What’s the Best Type of Birth Control?

By Terez Malka, MD
Medically reviewed checkmarkMedically reviewed
March 22, 2022

If you’re considering using birth control, you’re not alone. Nearly every person identifying as female in the United States will use some form of birth control during their lifetime.

Between 2015 and 2017, 65% of women ages 15-49 used some form of birth control. As people get older in adolescence and adulthood, they use birth control at a higher rate.

Some form of birth control was used by 37% of women ages 15–19, and by 73.7% of women ages 40-49. 

In this article, I’ll discuss the different types of birth control and how each kind of birth control works. I’ll explain what the side effects are for each type of birth control.

I’ll talk about how effective the various choices of birth control are.

Finally, I’ll explore how to get birth control.

Types of Birth Control

Five types of birth control are available.

One type, the emergency contraception pill ( Plan B or Ella), is for use immediately after another method fails and should be used only in emergencies. 

Abstinence (completely avoiding penetrative vaginal intercourse) is the only 100% effective method of preventing pregnancy, but is not technically “birth control” because contraception is defined as methods that prevent penetrative intercourse from leading to pregnancy. 

Sterilization 

Sterilization is the most effective choice of birth control.

Those with male or female genitalia both have the option of sterilization. 

For those with a uterus, the procedure is called tubal ligation, during which a surgeon or gynecologist ties off the fallopian tubes, which prevents eggs from being dropped from the ovaries for fertilization each month.

Periods, however, will continue as usual. 

The sterilization process for those with testicles is called a vasectomy.

During this procedure, the tubes that carry sperm are sealed off to prevent pregnancy.

A vasectomy is an outpatient procedure done under local or general anesthesia by a urologist or some family physicians.

Intrauterine Device (IUD)

An IUD is a small T-shaped device inserted into the uterus by a gynecologist or primary care doctor in an outpatient office procedure.

There are two kinds of IUDs.

The copper IUD, called the Paragard, contains no hormones, so it’s safe for people with uteruses who have health issues that prevent them from using hormone-based options.

The downside of this choice is it can’t be used by people with a copper allergy or Wilson’s disease.

Also, many have heavier periods when they use copper IUDs, so it’s not a good option for those who currently have heavy, painful periods or endometriosis.

Four different brands of hormonal IUDs exist: Mirena, Kyleena, Liletta, and Skyla. Hormonal IUDs work by releasing progestin, a synthetic version of the hormone progesterone.

Progestin works by thickening the mucus in the cervix, making it an unwelcoming environment for sperm.

Progestin also thins the lining of the uterus, further deterring sperm from fertilizing the egg.

Hormonal IUDs aren’t the right choice for people with pelvic infections, uterine irregularities, unusual vaginal bleeding, and/or cervical cancer.

Arm implant

Progestin rod arm implants are inserted into the upper arm under a local anesthetic.

The progestin rod is considered by many physicians the best choice for young (15–19) people because once it’s implanted, they don’t need to do anything else to stay protected from pregnancy.

Possible side effects from the progestin implant include changes in menstrual cycles, mood swings or depression, headaches, and acne.

Progestin shot

The progestin shot (Depo-Provera) is given in the upper arm or buttocks, and each shot lasts for 90 days. Injections need to be given four times a year to maintain their effectiveness. 

Many have light periods or stop getting periods entirely after one year of use.

Some report weight gain and headaches from progestin shots.

Others do have heavy or irregular vaginal bleeding, especially in the first few weeks. Speak with your provider if you experience any problematic side effects.

Oral contraceptives (the Pill)

There are three types of birth control pills: combined, extended use, and the mini pill.

Combined and extended use pills contain estrogen and progesterone, while the mini pill only has progesterone.

Combined: 

  • Monophasic pills: Each active dosage pill contains the same amount of hormones. During the last week of the menstruation cycle, the pills are inactive, and you still have your period.
  • Multiphasic pills: These are used in 1-month cycles. There are different levels of hormones during different phases of the cycle. During the last week of the cycle, the pills are inactive, and you still have your period.

Extended use: The extended-use birth control pill is a 13-week cycle pill. For 12 weeks, you take pills that contain hormones, and during the 13th week, you can either skip taking the inactive pills or take them as a placebo to keep you on schedule. During that time, you’ll have your period.

Minipill: Because the mini pill contains no estrogen, it’s suitable for people with vaginas over 35 who smoke or who can’t take hormones for other health reasons, such as deep-vein thrombosis or heart disease.

It’s likely that you won’t have a period at all when taking the minipill, though some experience vaginal spotting.

The patch

The patch is a hormonal birth control product similar in makeup to the birth control pill and injection.

For three weeks of the month, you put on a new patch each week, and the fourth week you don’t wear one.

That’s when you’ll get your period. 

As with the pill, possible side effects include:

  • Spotting or bleeding between periods
  • Nausea 
  • Breast tenderness 
  • Headache

Vaginal ring

Another hormonal birth control option, the vaginal ring, requires you to insert it and leave it in for three weeks and take it out one week each month.

It releases hormones that prevent pregnancy from occurring by suppressing ovulation. 

Along with the side effects of other hormonal birth control options, some notice vaginal discomfort and discharge when using the ring. 

Barrier methods of birth control

Barrier methods of birth control include condoms, the diaphragm, the cervical cap, and the sponge.

These methods create a barrier deep inside the vagina to prevent sperm from reaching the uterus and are only effective if used with spermicide.

Don’t use any of these products if you’re allergic to spermicide.

Condoms

Both external (penis) and internal (vagina) condoms are most effective when used with other forms of birth control. Condoms are the only birth control option that prevents infection from sexually transmitted diseases (STDs). 

Some people complain of irritation and discomfort with both male and female condoms.

If this occurs, you may want to try one made of a different material or one that is not coated in spermicide or lubricant.

The vaginal sponge

The birth control sponge is a soft, small, round sponge made from plastic.

You must insert it deep inside your vagina before you have intercourse.

The sponge works by covering your cervix. The sponge, unlike the diaphragm or the cervical cap, already has spermicide in it.

Diaphragm

A diaphragm is a dome-shaped silicone cup that you insert in your vagina that blocks sperm from entering the uterus by covering the cervix and forming a seal through suction.

A diaphragm is only effective when used with spermicide as directed.

Cervical cap

A cervical cap is a small cup (smaller than a diaphragm) made of silicone.

It fits over the cervix so sperm can’t get in and fertilize an egg. It is more effective when used with spermicide.

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Best Birth Control

It’s impossible to say what type of birth control is the right choice for everyone because each person has their priorities, needs, lifestyles, and medical conditions.

For example, a younger person who hopes to start a family someday but suffers from debilitating menstrual cramps might benefit from hormonal birth control like the pill, ring, or patch, while an older person who has had all the children they want to might prefer sterilization, as over 49% of women did between 2015–2017.

Those that have side effects with hormonal treatment might opt for non-hormonal methods like cycle tracking, a copper IUD, or barrier methods like condoms.

When deciding what the best type of birth control is for you, your partner, and your lifestyle, here are some things to consider:

  • What insurance do you have, and what is your budget?
  • If you have a regular partner, what are their needs and preferences?
  • What will be the simplest method of birth control for you? Are you good at remembering to take pills, or is a long-term solution more convenient?
  • Do you want to manage your menstrual cycle?
  • Do you want to have children or more children if you are already a parent?

Birth Control Effectiveness

There is a wide range of effectiveness for birth control methods.

When choosing your birth control, take into account the possibility of pregnancy.

If you absolutely don’t want to get pregnant anytime soon—or ever—the IUD or the progestin implant are your best choices.

Sterilization is a permanent solution for those who have finished having children or do not ever desire them. 

Here are the birth control methods and their effectiveness, ranging from typical to perfect use:

Birth Control MethodEffectivenessHow Often Taken or Replaced
Sterilization (male or female)99%One procedure
IUD—copper99%Replace 10–12 years
Mirena hormonal IUD99%Replace 5–7 years
Liletta hormonal IUD99%Replace 5–7 years
Kyleena hormonal IUD99%Replace 5 years
Skyla hormonal IUD99%Replace 3 years
Contraceptive arm implant99%Replace 3 years
Progestin injection94%Injection every 3 months
Oral contraceptives91%–99% depending on consistency of dosingTaken every day for 3 weeks, then placebo for 1 week
Hormone patch91%Replace weekly every 3 weeks, then 1week off
Vaginal ring91%Remove ring in 3 weeks and replace it 1 week later
Diaphragm with spermicide71%–98%Insert before intercourse
Vaginal sponge76%–91%Insert in vagina up to 24 hours before intercourse
Cervical cap with spermicide71%–98%Insert before intercourse
External condom82%–98%Put on before intercourse
Internal Condom79%–95%Insert before intercourse
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How to Get Birth Control

Some birth control options are available over-the-counter, including internal and external condoms, the vaginal sponge, spermicide, and the morning after pills Plan B and Ella.

You’ll need a prescription for birth control pills, the patch, and the vaginal ring.

For a diaphragm, you’ll need to be fitted by your physician or healthcare provider.

Your medical provider must implant progestin rods and IUDs.

A physician or a nurse can give hormone shots, or you can ask to be taught how to administer the injections at home.

Sterilization for those with testicles is done in the physician’s office under local or general anesthesia.

Sterilization for those with a uterus is a surgical procedure that is done in a surgery center or a hospital.

How K Health Can Help

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Terez Malka, MD

Dr. Terez Malka is a board-certified pediatrician and emergency medicine physician.