You know that you don’t want kids (or more kids) right now, or maybe ever. But you don’t want to have to worry about changing your lifestyle choices in order to avoid pregnancy. Instead you want the best birth control: something that is reliable at preventing pregnancy, doesn’t have nasty side effects, and fits in with your daily schedule.
Luckily, in 2018, you can have all those things.
For decades, birth control meant one option: the pill. Now, however, there are myriad choices. Women looking for the best birth control can chose low-hormone or even non-hormonal options. There are birth control options that you take daily, only use when needed, or get once and don’t have to think about again for years. You can even decide whether you want to have a monthly cycle or would prefer to skip your periods altogether.
All that choice is a wonderful thing because it allows you to find the best birth control for your body and lifestyle. Unfortunately, it can also be a bit overwhelming. Choosing the best birth control can mean doing a lot of research—and some soul searching—to decide what you really want.
HealthyWay spoke to women’s health experts about the advantages and disadvantages of the most common [linkbuilder id=”736″ text=”forms of birth control”], as well as what women should consider when trying to find the best birth control option for them. Here’s what they had to say:
What is the best birth control?
Finding the best birth control is individual to each woman, says GG Collins, MD, a fellow of the American Congress of Obstetricians and Gynecologists and a fertility specialist in Progyny’s provider network.
“There are benefits to each form of contraception, and matching the option that works best with your lifestyle and minimizes your side effects is the right choice,” she says.
Considering the effectiveness of the birth control, how long it is designed to last, and any side effects are all important when you’re trying to find the best birth control for you.
Here’s a breakdown of these factors for popular birth control options, arranged from most effective to least effective at preventing pregnancy.
As you consider what’s the best birth control for you, remember that most of these forms of birth control do not protect against sexually transmitted infections or diseases.
Copper IUD (ParaGard)
Effectiveness: Intrauterine devices (better known as IUDs) are the most effective form of birth control, preventing more than 99 percent of unwanted pregnancies. The copper IUD prevents pregnancy as soon as it is placed. It is also an extremely effective form of emergency contraception: If it is placed within five days of unprotected sex it will prevent pregnancy more than 99.9 percent of the time.
How It Works: All IUDs are t-shaped devices that sit in the uterus and disrupt how the sperm would normally get to an egg. With the sperm unable to reach the egg, pregnancy is unlikely to occur. The copper on ParaGard also provides an additional level of protection by creating an environment that is toxic to sperm and eggs.
This may be the best birth control for you if:
- You want effective, long-lasting birth control. The copper IUD can prevent more than 99 percent of pregnancies for up to 12 years.
- You do not want hormonal birth control. The copper IUD has no hormones, making it a popular choice for women who don’t want to disrupt their natural hormonal balance. “Many women choose the copper IUD because it does not have a hormonal component,” Collins says.
- You’re breastfeeding. The copper IUD can be used by breastfeeding moms.
- You need emergency contraception after having unprotected sex.
- You might want to become pregnant in a few years. Fertility returns quickly after any type of IUD is removed.
This may not be the best birth control for you if:
- Some women shy away from the copper IUD because it must be inserted by a physician. This can be uncomfortable, particularly for women who have not had children, Collins says.
- Some women also experience ongoing cramping or irregular bleeding, and more intense periods, Collins says. “The main reason for discontinuation tends to be due to heavier and more painful periods that occasionally occur with the copper IUD,” she explains.
Hormonal IUD
Effectiveness: Like ParaGard, hormonal IUDs (sold under the brand names Mirena, Kyleena, Liletta, and Skyla) prevent more than 99 percent of unwanted pregnancies. However, they can take up to seven days to start working fully, so be sure to use a back-up form of birth control in the meantime.
How It Works: Hormonal IUDs thicken cervical mucus and disrupt sperm’s journey through the uterus, making it less likely that sperm will reach an egg. In addition, these IUDs release the hormone progestin, which prevents the ovaries from releasing an egg. Depending on the brand, hormonal IUDs can prevent pregnancy for up to six years.
This may be the best birth control for you if:
- You want long-acting, effective birth control that you only need to think about once. “Once an IUD is in place, women don’t have to think about it,” says Jessica Grossman, MD, CEO of Medicines360. “It’s ‘set it and forget it’ contraception, a key benefit for women ages 20 to 40.”
- You have heavy periods. Unlike copper IUDs, hormonal IUDs make periods lighter or can stop them all together. You’ll also likely experience fewer cramps.
- You might want to become pregnant in a few years. Fertility returns quickly after any type of IUD is removed.
This may not be the best birth control for you if:
- Having a period gives you peace of mind: “Some women like to have a monthly period for social or personal reasons, and many women with the hormonal IUD do not have regular periods,” Collins says. You might also experience irregular spotting.
Tubal Ligation
Effectiveness: Tubal ligation, also known as female sterilization or having your tubes tied, is 99 percent effective at preventing pregnancy.
How It Works: During a surgical procedure, a doctor blocks or cuts the fallopian tubes, the pathway that an egg takes to get from the ovaries to the uterus. With the tubes blocked, sperm cannot reach the egg, so pregnancy can’t occur.
This may be the best birth control for you if:
- You are sure you don’t want to become pregnant in the future. This is a permanent procedure.
This may not be the best birth control for you if:
- You’re unsure about having kids, or you would like the option to have more kids in the future.
- You don’t like the idea of surgery. Unlike many long-lasting birth control options that can be placed in an office, tubal ligation is a surgical procedure that requires some anesthesia (it can be done with general or local anesthesia).
Birth Control Implant
Effectiveness: The birth control implant is more than 99 percent effective at preventing pregnancy. It is effective immediately if you get it within the first five days of your cycle. If not, use backup birth control (like condoms) for a week.
How It Works: The birth control implant is a rod the size of a matchstick that is implanted under the skin of your upper arm. It releases the hormone progestin, which stops an egg from being released, and also thickens the mucus around the cervix, making it harder for sperm to get into the uterus. The implant lasts for up to four years.
This may be the best birth control for you if:
- You want to avoid estrogen. While most hormonal birth controls contain estrogen, the implant provides highly effective birth control without it, making it a popular choice for women who want fewer hormones, Collins says.
- You want lighter periods or none at all. One third of women who use the implant stop getting a period within a year.
This may not be the best birth control for you if:
- You’re squeamish. Inserting and removing the implant is normally an easy procedure, but it does involve cutting the skin open. Sometimes the implant can migrate a few centimeters, making removal more difficult, Collins says.
- Most women don’t have many side effects with the implant, but some experience weight gain, cysts, or breast soreness.
The Birth Control Shot
Effectiveness: The birth control shot is 94 percent effective at preventing pregnancy with real-world use (which accounts for women who fudge a little on their shot schedules), but if you always get your shot on time, it is 99 percent effective.
How It Works: The shot contains progestin, which stops ovulation and thickens cervical mucus. You need to get the shot every three months.
This may be the best birth control for you if:
- You want long-term effectiveness without an implant or IUD.
- You don’t mind visiting the doctor. Although you need to go to the doctor every three months, getting the shot itself is quick, easy, and relatively non-invasive.
This may not be the best birth control for you if:
- You forget appointments. You must make an appointment every three months to get your shot in order to reliably prevent pregnancy.
- You want to get pregnant soon. Although you need the shot every three months to maintain peak effectiveness, there can be some delay in getting pregnant for up to 10 months after stopping this form of birth control.
The Birth Control Ring
Effectiveness: The ring is 91 percent effective. Because it must be inserted and removed, effectiveness depends upon your ability to put it in and take it out on time, as well as storing the ring properly (out of sunlight and sometimes in the refrigerator). Some antibiotics and other medications can also make the ring less effective.
How It Works: The small, flexible ring is inserted into the vagina for three weeks at a time, and then removed for a week. It releases the hormones estrogen and progestin, which thicken cervical mucus and stop an egg from being released each month.
This may be the best birth control for you if:
You don’t want to think about birth control daily. “Many women like this form of contraception if they would like a longer-acting form of contraception but do not want a long acting device placed like the IUD or implant,” Collins says.
You have other health concerns. The ring can help control acne, PMS, and cysts. It can also help you avoid bone thinning and iron deficiency.
This may not be the best birth control for you if:
- You’re not okay inserting it. “The ring placement requires you to be comfortable putting the ring in and removing it from the vagina,” Collins says.
- You’re forgetful. The effectiveness of the ring depends on you remembering to put it in and take it out on time.
- You’re on other medications. Since some medications can decrease the effectiveness of the ring, talk to your doctor about how your medications might interact with it.
Birth Control Pill
Effectiveness: The original form of hormonal birth control is 91 percent effective with typical use. For optimal effectiveness the pill must be taken at the exact same time every day. Medications and antibiotics can also reduce the effectiveness of the pill.
How It Works: The birth control pill stops ovulation. There are many brand names, but two main types of birth control pills:
- Combination pills contain estrogen and progestin that stop ovulation and thicken cervical mucus.
- “Mini pills” contain only progestin. They thicken the cervical mucus and stop ovulation, but not as consistently as combination pills. Because of this, mini pills are only about 87 percent effective at preventing pregnancy.
This may be the best birth control for you if:
- You’re looking for a simple solution. “The birth control pill tends to be a very popular option for most women due to its ease of use,” Collins says. Because it doesn’t have to be inserted or removed by a doctor, some women feel this is an easier birth control solution.
- You’re addressing other health issues. “Some women start the pill for contraception, but also use it to establish regular periods, to reduce acne, and potentially to reduce ovarian cysts,” Collins says.
- You need to avoid estrogen. The mini pill is a good option for breastfeeding moms, women over 40, women with gastrointestinal issues, and people who have had negative side effects on birth controls containing estrogen in the past, Collins says.
This may not be the best birth control for you if:
- Your schedule is unpredictable. Taking the pill at the same time each day is essential for effectiveness.
- You have other health concerns. “Due to primarily the side effects of the estrogen found in birth control pills, there are both absolute contraindications (meaning you should never take these medications) and relative contraindications (meaning speak to your physician before taking and decide if the benefits outweigh the risks),” Collins says. For example, women who have blood clots, impaired liver function, breast cancer, undiagnosed vaginal bleeding, or who are smokers over the age of 35 should never take a combination pill.
The Birth Control Patch
Effectiveness: The patch is 91 percent effective with real-world use. Some antibiotics and medication reduce its effectiveness. It can also fall off occasionally. In addition, the user must remember when to apply and remove the patch for it to be most effective.
How It Works: The patch contains estrogen and progestin that are released into the skin. A new patch is applied once a week for three weeks, then taken off for one week.
This may be the best birth control for you if:
- You want something you can apply yourself but don’t want to take a daily pill.
This may not be the best birth control for you if:
- You’re sensitive to estrogen. “The estrogen levels in women using the transdermal patch are higher than with most birth control pills,” Collins explains. In fact, the FDA now requires the patch to have a warning, since it exposes women to 60 percent more estrogen than the pill does.
- You weigh over 198 pounds, in which case the patch may not prevent pregnancy.
Fertility Awareness
Effectiveness: Fertility awareness methods—also known as natural family planning and the rhythm method—are between 76 and 88 percent effective.
How It Works: There are a variety of fertility awareness methods, but all share a common idea: You monitor your monthly cycles (using a chart or app) in order to know when you are most fertile. During that time you either avoid intercourse or use a backup birth control method like condoms, a diaphragm, or a sponge.
This may be the best birth control for you if:
- You want to avoid hormones or implants. Fertility awareness relies on your intimate understanding of your body, without any additional prevention methods.
- It wouldn’t be a huge issue if you got pregnant. Since fertility awareness methods are less reliable, they’re best for people who wouldn’t be upset if they became pregnant.
- You have a solid understanding of how your cycles work. “If you wish to pursue the natural family planning method, it would be worthwhile to consult with a reproductive endocrinologist to grasp a strong foundation in the menstrual cycle,” Collins says.
This may not be the best birth control for you if:
- You absolutely do not want to be pregnant. No matter how well you track your cycles, there is always room for error with this method, Collins says. “Natural family planning is the least effective form of contraception as [menstrual cycles often] vary and the peak fertility time periods may shift each month,” she explains.
- You have irregular cycles. That makes it even harder to regularly track your fertile window.
Condoms and Withdrawal
Effectiveness: Effectiveness ranges from 78 percent (for withdrawal, also known as pulling out) to 79 percent (for female condoms) to 85 percent (for male condoms).
How It Works: These are options that you are likely to use in the heat of the moment. Male condoms prevent pregnancy (and STIs) by preventing sperm from entering the vagina. Using the withdrawal method, a man does not ejaculate in the vagina, reducing the risk that sperm will meet with an egg and result in pregnancy.
Male condoms and withdrawal alone aren’t the best birth control since they are often ignored in the heat of the moment. “Condoms and the withdrawal method are the least effective forms of contraception as they are often forgotten at the time of intercourse,” Collins says.
Condoms are effective at preventing many STIs, and should be used even by people who are on other forms of birth control. “All patients, regardless of what contraception they are using, should consider the use of a condom from the beginning to protect against sexually transmitted infections,” Collins says.
How to Find the Best Birth Control for You
In addition to considering the information above, it’s a smart idea to book an appointment with your doctor to discuss what the best birth control for you is given your health history, lifestyle, and future reproductive plans.
“Each woman should have a discussion with either their gynecologist or their reproductive endocrinologist about their concerns and desires to match the best form of contraception with what would work best for her lifestyle,” Collins says.
When you’re talking to your doctor, consider these questions:
Do you plan to have children in the future? When?
This question can help you identify how long you would like your birth control to last.
Do you have other health concerns?
Sometimes a birth control method isn’t a good choice for women with certain health conditions. If you’re a smoker, have physical or mental health conditions, or have painful periods, these factors need to be part of your discussion with your doctor about the best birth control given your needs. You want one that is safe to use with your condition or can even help alleviate it, Collins says. In addition, it’s important to talk about any other medications that you’re currently taking, since some medications can affect the reliability of birth control.
If you’re particularly concerned about uterine cancer (perhaps due to a family history), the patch, pill, ring, and shot can offer some protection. The patch, pill, and ring can also help protect you from ovarian cancer.
Have you experienced positive or negative side effects from birth control in the past?
Think about your experiences with past birth control options. Have you gained weight on the pill, for example, or had your acne clear up? Perhaps you enjoyed not getting a regular period when you had an IUD. Think about what has worked well for you in the past (and what hasn’t), and discuss both good and bad side effects with your doctor.
What does your sex life look like?
Considering your sex life is a huge part of finding the best birth control for you. For example, if you have multiple partners, no matter what birth control method you use, you’ll also want to use a birth control method that prevents STIs, like male condoms, Collins says. If you rarely have sex, you might be more comfortable relying on as-needed methods, whereas if you are frequently sexually active, you might want a birth control form that you don’t need to think about in the moment.
If you try something new but suspect it might not be the best birth control for you, try to give it six months before changing, Collins recommends. Of course, if your symptoms are severe (like chest pain or shortness of breath) stop the birth control immediately and call your doctor.
Finding the best birth control for you can be an intensive process, but Grossman says it is important: “Knowing which method best suits your lifestyle is important to your overall health and well-being, and ultimately, for avoiding unintended pregnancy.”
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