The Ultimate Birth Control Comparison Guide

Updated October 14, 2021.

Choosing a birth control method is an important — and very personal — decision. Having thorough, accurate information at your fingertips is essential. Here you’ll find a detailed comparison of the most popular types of contraception available. Schedule an appointment with your provider to discuss your unique health history and fertility goals and to learn more about which option might be right for you.

Brand Name(s): Paragard®

Effectiveness: Highest. Perfect use and typical use are almost identical. Fewer than 1 in 100 non-hormonal IUD users will become pregnant.

What is it?

The Copper IUD is a small T-shaped device made of flexible plastic that is inserted into the uterus by a health care provider. It sits inside the uterus for the duration of use and is effective for up to 12 years.

How does it work?

The non-hormonal IUD works by preventing fertilization. The presence of the device alters the environment of the uterus so that sperm are no longer able to swim. The copper in the device has additional spermicidal effects.

Pros

• Longest-lasting reversible birth control method available
• No maintenance and highly effective
• Once removed, you can become pregnant right away
• Does not have hormones
• Safe to use while breastfeeding
• Cost-effective – without insurance, it costs $500-$1000 upfront, but distributed over 10 years it’s generally less expensive than other methods

Cons

• Menstrual periods may be heavier and last longer, and cramps may be stronger
• You may have spotting between periods
• Insertion and removal requires an office visit
• Insertion is quick – 5 to 10 minute – but it’s common to experience strong cramping during the insertion, similar to strong menstrual cramps. Everyone experiences IUD insertion differently, with varying levels of discomfort.
• Can be expelled or dislodged, which does not usually pose a health risk but can lead to pregnancy
• Very slight risk of injury to the uterus during insertion
• Does not protect against HIV or other STIs

Brand Name(s): Mirena®, Skyla®, Liletta®, Kyleena®

Effectiveness: Highest. Perfect use and typical use are almost identical. Fewer than 1 in 100 progestin IUD users will become pregnant.

What is it?

The Progestin IUD is a small T-shaped device made of flexible plastic that is inserted into the uterus by a health care provider. The device sits inside the uterus for the duration of use. Some types are effective for 5 to 7 years, and others are effective for up to 3 years.

How does it work?

The progestin IUD works by preventing fertilization of the egg. The presence of the device alters the environment of the uterus so that sperm are no longer able to swim. The device also releases a low dose of progestin, which thickens cervical mucus, creating a barrier to sperm entering the uterus. Progestin may also suppress ovulation in some users.

Pros

• Long-lasting, continuous method
• No maintenance and highly effective
• Periods may be lighter or stop altogether, cramping may lessen
• Once removed, you can become pregnant right away
• Does not contain estrogen–helpful if you must avoid estrogen
• Safe to use while breastfeeding
• Cost-effective and typically covered by insurance – without insurance, it costs $500-$1000 upfront, but distributed over 10 years it’s generally less expensive than other methods

Cons

• Spotting between periods or irregular bleeding may occur, especially during the first three to six months
• Insertion and removal requires an office visit
• Insertion is quick – 5 to 10 minutes – but it’s common to experience strong cramping during the insertion, similar to strong menstrual cramps. Everyone experiences IUD insertion differently, with varying levels of discomfort.
• Can be expelled or dislodged, which does not usually pose a health risk but can lead to pregnancy
• Very slight risk of injury to the uterus during insertion
• Does not protect against HIV or other STIs

Brand Name(s): Nexplanon®

Effectiveness: Highest. Perfect use and typical use are almost identical. Fewer than 1 in 100 implant users will become pregnant.

What is it?

The progestin implant is a flexible plastic rod, about the size of a matchstick, that is inserted into the skin of your upper arm by a health care provider. It is invisible once implanted and is effective for up to 4 years.

How does it work?

The implant releases a low dose of progestin, which prevents ovulation and thickens cervical mucus, creating a barrier to sperm entry.

Pros

• Long-lasting, continuous method
• No maintenance and highly effective
• Insertion is quick–a few minutes–and is painless due to use of local anesthetic
• Periods may become lighter or stop entirely
• When the implant is removed, you can become pregnant right away
• Safe to use while breastfeeding
• Does not contain estrogen–helpful for women who must avoid estrogen
• Cost-effective: without insurance, it costs $400-$800 upfront, but distributed over 3 years it’s generally less expensive than other methods

Cons

• Irregular bleeding is common
• Insertion and removal require an office visit
• Small risk of scarring during removal
• Does not protect against HIV or other STIs

Brand Name(s): Essure®

Effectiveness: Highest. Perfect use and typical use are almost identical. Fewer than 1 in 100 individuals choosing tubal sterilization will become pregnant.

What is it?

Tubal sterilization is for people with a uterus. It is a permanent form of birth control and is only for people who are certain they never want to become pregnant in the future.

Sterilization can take the form of tubal ligation (“getting your tubes tied”) in which the fallopian tubes are cut or tied and then sealed using clamps, clips, rings, or via electrical current. Essure® is the brand name of a method in which tiny inserts are placed within the fallopian tubes, causing tissue to surround the inserts and block the tubes.

How does it work?

Sterilization involves blocking the fallopian tubes so that sperm cannot reach the egg.

Providers recommend considering all other birth control options first and thinking carefully about whether a life change (such as a new partner) might change your mind about a future pregnancy.

Pros

• Long-lasting, continuous method
• No maintenance and highly effective
• Non-hormonal
• Tubal ligation is effective right away
• Can be done at the time of delivery or c-section

Cons

• Not reversible
• Essure™ takes about three months to become effective
• Requires an outpatient surgery
• Failure of the procedure — the fallopian tubes reconnect and allow sperm to reach the egg– is highly unlikely. However, in the case that it occurs, ectopic pregnancy is possible and can be life-threatening
• Additional risks depending on the type of sterilization
• Some states have age restrictions or waiting periods
• Without insurance, can be costly (between $1,500 and $6,000)
• Does not protect against HIV and other STIs

Effectiveness: Highest. Perfect use and typical use are almost identical. Fewer than 1 in 100 individuals will become pregnant with partners who have undergone a vasectomy.

What is it?

A vasectomy is a procedure to block the vas deferens, the tubes that carry sperm to the urethra in people with a penis.

How does it work?

With these tubes blocked, sperm cannot be released during ejaculation and pregnancy cannot occur. Semen is still released during orgasm, but it does not contain sperm.

Pros

• No maintenance and highly effective
• Simpler, more effective procedure than sterilization for people with a uterus
• Without insurance, costs must less than sterilization for people with a uterus ($300-$1500 upfront) and is cost-effective in the long-run

Cons

• Although it can be reversed, the reversal procedure is difficult and not always effective
• Takes up to three months to become effective since sperm that were in the vas deferens prior to the procedure must be ejaculated
• Requires an office visit for the procedure and follow-up care
• In very rare cases, the tubes can grow back together and sperm are released, allowing the possibility for pregnancy to occur
• Rare complications, such as infection, associated with the procedure
• Does not protect against HIV and other STIs

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Brand Name(s): Trojan™, Durex®, LifeStyles®, FC2 Female Condom, and more.

Effectiveness: Moderate. With perfect use, 2 out of 100 people using male condoms (and 5 out of 100 female condom users) will become pregnant. With typical use, 18 in 100 people using male condoms (and 21 of 100 female condom users) will become pregnant.

What is it?

Male condoms are worn on the penis during intercourse. Most condoms are latex, but polyurethane condoms are available for people with latex allergies.

Female condoms are a tube-shaped barrier method worn by the receptive partner during vaginal or anal intercourse. As opposed to male condoms, they are usually made of polyurethane or nitrile, so they are good for people with latex allergies. The closed end of the female condom rests inside the vagina or anus while the open end sits on the outside of the body. Flexible rings on either end of the female condom help guide insertion. Note: only one condom (male or female) should be used during a sexual act.

Latex condoms (most male condoms) should only be used with water-based lubricant such as K-Y® Jelly. Oil-based lubricant, such as Vaseline, will break down the latex and make the condom less effective. Since female condoms are made with polyurethane, they can be used with both water- and oil-based lubricants.

How does it work?

Condoms act as barriers, collecting semen during ejaculation and preventing sperm from entering the uterus. Condoms also protect against many sexually transmitted infections. Effectiveness is increased if condoms are used with spermicide or in conjunction with withdrawal.

Pros

• No office visit or prescription required
• Protects against HIV and many other STIs
• No side effects
• Non-hormonal
• May help alleviate premature ejaculation
• Can be used with other birth control methods to increase effectiveness
• Can be used while breastfeeding

Cons

• May break or slip off, requiring the need for emergency contraception
• Reduces spontaneity (although female condoms can be inserted prior to sex play)
• May reduce sensation for both partners
• Female condoms may make intercourse noisy

Brand Name(s): Caya®

Effectiveness: Moderate. With perfect use, 6 out of 100 diaphragm users will become pregnant. With typical use, 12 in 100 diaphragm users will become pregnant.

What is it?

The diaphragm is a dome-shaped silicone cup with a flexible rim. Before intercourse, you fill the diaphragm with spermicide and then place it inside the vagina, covering the cervix. It must remain within the vagina for six hours after intercourse and can be kept inside for up to 24 hours.

The most common type today, Caya, is one-size-fits-most. It requires a prescription, but unlike older versions of diaphragms, it does not need to be fitted by a healthcare provider. However, it may be helpful if your provider shows you how to place it correctly.

How does it work?

The diaphragm covers the cervix, preventing sperm from entering the uterus. The spermicide used in conjunction with the diaphragm immobilizes sperm.

Pros

• Is generally not felt by the user or their partner
• Can be inserted hours before intercourse
• Does not contain hormones
• Can be used with other birth control methods, including condoms, to increase effectiveness
• Can be used while breastfeeding
• Relatively cheap to purchase and can last up to two years when properly cared for

Con

• Can increase the frequency of urinary tract infections
• May be pushed out of place during intercourse, causing a risk of pregnancy
• Silicone and/or spermicide can cause vaginal irritation
• The spermicide used most often with diaphragms, nonoyxnol-9, has been associated with a greater risk of HIV transmission when used frequently by people who are at high risk of HIV transmission
• Does not protect against HIV or other STIs

Brand Name(s): The Today Sponge®

Effectiveness: Moderate. The sponge is more effective if you have never given birth. Among women who have never given birth, 9 in 100 will become pregnant with perfect use and 12 in 100 will become pregnant with typical use. Among women who have given birth, 20 in 100 women will become pregnant with perfect use vs. 24 in 100 women with typical use.

What is it?

The sponge is about two inches in diameter and is made of soft foam that contains spermicide. You moisten it with water and then insert it into the vagina, covering the cervix. It must remain within the vagina for 6 hours after intercourse and can be kept inside for up to 30 hours. A nylon band on one end makes for easy removal. Unlike the diaphragm and cervical cap, which are reusable, the sponge is discarded after a single use.

How does it work?

Like other barrier methods, the sponge blocks sperm from entering the uterus. The spermicide in the sponge immobilizes sperm.

Pros

• Can be purchased over-the-counter and doesn’t need to be fitted by a health care provider
• Can be inserted into the vagina up to 24 hours before intercourse
• Generally not felt by users or their partners
• Does not contain hormones
• Can be used with other birth control methods, including condoms, to increase effectiveness
• Can be used while breastfeeding

Cons

• Some users report that the water and spermicide can make sex messy
• May cause vaginal dryness- using lubricant can help
• May require practice to insert
• Is less effective after childbirth
• May cause vaginal irritation
• The spermicide used most often with the cervical cap, nonoyxnol-9, has been associated with a greater risk of HIV transmission when used frequently
• More expensive than other disposable methods: $9-$12 for a package of 3
• Does not protect against HIV or other STIs

Brand Name(s): NuvaRing®

Effectiveness: High. With perfect use, fewer than 1 in 100 ring users will become pregnant. With typical use, 9 in 100 ring users will become pregnant.

What is it?

The ring is a flexible plastic ring which you insert into the vagina and leave in place for three continuous weeks. The ring can be kept in place during sex. You remove the ring during the fourth week, during which time you usually get your period. At the start of the new month, you insert a new ring into the vagina, and the cycle begins again.

How does it work?

The ring contains the hormones progestin and estrogen, the same hormones that are in combination birth control pills and the patch. These hormones prevent pregnancy by preventing ovulation and thickening cervical mucus, creating a barrier to sperm entering the uterus.

Pros

• Periods may become lighter and cramping may be reduced
• Lower maintenance- no daily pill
• You can choose when you have a period – or you can simply replace the ring every three weeks to avoid having a period entirely
• Some users report fewer side effects (spotting, breast tenderness, and nausea) than with the Pill
• May improve hormonal acne
• Fertility returns soon after discontinuing use

Cons

• Requires insertion every three weeks
• May increase vaginal discharge or cause vaginal irritation
• Side effects include: spotting between periods, breast tenderness, and nausea
• Estrogen is contraindicated if you are at risk for cardiovascular disease or blood clots, if you have hypertension or certain types of migraines, and if you smoke.
• Not recommended during the first four weeks after labor and delivery
• Does not protect against HIV or other STIs

Brand Name(s): Xulane®

Effectiveness: High. With perfect use, fewer than 1 in 100 patch users will become pregnant. With typical use, 9 in 100 patch users will become pregnant.

What is it?

The patch is a thin plastic patch that you place on the skin of the upper arm, upper torso, buttocks, or back. You leave the patch in place for one week, then replace it with a new patch. After three consecutive weeks, you have one week with no patch, during which time you’ll usually get your period. At the end of the patchless week, you place a new patch on your skin, and the cycle begins again.

How does it work?

The patch contains the hormones progestin and estrogen, the same hormones that are in combination birth control pills and the vaginal ring. The main way these hormones prevent pregnancy is by preventing ovulation. Other effects include thinning the lining of the uterus, which could prevent implantation, as well as thickening the cervical mucus, which creates a barrier to sperm entering the uterus.

Pros

• Periods may become lighter and cramping may lessen
• Lower maintenance- requires a weekly application of the patch but no daily pill
• May improve hormonal acne
• May reduce the risk of ovarian cancer and endometrial cancer
• Fertility returns soon after discontinuing use

Cons

• May cause irritation at the site where you place the patch
• Side effects include: spotting between periods, breast tenderness, and nausea
• Estrogen is contraindicated if you are at risk for cardiovascular disease or blood clots, if you have hypertension or certain types of migraines, and if you smoke.
• Not recommended in the first month following childbirth
• Does not protect against HIV or other STIs

Brand Name(s): Depo-Provera®

Effectiveness: High. With perfect use, fewer than 1 in 100 progestin shot users will become pregnant. With typical use, 6 in 100 users of the shot will become pregnant.

What is it?

A health care provider injects the hormone progestin into the upper arm. The injection is effective at preventing pregnancy for three months at a time.

How does it work?

The shot releases a low dose of progestin, which prevents ovulation and thickens cervical mucus, creating a barrier to sperm entering the uterus.

Pros

• Only requires action every three months
• Periods may eventually stop
• Does not contain estrogen–helpful for those who must avoid estrogen
• May help prevent endometrial cancer

Cons

• Requires returning to a health care provider every three months
• Side effects include: irregular bleeding (common, especially in the first 6 to 12 months), weight gain, depression, body hair changes, and changes in sex drive
• Side effects may last for three to six months after discontinuing use
• May take 6 to 10 months to become pregnant after discontinuing use
• May cause temporary thinning of bones. This stops as soon as the shot is discontinue
• Can be expensive without insurance coverage ($35-$250 per visit)
• Does not protect against HIV or other sexually transmitted infections (STIs)

Brand Name(s): Yaz®, Seasonique®, Ortho Tri-Cyclen®, Lybrel®, and many more.

Effectiveness: High. With perfect use, fewer than 1 in 100 pill users will become pregnant. With typical use, 9 in 100 pill users will become pregnant.

What is it?

The birth control pill is a daily pill to prevent pregnancy. Most pills are taken daily for three weeks in a row, then discontinued for one week, during which time you usually get your period. The pill is also safe to use continuously, leading to no period. Birth control pills are most effective when taken at the same time every day.

How does it work?

Combination birth control pills contain the hormones progestin and estrogen, the same hormones that are in the patch and the vaginal ring. These hormones prevent pregnancy by preventing ovulation and thickening cervical mucus, creating a barrier to sperm entering the uterus.

There are many different pills on the market with varying amounts or types of progestin and estrogen. If the Pill you are using is not a good fit, it may be worth discussing with your provider other types of the Pill or the patch or ring, described in this post, which use the same hormone combination but have a different delivery method.

Pros

• Periods may become lighter and cramping may be reduced
• May improve hormonal acne
• Can be used to control when you have a period–the Pill can be taken continuously to avoid having a period and some types are designed to only cause a period a few times a year
• Fertility returns soon after discontinuing use
• Lowers chances of pelvic inflammatory disease

Cons

• Must be taken every day and is most effective when taken at the same day each day
• Side effects include: spotting between periods, breast tenderness, and nausea. Different brands may cause different side effects.
• Estrogen is contraindicated if you are at risk for cardiovascular disease or blood clots, if you have hypertension or certain types of migraines, and if you smoke.
• Not recommended in the first month following childbirth
• Does not protect against HIV or other STIs

Brand Name(s): Camila®, Jolivette®, Ovrette®, and more.

Effectiveness: 92-99% when used correctly

What is it?

The progestin-only pill is an oral contraceptive that only contains progestin. Like combination pills, the progestin-only pill is taken daily, but unlike the combination pill, it must be taken at the same time each day. In addition, the progestin-only pill is taken continuously with no week break at the end of the month. Some people get a period every month, others experience spotting, and still others others experience no period.

How does it work?

Progestin releases a low dose of progestin, which prevents ovulation and thickens cervical mucus, creating a barrier to sperm entering the uterus.

Pros

• Does not contain estrogen–helpful for people who must avoid estrogen
• Periods may become lighter and cramping may be reduced
• Can be used at all stages postpartum and while breastfeeding
• Lowers chances of pelvic inflammatory disease

Cons

• Must be taken at the same time every day. If you take a progestin-only pill more than three hours past your scheduled time, you can become pregnant and must use a backup method for 48 hours
• Side effects include: Spotting (common side effect), depression, body hair changes, and changes in your sex drive

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Effectiveness: 86-93% when used correctly

What is it?

Phexxi is a non-hormonal birth control option with 3 active ingredients: lactic acid, citric acid, and potassium bitartrate. 

How does it work?

Phexxi prevents pregnancy by making the environment of the vagina more acidic, making it harder for sperm to move and reach the egg. It is inserted in the vagina (like a tampon) before sex and lasts for 1 hour before wearing off.

Pros

• It is non-hormonal. Good option in which hormonal birth control is medically contraindicated
• No need to take it daily. You just use it as needed before sex.
• Unlike spermicide, it does not increase your risk for STIs

Cons

• Timing is key! In order for Phexxi to work, you have to use it correctly every time. 
• Side effects can include burning, itching, irritation or discomfort in your vagina and potentially your partner as well.
• It can increase your risk for yeast infections, bacterial vaginosis, and urinary tract infections, so it is not a good fit for individuals who have recurrent UTIs, urinary tract problems, or yeast/BV infections.