What are the different kinds of birth control? How do they work and how effective are they?

Birth control refers to something that is used to prevent pregnancy. There are so many methods available! They all fall into one of four different categories: hormonal, barrier, behavioral or spermicidal.

Below, we explain what these different methods are, how they work and how effective they are—when used correctly and consistently—at preventing pregnancy. When birth control fails, it’s usually because it wasn’t used properly. Human error (“Oops, I forgot to take my Pill!”) is a huge factor in whether birth control works or not. This is why manufacturers of drugs actually note two different rates of effectiveness for each birth control method. One rate is with “perfect use,” and the other is the “typical use” rate.

Keep in mind that the effectiveness rates represent the number of couples who do not get pregnant out of a hundred. For example, condoms are 98 percent effective with perfect use, which means that if 100 couples correctly use condoms every time they have sex, 98 couples don’t get pregnant and two do.

Barrier Methods

Barrier methods (such as condoms or diaphragms) create a physical barrier between sperm and the egg.

External Condom

These latex, polyisoprene or polyurethane sheaths cover the penis and prevent bodily fluids from transferring from one person to another. External condoms are effective in preventing pregnancy and the transmission of STDs.

• Effectiveness
  Perfect use: 98 %
  Typical use: 82 %
• How It Works
  The external condom fits right over an erect penis and should be put on before engaging in any type of sexual intercourse. This creates a barrier so no bodily fluids are exchanged between partners. This means sperm can’t enter a vagina to cause a pregnancy. It also means partners are less likely to be at risk of getting sexually transmitted diseases (STDs).
• Keep in Mind
  External condoms are really effective at protecting against both pregnancy and most STDs when they’re used correctly. They are cheap and easy to obtain and use. They come in a variety of sizes, shapes and textures as well as flavors for use during oral sex. Use water-based lubricant when engaging in vaginal or anal sex with a condom.

Internal Condom

The internal condom—also known as the female or receptive condom—is a polyurethane or nitrile sheath with flexible rings at the ends that help the condom stay in place.

• Effectiveness
  Perfect use: 95 %
  Typical use: 79 %
• How It Works
  The internal condom is inserted into the vagina and held in by a ring that covers the cervix. On the other end is another ring that stays outside of the vagina, partly covering the labia. Like the external condom, this condom creates a barrier that prevents the exchange of bodily fluids that could cause STDs or pregnancy.
• Keep in Mind
  Internal condoms can be a bit tricky to insert, but anyone can get the hang of it with some practice. The internal condom gets some major points because it can be inserted up to eight hours before sex.

Cervical Cap

The cervical cap is a silicone rubber cup that covers the cervix—the lower part of the uterus—and prevents sperm from entering the uterus. Spermicide should be placed on the inside and outside of the cap, which increases the effectiveness. After intercourse, the cervical cap must be left in place for at least six hours after sex to be effective.

• Effectiveness
  Perfect use: 91 %
  Typical use: 71-86 %
• How It Works
  The cervical cap fits over the cervix—the lower part of the uterus—and keeps sperm from entering the uterus.
• Keep in Mind
  You have to visit a clinic or see a health care provider to be fitted for a cervical cap. Like diaphragms, cervical caps are most effective when used with spermicide. They are also reusable and must be washed and stored in a dry container. Cervical caps do not provide protection against STDs.

Diaphragm

The diaphragm is a thin silicone dome with flexible rim that is held in place by the muscles in the vagina. It should be used with spermicide and should be inserted before engaging in any sexual behaviors. After intercourse, the diaphragm must be left in place for at least six hours after sex to be effective.

• Effectiveness
  Perfect use: 94 %
  Typical use: 88 %
• How It Works
  The diaphragm works as a barrier that covers the cervix—the lower part of the uterus— and keeps sperm from entering the uterus.
• Keep in Mind
  You have to visit a clinic or see a health care provider to be fitted for a diaphragm. They are most effective when used with spermicide. Diaphragms are reusable; they must be washed and stored in a dry container. They do not provide protection against STDs.

Today Sponge

The Today Sponge is a single-use polyurethane sponge that contains spermicide. The sponge has a loop for easy removal.

• Effectiveness
  Perfect use: 80-91 %
  Typical Use: 76-88 %
• How It Works
  The Today Sponge fits over the cervix—the lower part of the uterus—and keeps sperm from entering the uterus, and the spermicide kills sperm.
• Keep in Mind
  The Today Sponge can be bought in drugstores. It must stay in place at least six hours after sex to be effective. The Today Sponge is not reusable and does not provide protection against STDs.

Hormonal Methods

Hormonal methods (such as the Pill, the Patch and the Ring) use hormones to prevent ovulation and thicken cervical mucus, creating a barrier that can prevent sperm from entering the uterus. Some hormonal methods also thin the lining of the uterus, so if an egg is fertilized it cannot implant. Without an egg present, pregnancy can’t happen. Hormonal methods of birth control are more than 99 percent effective. But that’s only if they’re used correctly and consistently.

Contraceptive Pill (the Pill)

Often referred to as simply “the Pill,” this hormonal contraceptive method is a pill taken at the same time each day.

• Effectiveness
  Perfect Use: 99.7 %
  Typical Use: 91 %
• How It Works
  The Pill works by releasing synthetic hormones similar to estrogen and/or progesterone. The Pill stops ovulation so no eggs are released. It also thickens cervical mucus to make it difficult for sperm to enter the uterus.
• Keep in Mind
  The Pill requires a prescription and a visit to a health care provider. The Pill must be taken every day at the same time. When the Pill is taken with some drugs, such as antibiotics, its effectiveness may be decreased. The Pill does not provide protection against STDs.

Depo-Provera (the Shot)

Depo-Provera is a shot that injects hormones into the body to prevent pregnancy for three months.

• Effectiveness
  Perfect Use: 99.8 %
  Typical Use: 94 %
• How It Works
  The Depo-Provera shot injects high levels of progestin, a synthetic hormone similar to progesterone, into the body. This stops the ovaries from releasing eggs, thickens the cervical mucus and changes the lining of the uterus. Depo-Provera users get an injection (shot) once every three months in their upper arm or upper buttocks/lower back.
• Keep in Mind
  The Shot requires a prescription and a visit to a health care provider. It is effective after 24 hours and requires no daily attention. The Shot does not provide protection against STDs.

Implanon or Nexplanon (the Implant)

This flexible rod is inserted into the body through a small incision in the upper arm. The rod must be inserted by a health care provider and is about 1.5 inches long.

• Effectiveness
  Perfect use: 99.95 %
  Typical use: 99.95 %
• How It Works
  Implanon or Nexplanon is another device that releases progestin in order to prevent ovulation and thicken the cervical mucus.
• Keep in Mind
  The Implant requires no attention for up to three years. It has to be inserted by a health care professional and requires an incision in the arm. The Implant does not provide protection against STDs.

NuvaRing (the Ring)

This small, clear, flexible ring is inserted into the vagina once a month for three weeks. On the fourth week, the ring is removed and withdrawal bleeding similar to a period takes place. The next week, the Ring is inserted and the cycle repeats.

• Effectiveness
  Perfect use: 99.7 %
  Typical use: 91 %
• How It Works
  NuvaRing releases synthetic hormones similar to estrogen and progesterone, which prevent ovulation and thicken the cervical mucus.
• Keep in Mind
  The Ring only requires attention monthly, but it might be a bit tricky to insert the ring until you get the hang of it. The Ring does not provide protection against STDs.

The Patch

This thin, smooth beige patch looks like an oversized Band-Aid and is worn on the buttocks, back, abdomen or upper arm.

• Effectiveness
  Perfect use: 99.7 %
  Typical use: 91 %
• How It Works
  The Patch releases synthetic hormones through the skin to prevent ovulation. After the Patch is placed on the skin, it remains in place for one week. It is replaced once a week for three weeks in a row. On the fourth week, the patch is removed and withdrawal bleeding similar to a period takes place. The next week, a new patch is applied and the cycle repeats.
• Keep in Mind
  The Patch does not provide protection against STDs. The Patch also delivers more hormones into the body than the Pill does. Those who should not take estrogen-based products should not use the Patch. Talk with your health care provider to find out more.

Intrauterine Device (IUD)

IUDs are a small T-shaped object that is placed in the uterus by a health care provider. Some contain hormones and others do not. They are effective anywhere from three to 10 years.

• Effectiveness
  Perfect use: 99.8 %
  Typical use: 99.2 %
• How It Works
  Hormonal IUDs—such as Mirena, Liletta or Skyla—work by releasing hormones into the uterus to thin the lining of the uterus so that a pregnancy cannot begin. They also thicken the cervical mucus to make it harder for sperm to reach an egg and may work in other ways as well to prevent implantation. In addition, there is a copper IUD—ParaGard—that works without using hormones. The copper ions (tiny atoms or molecules) released by ParaGard work in a couple of ways to prevent pregnancy: they harm sperm and make it harder for sperm to move and they thicken the cervical mucus in the uterus, making it very difficult for sperm and egg to meet.
• Keep in Mind
  The IUD does not provide protection against STDs and it has to be prescribed and inserted by a health care provider. It also has to be removed by a health care provider. They last for a very long time, though, and require little or no attention once in place. Talk with your health care provider to find out more.

Behavioral Methods

Behavioral methods (such as abstaining from sex or using the withdrawal method) are ways that people conduct their sexual behavior in an attempt to prevent pregnancy.

Abstinence

The only completely safe sex is no sex—including vaginal, oral and anal sex.

• Effectiveness: 100 %
• How It Works
  No intercourse whatsoever.
• Keep in Mind
  Remaining abstinent can be difficult because it requires resisting natural sexual urges. For abstinence to be 100 percent effective, you must not have any type of intercourse, including vaginal, oral and anal sex. When abstinence is practiced properly, it prevents any risk of pregnancy or STDs.

The Withdrawal Method (Pulling Out)

The withdrawal method, also known as pulling out, is all about getting the penis out of the vagina and away from the vulva before ejaculation.

• Effectiveness
  Perfect use: 96 %
  Typical use: 78 %
• How It Works
  This method works by removing the penis from the vagina before ejaculation so that sperm cannot enter the vagina.
• Keep in Mind
  It is a better form of birth control than none at all. It is always available when needed, but it is not very reliable. Many younger partners with a penis may not be able to totally control their ejaculation and so run the risk of ejaculating too early or too close to the vulva. The withdrawal method does not protect against STDs.

Spermicidal Methods

Spermicides are chemicals that kill sperm. They come in a variety of forms including gel, cream, foam, suppositories and film, which can be purchased in most drugstores or grocery stores and don’t require a prescription. They are often used as a back-up method with one of the other methods, such as a condom.

Spermicides When Used Alone

• Effectiveness
  Perfect use: 82 %
  Typical use: 72 %
• How It Works
  Spermicides work by killing sperm and keeping them from joining with an egg. They come in many forms—creams, films, foams, gels and suppositories. The spermicide is gently inserted deep into the vagina using fingers or an applicator while laying down or squatting. Spermicide should also be put inside a cervical cap or diaphragm.
• Keep in Mind
  For most spermicides, you will need to wait 10-15 minutes after inserting the spermicide before having penile-vaginal intercourse. This allows time for the spermicide to dissolve. Spermicide typically remains effective for only one hour after insertion, and more spermicide must be inserted each time a couple has penile-vaginal intercourse. Spermicides can also cause irritation. Some people are allergic to them. Spermicides do not provide protection against STDs.

Keep in mind that 85 percent of couples having penile-vaginal sex who do not use ANY method of birth control will become pregnant within a year. If you don’t want to get pregnant, it’s important to use birth control correctly and consistently—this means every time you have sex.