Options Abound for Birth Control

August 25, 2022

When it comes to birth control, women have many choices. Nearly all U.S. women have used at least one contraceptive method in their lifetime, according to the Centers for Disease Control (CDC).

However, when it comes to choosing the one that’s safe, effective, and right for you, it can seem overwhelming, acknowledges Stephanie Teal, MD, an obstetrician and gynecologist at University Hospitals.

“Learning about different birth control methods, how well they work, and issues you should weigh when choosing one can help you make an informed decision,” she says.

Under the Affordable Care Act, most insurance plans must cover FDA-approved prescription birth control without making women share the costs. Even if you don’t have health insurance, many family planning clinics provide some contraception methods for free or at low cost.

Things to Consider

The type of contraception that’s best for you depends on several factors. Dr. Teal recommends considering the following:

Effectiveness – how well a method prevents pregnancy
Cost and availability – the expense involved and whether you need a prescription from your healthcare provider
Health risks – how your overall health relates to the method
Frequency – how often you have to manage your birth control
Permanence – whether you need a temporary or permanent method
Prevention of sexually transmitted infections (STIs) – most methods provide no protection
How often you have sex and how many sexual partners you have

Barrier Methods

These methods block sperm and must be used each time you have intercourse. Condoms, diaphragms, cervical caps, contraceptive sponges and spermicide are barrier methods. Condoms offer the most protection against STIs.

The failure rate of barrier methods is much higher than hormonal methods like birth control pills. When spermicide alone is used, 28 women out of 100 will get pregnant within a year.

Hormonal Methods

These methods regulate or prevent ovulation (the release of an egg) by putting the hormones progestin and estrogen, or sometimes just progestin, into your body. Requiring a prescription from your provider, they include the birth control pill, patch, vaginal ring, hormone shots, subdermal implants, and some intrauterine devices (IUDs).

For some women, hormonal contraceptives may cause side effects, such as nausea, high blood pressure, or weight gain. However, they can also improve medical conditions associated with hormonal changes, such as acne and endometriosis, and have been shown to prevent certain types of ovarian and endometrial cancers. They are also more effective at preventing pregnancy than any of the barrier methods—only four to seven women out of 100 will get pregnant when taking birth control pills, and IUDs and implants have a failure rate of less than 1 percent.

Birth control pills must be taken daily to be effective, while other methods, such as an implant or hormonal IUD, need to be replaced every few months or years (every three and five years, respectively).

Other Methods

Sterilization. Operations on either sex that permanently prevent pregnancy are close to 100 percent effective.

These methods include tubal ligation, a surgery in which the fallopian tubes are cut, tied or blocked to prevent egg and sperm from traveling through them; hysterectomy, a surgery to remove the uterus; and salpingectomy, surgery to remove the fallopian tubes.

Vasectomy is a surgical sterilization method for men in which the vas deferens (tube that carries sperm from the testes) is cut or clamped.

Natural family planning. This method involves a woman tracking her menstrual cycle and fertility signals in order to avoid pregnancy. However, this method has a high failure rate, and approximately 25 percent of women who avoid having sex while ovulating will still become pregnant.

Abstinence. Not having sex is 100 percent effective in preventing pregnancy and STIs.

With so many different options for birth control, it is important to know the facts about the various methods in order to choose the one that’s right for you.

"Talk with your provider for help weighing all of the risks and benefits,” Dr. Teal advises.