Birth control methods: options, effectiveness, choosing

In short

• Methods that do not rely on daily action, such as IUDs and the implant, have the lowest typical-use failure rates.
• Typical-use effectiveness is lower than perfect-use effectiveness for methods that depend on remembering.
• Most methods do not protect against sexually transmitted infections; condoms are the main exception.
• Emergency contraception works best the sooner it is used, and a copper IUD is the most effective option.
• The right method depends on your health, your plans, how often you have sex and what you can use consistently.

Typical use versus perfect use

In everyday life pills get missed, condoms are put on late and calendars slip. The CDC therefore lists the percentage of people who become pregnant in the first year of typical use. For methods that depend on the user, that is noticeably higher than the figure for perfect use. For methods placed by a clinician, such as the implant and IUD, there is little to forget.

Typical-use pregnancy rates in the first year, as given by the CDC, are shown below.

• Implant: 0.1 percent. Levonorgestrel IUD: 0.1 to 0.4 percent. Copper IUD: 0.8 percent.
• Tubal surgery: 0.5 percent. Vasectomy: 0.15 percent.
• Injection: 4 percent.
• Combined pill, progestin-only pill, patch and vaginal ring: 7 percent.
• Male condom: 13 percent. Sponge and diaphragm: 17 percent. Female condom and spermicides: 21 percent. Cervical cap: 22 percent.
• Fertility awareness-based methods: between 2 and 23 percent, depending on the method.

The main groups of methods

1. Long-acting reversible methods.An IUD, hormonal or copper, is placed in the uterus by a clinician; hormonal IUDs last years and the copper IUD can last up to 10 years. The implant is a thin rod placed under the skin of the upper arm that releases progestin for several years.
2. Injection.A progestin shot every three months, given by a provider or self-injected.
3. Pill, patch and ring.Hormonal methods that need regular use. Combined versions contain estrogen and progestin, while a progestin-only pill may suit people who cannot take estrogen.
4. Barrier methods.Condoms, the sponge, diaphragm, cervical cap and spermicides. Condoms and spermicides are sold over the counter, while diaphragms and caps are prescribed.
5. Permanent methods.Tubal surgery works right away. After a vasectomy you need another method until a test shows sperm are gone, which takes about 12 weeks.
6. Fertility awareness and breastfeeding.Fertility awareness tracks fertile days and requires avoiding sex or using a barrier on those days. The lactational amenorrhea method works only if you have no periods, your baby is fully or nearly fully breastfed and is under 6 months old.

Hormonal methods and your health

Not every method suits every person. The CDC publishes US Medical Eligibility Criteria that tell clinicians which methods are appropriate for people with particular conditions. Tell your provider about your medical history, other medicines you take and your family history, since these shape which options are suitable.

Options that do not contain estrogen, such as the progestin-only pill, injection, implant and IUDs, are available for people who cannot take it. Side effects and suitability differ from person to person, so you may need to try more than one type.

How to choose

1. Plans.Do you want children, and when? This points toward reversible or permanent options.
2. Consistency.Can you take a pill at the same time every day, or would a method that needs no daily action suit you better?
3. Health.Your health conditions and medicines affect which methods are appropriate.
4. Protection.Do you need STI or HIV protection, for example with new or multiple partners?
5. Side effects and cost.Consider side effects, how easily you can stop or have the method removed, and what it costs.

WHO stresses that the choice should be voluntary and informed. A provider can help you weigh these points.

Emergency contraception

Emergency contraception is not a regular method. It is used after unprotected sex or a condom that broke. The two options are a copper IUD, inserted by a provider within 5 days (120 hours) of unprotected sex, and emergency contraceptive pills, taken as soon as possible. The IUD is the most effective option.

The sooner either is used, the more effective it usually is. One type of pill works within 3 days (72 hours) and another within 5 days (120 hours), so ask a pharmacist or clinician which fits your situation.

Protection against infections

Most contraceptive methods do not protect against sexually transmitted infections, including HIV. Condoms, used alone or with another method, help protect against HIV and other STIs, and latex condoms are the most common type. Female condoms might help too. PrEP can help protect against HIV.

That is why, with a new or more than one partner, people often use a condom in addition to another method.

When to see a doctor

Talk to a provider to choose the best method, because some methods are started or inserted in the office. Return for advice about side effects that bother you, bleeding that does not settle, a method you find hard to use consistently, or if you are worried your IUD has moved.

Red flags, call 911: sudden chest pain or severe shortness of breath, a severe headache with vision or speech changes, weakness on one side of the body, or pain and swelling in one leg, particularly while using hormonal methods.

Questions and answers

Sources

1. CDC — Contraception
2. CDC — U.S. Medical Eligibility Criteria for Contraceptive Use
3. WHO — Family planning and contraception
4. MedlinePlus — Birth Control
5. NHS — Emergency contraception

Sources checked on 29 October 2026.