Birth Control Comparison Chart

The term “birth control,” also known as “contraception” refers to a variety of methods that partners engaging in sexual activity use to prevent pregnancy. The most common Types of birth control are hormonal methods, barrier methods, surgical procedures, withdrawal, and abstinence.1 These methods allow partners to engage in sex without having to worry about the risk of an unwanted pregnancy. Specific types of birth control can be grouped together based on the way the birth control is taken, the hormones it uses, and its relative effectiveness. There are distinct advantages and disadvantages to consider when deciding which type of contraception to use. This article serves as a guide to distinguish which type of contraception is best for you.

 

Effectiveness

The effectiveness of birth control is measured by two separate criteria: perfect-use and typical-use.2 The perfect-use success rate is the percentage of success for a method of birth control when it is used every time partners engage in sexual activity and is used exactly as the manufacturer has intended. For example, when male condoms are used properly every single time the male has sexual intercourse, the perfect-use is 98%. This means that if 100 men have sex and wear the condoms properly every time, only 2 of those condoms will malfunction.3 The typical-use is a more accurate percentage to use when judging a birth control method. This percentage is found by observing the number of unintended pregnancies among people who actively use birth control. When we look at the typical-use rate for male condoms, the percent jumps up to 82% effectiveness.3 The main reason for this drastic change in the failure rate is due to incorrect uses.

Since the typical-use failure rate is taken from a large sample of individuals and includes everyday error, it is more accurate to judge birth control by this standard. The typical-use failure rate is highly fluid and is different for each person based on that person’s habits. For example, if the average perfect-use rate for male condoms is 98% and the average typical-use rate is 82%, one male might be more careful than most people and have an individual failure rate of 5%, while a male who rarely wears condoms (or uses them improperly) may have a 50% failure rate. Some birth control methods do not have typical use failure rates, such as the implant. This is because these types of contraception are not subject to user error, which makes them more reliable forms of birth control.

Common Concerns

When looking for the appropriate birth control, you should consider the following questions:

  • How effective is this birth control method?
  • How often do I have to take this birth control?
  • How does this birth control enter my body?
  • How will this birth control affect my menstrual cycle?
  • Is this birth control hormonal?
  • Do I want kids in the future? If so, how soon will I want them?

These criteria are commonly used when deciding which birth control method is best for a particular person. It is common for hormonal methods of contraception to have higher rates of effectiveness.1 As mentioned, typical-use failure rate is commonly used as a standard since it accounts for everyday error. Commitment to using the contraception can also be a concern for some. For example, some people cannot commit to taking the birth control pill every day at the same time and would rather choose an implant that can be inserted and forgotten about for a few years. Hormonal methods of birth control can also affect a female’s menstrual cycle. Usually, birth control will make periods lighter or decrease cramps, but this is not always the case, as some women’s bodies negatively react to the hormone estrogen and are limited to only barrier methods or progestin-only methods. Finally, it takes time for a female’s fertility to return after the use of certain birth control methods. Commonly, barrier methods do not affect fertility and are immediately reversible, which is why some women opt for that choice. Regardless of the type of birth control a female chooses to use, it is important to be aware of these common concerns and how contraception can affect the body and fertility.

 

Abstinence

Common Concerns:

 

Abstinence

How often is it taken

Abstinence is the choice made every day to abstain from sexual intercourse.

 

Hormones

None

Perfect Use

100%

Advantages

No cost.

Abstaining from oral, anal, and vaginal intercourse is the most effective method of STI prevention. To prevent STI transmission, latex condoms and dental dams should be used every time the user decides to engage in oral, anal and vaginal sex, even if penetration does not occur.

Can still get sexual pleasure through masturbation.

Can focus on alternate activities with your partner.

Disadvantages

Requires discipline and self-control. 

Pregnancy can occur from non-coital activities, like dry humping while unclothed. Any activity that allows semen to come into contact with the vaginal opening carries a risk of pregnancy.

Negative Side Effects/Risks

May be unprepared for protection against pregnancy or infection if user decides to forego abstinence.

 

 

Hormonal Intrauterine System (IUS), Implant, and Contraceptive Shot

The hormonal intrauterine device (IUS), implant, and contraceptive shot (or “injection”) are all non-oral, hormonal birth control methods. These methods are often chosen because they can be left in the female for an extended period of time and do not interrupt sexual spontaneity. These three types of birth control only use progestin, which allows women with negative reactions to estrogen to avoid those bad reactions.

 

Common Concerns:

 

IUS

Implant

Contraceptive Shot

How often is it taken

Lasts between three to seven years:

Mirena lasts up to seven years.4

Liletta lasts up to seven years.4

Kyleena lasts up to five years.4

Skyla lasts up to three years.4

Lasts up to three years.7

Lasts between eight and thirteen weeks:

Depo-Provera lasts thirteen weeks.8

Sayana Press lasts thirteen weeks.8

Noristerat lasts eight weeks.8

Where it is taken

Inserted into the uterus by a specialized doctor.

Nexplanon is a small flexible rod placed under the skin of the upper arm.

Depo-Provera: buttocks/upper arm.8

Sayana Press: abdomen/upper thigh.8

Noristerat: buttocks/upper arm.8

Effects on menstrual cycle

Can make periods lighter and shorter.5

Can lead to complete cessation of periods.

Can either make periods lighter and shorter or longer and heavier.7

Irregular bleeding.

Can lead to complete cessation of periods.

Hormones

Progestin

Progestin

Progestin

Irreversibility

Pregnancy is possible immediately after removal.5

Pregnancy is possible immediately after removal.7

One year for effects to reverse.8

Typical Use

99.75%6

99.99%6

96%6

Perfect Use

99.97%

99.97%

99.97%

Advantages

 

 

Can be removed at any point.

Remains in place; allows for sexual spontaneity.5

Only requires monthly thread checks.

Can be used while breastfeeding.5

Can help lessen the symptoms of endometriosis and PCOS.4

Remains in place; allows for sexual spontaneity.7

Can be used while breastfeeding.7

Inserted and removed by a healthcare professional which leaves little room for error.

Injections are administered by medical professionals so there is little room for error.

It is not effected by other medications.8

If it is used within first 5 days of menstrual cycle, then there is immediate protection.8

 

 

 

 

 

Disadvantages

Uncomfortable feeling for a couple days after insertion.4

Some side effects can last 3-6 months after insertion.4

Some report irregular periods, backaches, or cramping.4

Can have high upfront costs of around $1,300, but some or all of the cost can be covered.4

Minimal bruising and tenderness after insertion.7

Some medications make the device less effective (those for HIV, epilepsy, tuberculosis, and certain antibiotics).7

Sometimes the bump can be seen or felt.

Must get injection before prior injection expires.8

Must have repeated visits to the doctor.8

Negative Side Effects/Risks

Small risk of infection within 20 days of insertion.5

Small chance that you will experience “rejection,” which is when the IUS is expelled, or displacement from the uterus.5

Small chance of the IUS causing a hole in the wall of the uterus.5

If the IUS fails and pregnancy occurs, ectopic pregnancy could occur.5

A common side effect is amenorrhea (the cessation of menstruation in which your periods stop until the device is removed).

May cause temporary bone thinning. Bone density should increase once the female stops Depo-Provera, but it is important to make sure to get adequate calcium from diet or supplements. Due to this loss of bone density, the FDA encourages users to take the shot for no more than two years.8

Small risk of infection or allergic reaction at the site of insertion.8

 

Sterilization: Vasectomy and Tubal Ligation

Common Concerns:

 

Vasectomy

Tubal Ligation

How often

One surgical procedure needed.

Considered a permanent procedure.

One surgical procedure needed.

Considered a permanent procedure.

Where it is taken

Tubes that carry sperm to male’s penis (vas deferens) are cut and blocked.9

The fallopian tubes are blocked to prevent eggs from reaching sperm.10

Irreversibility

A reverse procedure known as a “vasovasostomy” is possible, with a success rate of 55% if done within ten years of the vasectomy.9

A reversal procedure is possible for some and depend on BMI and age. An original ligation using clips and rings is more easily reversed.11

Doctor visits involved

Must visit doctor for operation.

Must take two semen tests around 12 weeks after the operation to test for sperm in semen. Once no sperm is detected, the man is officially sterilized.9

Must visit doctor for operation.

Must take a test to ensure tubal ligation was successful. Some methods work immediately.12

Effectiveness

Over 99% effective.9

Over 99% effective.10

Advantages

Does not effect sex drive or ability to gain an erection.9

The male partner can choose this procedure rather than the female partner, because it is often a safer and more reliable procedure than tubual ligation.9

Ease of surgery. The surgery is performed under general anesthesia and only takes about 30 minutes and the patient can usually return home within the next hour.

Does not affect sex drive or hormone levels.10

Ease of surgery. The surgery is performed under general anesthesia and only takes about 30 minutes, and the patient can usually return home within a few hours. Can be performed on patients within 24 hours after childbirth or on outpatients.

Disadvantages

Must use contraception for 8-12 weeks after the operation since there is still some sperm in vas deferens.9

Scrotum can be bruised or swollen after the operation.9

Need to use contraception for up to three months after operation.10

Seen as a more difficult procedure with more risks when compared to a vasectomy.12

Includes a longer recovery time of five days (as compared to male’s 1-2 days recovery).10

Negative Side Effects/Risks

Small risk of infection.9

If operation fails, ectopic pregnancy can occur.10

Risk of infection at site of incision.10

 

Combination and Progestin-Only Pills
 

Common Concerns:

 

Combination Pills

Progestogen Only Pills (POP)

How often

Usually taken for 21 days with seven days off.

Taken at the same time each day.

Usually taken for 21 days with seven days off.

Taken at the same time each day.

One kind must be taken within a three hour timeframe each day; other kind must be taken within a 12 hour timeframe each day.15

Where it is taken

Orally ingested

Orally ingested

Effects on menstrual cycle

Generally regulates menstrual cycle and makes the periods lighter and shorter.13

Can reduce PMS pain.

Periods may become lighter or shorter or become irregular.15

Hormones

Estrogen and progestin

Progestin

Irreversibility

Should be immediately reversible, but the menstrual cycle could take a couple months to regulate.14

Should be immediately reversible, but the menstrual cycle could take a couple months to regulate.14

Typical Use

 91%

92%15

Perfect Use

> 99%

>99%15

Advantages

Can help alleviate heavy periods or endometriosis.13

Has no effect on vaginal or penile sensation.

Can take this pill if over the age of 35 and smokes.15

Does not contain estrogen, which can produce negative side effects.15

Allows for flexibility by allowing someone a 12 hour timeframe to take the pill.

Is effective 48 hours after starting the pill, which is much faster than the seven days it takes for the combo pill.14

Disadvantages

Must take the pill at the same time every day.

Could get pregnant if pill isn’t taken at the same time each day, or a pill is missed.13

Some medications decrease effectiveness.

After stopping the pill, a female may have irregular or absent periods for the first 2 months.14

 

Must take the pill at the same time every day.

Some medications decrease the pill’s effectiveness.

 

Negative Side Effects/Risks

Not suitable for those over 35 years old who smoke.13

Risks if the user has blood clots or breast cancer.13

May cause adverse side effects, including nausea and vomiting, breast tenderness, irregular bleeding, abdominal pain, back pain, decreased vaginal lubrication, and an increase in appetite that may lead to weight gain. Most side effects will disappear within 3 months.13

 

Side effects are rare (due to a lack of the hormone estrogen), but can include tender breasts, acne, mood changes, an increased or decreased sex drive, headaches, or nausea. These should clear up in a couple months.15

Small risk of developing breast cancer or ovarian cysts, though the cysts usually disappear on their own.15

 

The Patch and the Vaginal Ring
 

Common Concerns:

 

The Patch

The Vaginal Ring

How often

Worn for a total of three weeks, changing to a new patch every week. Then, no patch is worn for the final week of the month.

 

The ring is left in the vagina for 21 days, and left out for one week.18

A person can skip their period because a ring contains five weeks of hormones.19

Where it is taken

A small patch can be stuck to almost anywhere on the body except the breasts and skin that is covered in hair or rubbed with tight clothes.16

A small flexible ring placed inside the vagina.

Effects on menstrual cycle

Can alleviate heavy or painful menstrual cycles.16

Can alleviate heavy or painful menstrual cycles.18

Hormones

Estrogen and progestin

Estrogen and progestin

Irreversibility

It is possible to get pregnant immediately after discontinuation. Menstrual cycles return about one to two months after discontinuation.17

It is possible to get pregnant immediately after discontinuation. Menstrual cycles return about one to two months after discontinuation.19

Doctor visits involved

Prescribed by a doctor.

Prescribed by a doctor.

Typical Use

 91%17

91%19

Perfect Use

> 99%

>99%

Advantages

Can be effective even while vomiting or having diarrhea.16

Can be worn while swimming or being active.16

May protect against ovarian, womb, or bowel cancers.16

External visibility can serve as a visual reminder for females to apply a new patch.

 

Can continue to have sex while the ring is in place.18

Can be effective even while vomiting or having diarrhea.18

Can be left in place for around three to five weeks. If left for five weeks it can cause users to skip a period.19

Hormones are absorbed directly from the vagina, so the ring releases a lower dosage of estrogen into the bloodstream compared to the combination pill or the patch. This can put females on the ring at a lower risk of blood clots, vaginal spotting and cancer.

Can reduce the risk or prevalence of iron-deficiency anemia, endometriosis, ovarian cysts, acne and hirsutism (excessive facial and body hair).18

Disadvantages

Less effective if used by a person over the age of 35, who smokes, or is over 200 pounds.16

The patch can fall off.

Must be replaced weekly.

Less effective if used by a person over the age of 35 who smokes.19

The ring may slip out, but if it does, it should be rinsed in lukewarm or cool water and placed back into the vagina within three hours.19

Negative Side Effects/Risks

The patch can increase blood pressure and cause headaches or blood clots (rare).16

Some bleeding during the first six months is common.17

Some bleeding during patch-free week may occur, and is not cause for concern. Some women do not experience this, but if two “bleeds” are missed, it is recommended to visit a doctor.16

Small chance of developing blood clots.

Temporary side effects include tender breasts, headaches, and increased vaginal discharge.18

Rare chance of developing blood clots.18

Bleeding or spotting is normal and usually goes away after a couple months.19

Estrogen can lower breastmilk’s quality within first three weeks of breastfeeding.19

 

Emergency Contraception

Common Concerns:

 

Plan B One-Step

Ella

Copper IUD

Where it is taken

Orally ingested.

Orally ingested.

Placed inside the vagina.

Can be left in place for 12 years.21

Effects on menstrual cycle

Can cause the next period to be irregular.20

Can cause the next period to be irregular.20

Can cause periods to become heavier and longer.21

Hormones

Includes progestin

Anti-progestin (acts by blocking receptors for progestin hormone).

None, simply releases copper.20

Doctor visits involved

No prescription needed.21

Requires prescription.

Need a doctor to insert the device into the vagina during a procedure.

Perfect Use

Can lower chances of pregnancy by 75-89% if taken within three days of unprotected intercourse.21

Lowers chances of pregnancy by 85% if taken within five days of unprotected sex.21

99.99% effective if put in within five days of unprotected intercourse.21

Typical Use

Can work for up to five days, but effectiveness decreases after day three.21

Equally effective for all five days.20

99.2%6

Advantages

No prescription needed.

Equally effective for all five days taken after unprotected intercourse.20

More effective emergency contraceptive pills for those with increased body mass index (BMI).21

Can be left in as a regular birth control method.20

Most effective method of emergency contrapcetion.21

Unaffected by person’s body mass index (BMI).21

Disadvantages

If you vomit within two hours of taking it, it is ineffective.20

Cannot be used as a continued regular birth control method.20

If you vomit within three hours of taking it, it is ineffective.20

Cannot be used as a continued regular birth control method.20

Not an ideal method to use if currently on a hormonal contracepive because it makes both less effective.21

Decreased effectiveness if using certain medications such as those for HIV treatment, epilepsy, or tuberculosis.20

If used as a regular birth control method can make periods heavier and longer.20

 

Can be relatively expensive, but can be more cost-effective in the long-run.21

Negative Side Effects/Risks

Can produce a headache or stomach ache.20

Side effects are less common though menstrual cycle may be irregular for the following month.21

Can experience spotting between periods.21

Can experience moderate pain where IUD was inserted.21

Side effects usually go away within three to six months of beginning the contraception.21

 

 

The Sponge and Diaphragm/Cap

Common Concerns:

 

Sponge

Diaphragm/Cap

How often

Placed before sex up to 24 hours prior to every intercourse.22

Must be left in for at least six hours after intercourse to allow spermicide to properly eliminate remaining sperm. The maximum period the sponge can be left in is of 30 hours.22

Placed up to six hours prior to intercourse, but must remain in place for at least six hours after to allow spermicide to properly eliminate remaining sperm. The maximum period the sponge can be left in is of 30 hours.23

Where it is taken

Small round sponge placed on the cervix.22

Plastic dome inserted in vagina.

Effects on menstrual cycle

None because it is not hormonal.

None because it is not hormonal.

Hormones

None. Uses spermicide to further block sperm.22

None. Uses spermicide to further block sperm.23

Irreversibility

Easily reversible.22

Easily reversible.23

Doctor visits involved

None needed. Available over the counter.

Visit required to get fitted. Can use same cap for around a year.23

Typical Use

80%22

83%6

Perfect Use

91%22

94%23

Advantages

Low cost of around $15 for a pack of three sponges.22

Can be placed hours prior to intercourse, so it does not effect sexual spontaneity.

Acts as a barrier method, lacking any hormonal side effects.

Reusable and relatively inexpensive.

More effective than the sponge.

Disadvantages

Not suitable for those with a history of Toxic Shock Syndrome (TSS) or allergies to spermicide.22

Should not be used if user recently had an abortion, miscarriage, or birth.22

Less effective for those who have given birth.22

Must replace each time you have intercourse.

Difficult to learn how to correctly insert.

Requires spermicide which can cause irritation.

Requires initial professional fitting.

May be difficult to insert or remove. Requires insertion prior to every act of intercourse (compared to the hormone-releasing vaginal ring, which can remain in place for up to three weeks).

Spermicide must be reapplied before each sex act or if two hours have passed since insertion.

The spermicide may cause irritation, which could increase the risk of STI transmission.

Negative Side Effects/Risks

Spermicide can irritate the vagina which increases the risk of contracting an STI.22

Some users develop cystitis and must be fitted again with a new cap.23

 

Condoms

Common Concerns:

 

Male Condoms

Female Condoms

How often

Worn every time you have sex.

Worn every time you have sex.

Where it is taken

A “sheath” placed over the penis.

A “bag” that fits inside the vaginal cavity.

Hormones

None

None

Typical Use

82%

79%

Perfect Use

98%

95%

Advantages

Provides STI protection.

Allows males to share responsibility in pregnancy prevention and STI protection.

Male condoms are widely available at local drugstores and family planning clinics. They are inexpensive and can be purchased without a prescription.

Polyurethane, polyisoprene, and lambskin condoms can be used if one is allergic to latex. Lambskin condoms are porous and therefore do not protect against STIs.

Immediately effective upon placement and immediately reversible upon removal.

Can be used in combination with any method, except the female condom. (When two condoms are used together, friction between the condoms can cause ripping or tearing).

Provide STI protection.

Can be used for vaginal and anal intercourse.

Remains in place whether or not the male has an erection.

Can be inserted up to 8 hours ahead of time so that it does not interrupt sexual spontaneity.

The ring may stimulate the clitoris during vaginal intercourse.

 

Disadvantages

Disrupts sexual spontaneity.

Can decrease penile sensitivity.

It requires the male to maintain an erection as long as the condom is in use and to withdraw promptly after ejaculation.

May rip during use, especially if expired or put on incorrectly.

May cause vaginal, penile, or anal irritation.

Can slip into the vagina or anus during intercourse.

Can decrease penile and/or vaginal sensitivity.

Can generate distracting noises during intercourse.

Negative Side Effects/Risks

Should not be used with oil-based lubricants like petroleum jelly, baby oil, Vaseline or vegetable oil. These will increase the chance of the condom ripping or tearing.

Can be used in combination with any method, except the male condom. (When two condoms are used together, friction between the condoms can cause ripping or tearing).

 

Concluding Remarks

Birth control is a powerful tool that allows partners to engage in sexual intercourse without the risk of an unwanted pregnancy. There are many types of contraception available, including some emergency contraception that can be used after unprotected intercourse. Each type of contraception comes with various advantages and disadvantages. When comparing each type of birth control it is important to weigh all the factors to determine the best method.

 

References:

1. “Contraception: Which Method Suits Me?” National Institute of Health. Date Accessed: 3 June 2019.

2. “National Center for Health Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 31 May 2019. Date Accessed: 3 June 2019.

3. Parenthood, Planned. “Internal Condoms | Female Condoms.” Planned Parenthood. Date Accessed: 5 June 2019.

4. Parenthood, Planned. “IUD Birth Control | Info About Mirena & Paragard IUDs.” Planned Parenthood. Date Accessed:4 June 2019.

5. “IUS, Intrauterine Systems.” National Institute of Health. Date Accessed: 3 June 2019.

6. “Contraception: Birth Control Methods.” Centers for Disease Control Prevention. Date Accessed: 2 June 2019.

7. “Contraceptive Implant.” National Institute of Health. Date Accessed: 4 June 2019.

8. “Contraceptive Injection.” National Institute of Health. Date Accessed: 3 June 2019.

9. “Vasectomy (Male Sterilization).” National Institute of Health. Date Accessed: 5  June 2019.

10.  “Female Sterilization.” National Institute of Health. Date Accessed: 3 June 2019.

11.  “Tubal Ligation Reversal.” MayoClinic. Date Accessed: 2 June 2019.

12.  “How Effective is Tubal Ligation?” Planned Parenthood. Date Accessed: 5 June 2019.

13.  “Combined Contraceptive Pills.” National Institute of Health. Date Accessed: 2 June 2019.

14.  “How Do I Use the Birth Control Pill?” Planned Parenthood. Date Accessed: 3 June 2019.

15.  “The Progestin-Only Pill.” National Institute of Health. Date Accessed: 2 June 2019.

16.  “Contraceptive Patch.” National Institute of Health. Date Accessed: 6 June 2019.

17.  “How Effective is the Birth Control Patch?” Planned Parenthood. Date Accessed: 3 June 2019.

18.  “Vaginal Ring.” National Institute of Health. Date Accessed: 1 June 2019.

19.  “How Effective is the Birth Control Ring?” Planned Parenthood. Date Accessed: 6 June 2019.

20.  “Emergency Contraception” National Institute of Health. Date Accessed: 2 June 2019.

21.  “What’s the Plan B Morning After Pill?” Planned Parenthood. Date Accessed: 4 June 2019.

22.  “Birth Control Sponge.” Planned Parenthood. Date Accessed: 2 June 2019.

23.  “Contraceptive Diaphragm or Cap.” National Institute of Health. Date Accessed: 6 June 2019.

 

Last Updated: 10 June 2019.