use, according to Bedsider. 

Other Hormonal Methods

Even though LARCS are having a comeback, many women still prefer the classic pill. And that’s ok! The pill, the birth control patch, and the birth control ring, are all about 91% effective with typical use, according to Planned Parenthood. Why the lower effectiveness? Well, these methods do require some responsibility, and let’s just say, life can make it hard to remember exactly when to take or change your method. Additionally, these methods all use two hormones: estrogen AND progesterone (except for the “mini pill”, which is a progesterone-only birth control pill). If you have any health conditions that prevent you from using estrogen, you may want to consider other birth control methods. Estrogen is not recommended for women who have a history of blood clots or clotting disorders, breast cancer, stroke, heart attack, migraine headache with aura, or those currently experiencing uncontrolled blood pressure or liver disease, according to Planned Parenthood. These methods work in similar ways: the combined hormones work to suppress the ovaries, preventing ovulation (no egg = no pregnancy!). They also, like the LARCs above, thicken cervical mucus, keeping those sperm at bay.

5. The Pill

How often to you take the pill? Daily, at the same time (ideally).

What are common, not so ideal, side effects? Bleeding in between periods (also called “breakthrough bleeding”) and nausea can occur.

What are benefits? There are many! Birth control pills help prevent ovarian and uterine cancer and ovarian cysts, can lessen acne and PMS symptoms, and typically shorten, lighten, and regulate periods.

Any impact on future fertility? No.

How effective is it? 91 – 99% depending on accuracy of use.

6. The Patch (Xulane)

How often do you change the patch? Weekly, on the same day, for 3 weeks; 4th week will be patch-free.

Where can the patch be applied? The patch can be applied on the upper arm, top of buttocks, lower pelvis, and upper back.

What are common, not so ideal, side effects? Bleeding in between periods may occur.

What are benefits? Benefits are similar to those of the birth control pill.

Any impact on future fertility? No.

How effective is it? 91% – 99% depending on accuracy of use.

7. The Ring (Nuvaring)

How often do you change the ring? The ring is inserted and left in place for 3 weeks; 4th week will be ring-free.

How do you insert? And remove? To insert the ring, all you need to do is insert it into the vagina (as long as it’s in the vagina, it’s working!). Some women find it helpful to use a tampon applicator to help insert. For removal, insert one finger into the vagina, loop around the edge of the ring, and remove the ring.

What are common, not so ideal, side effects? Bleeding in between periods may occur.

What are benefits? Benefits are similar to those of the birth control pill and the birth control patch.

Any impact on future fertility? No.

How effective is it? 91-99% depending on accuracy of use.

Non-Hormonal Methods

For those not into the idea of hormones (or for those who can’t use methods with them), we haven’t totally forgotten about you, either. While the options are slightly more limited, they vary from minimal commitment required (condoms) to total commitment (sterilization).

8. Condoms

How effective are they? Approximately 82% effective with typical use, according to Bedsider.

What are benefits? Condoms are the only method of birth control that protect against STI’s (sexually transmitted infections) which is a huge perk! Other benefits include no daily medication and no prescription needed– pretty easy.

Cons to condoms? Condoms are not the most effective method and require some planning ahead.

How effective is it? 79% – 99% depending on accuracy of use.

9. Fertility-awareness method

How effective is it? 76-88% effective, according to Planned Parenthood.

How does it work? Fertility awareness methods (there are a few) are methods that require ovulation tracking. In short, you avoid having unprotected intercourse on the days surrounding ovulation (per planned parenthood, in the 5 days prior to ovulation, the day of ovulation, and possibly the 2 days following). Fertility awareness methods work best if you have a very regular, consistent cycle.

How effective is it? 76% – 88%.

10. Non-hormonal IUD (covered above) 
11. Sterilization (Tubal Ligation)

What is it? A procedure done where the fallopian tubes are either partially removed or are clipped, preventing pregnancy.

How effective is it? 99.9% effective at preventing pregnancy.

What are benefits? Very effective birth control, and no need to remember anything, ever again!

Is it reversible? This is permanent, so make sure you are certain about not wanting any future pregnancies.

Any downsides? While this procedure is typically minimally invasive, it is still a procedure that has to be performed in the hospital and under anesthesia.

How effective is it? 99.9%.

Phew! We’ve covered a lot of options. Having options is a blessing, but sometimes it can feel overwhelming when there are this many. If one (or a few!) methods seem like they could be a good fit for you, pay your women’s healthcare provider a visit to discuss. They can help you narrow it down and make the decision that is best for you and your body. And don’t get discouraged if the first thing you try doesn’t work for you; birth control isn’t a one-size-fits-all, and every woman’s body is different. Be patient, listen to your body, and always remember that this is your choice– no one else’s!

Resources

Planned Parenthood

Bedsider

About the author

Kara Earthman, WHNP-BC

Kara Earthman is a Nashville-based women's health nurse practitioner and writer. Kara's work and advice have been featured in both Healthline and Modern Fertility.

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