- Progesterone-releasing IUD – this type of IUD is over 99% effective at preventing pregnancy and is good for up to 5 years, depending on the brand. As an added bonus, your menstrual cycle is usually lighter, although sometimes the cycle can be a bit irregular.
- Copper IUD – this type of IUD is also over 99% effective at pregnancy prevention and can be used up to 10 years. It’s also hormone free, although sometimes it can make for heavier periods.
- Nexplanon – another very effective birth control option, it releases progesterone and is over 99% effective for pregnancy prevention and works for up to 3 years. Some users may experience irregular bleeding or weight gain.
- Birth control injection – a progesterone shot that when used perfectly, is over 99% effective, but typically falls around 94% effective due to late injections. Its side effect profile is similar to the implant, but slow return of menstrual cycle can cause a delay in the ability to conceive when stopped. Also, there is an FDA warning regarding loss of bone density with longterm use.
- Birth control patch – with the next few methods, efficacy can vary somewhat. Perfect use happens when the contraception is used precisely as directed; typical use is, you guessed it, the way the method is typically used. For the patch, perfect use would be about 99% effective, but typical use is closer to 91% effective. The patch combines estrogen and progesterone is changed weekly, but sometimes it may fall off sooner. This would require early replacement and may decrease efficacy. Also, if you weigh over 198 lbs, then it may be less effective at pregnancy prevention.
- Vaginal ring – another combination of estrogen and progesterone, the vaginal ring has a perfect use efficacy of 99% but again is only about 91% effective with typical use. If not replaced on time or left out for more than 48 hours during the weeks it’s supposed to be in place, then these missteps can decrease efficacy.
- Birth control pills – these can either be a combination of estrogen and progesterone or progesterone only (there are different indications for each), but again perfect use is over 99% effective whereas typical use is about 91% effective. Be sure to review antibiotics and other medications with your provider to ensure there’s no interaction that can make the birth control pills less effective.
- Condoms – condoms are great at reducing risk of sexually-transmitted infection, but they are a bit less effective at pregnancy prevention. Even used perfectly, the male condom is only 98% effective, and this decreases to 85% with typical use. Female condoms are even less effective, with only 95% effectiveness with perfect use and dropping to 79% with typical use.
- Fertility tracking – whether basal body temperature, calendar method or cervical mucous method, this type of pregnancy prevention only works between 76-88% of the time, and if you have irregular cycles, the efficacy can decrease even further.
- “Pullout method” – interestingly, this method can have a very substantial variation in just how effective it is. While in theory, if done before ejaculation, the efficacy could be as high as 96-98%, typically it fails 20-30% of the time. That’s essentially the same as using no contraception. Part of that may be due to user error, whether in withdrawing too late or not understanding exactly when the sperm is released, and part of it may have to do with an individual’s particular composition of pre-ejaculate fluid, and another part may be due to residual sperm in the urethra from previous ejaculation (those little swimmers live for up to 5 days after all).
- Permanent sterilization – both vasectomy and tubal ligation are over 99% effective; however, both are meant to be PERMANENT, so be sure that you’re sure no more children are in your future before considering a sterilization procedure. While there are procedure to attempt reversal of sterilization, these are expensive, generally not covered by insurance and not always effective.
- Nothing – pregnancy generally occurs 20-30% of the time with regularly unprotected intercourse each month, and most couples conceive within a year.
Dr. Nick