Contraceptive Awareness
Welcome to the wide and wild world of contraception, also known as birth control. There are many options available, ranging in effectiveness (of preventing pregnancy), symptoms, and effects on your cycle. Contraception is broken into a few ‘families,’ as seen below.
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Estrogen + Progestin:
The Pill, The Patch, Vaginal Ring
Progestin-only:
The Mini-pill, The Shot, Implant, Hormonal IUD/LNG-IUD
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Reversible:
Copper IUD, Hormonal/LNG-IUD, Implant
Irreversible:
Sterilization
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Barrier Methods:
Male Condom, Female Condom, Spermicide, Diaphragm, Cervical Cap
Behavioral Methods:
Fertility Awareness, Withdrawal (Pulling Out), Breastfeeding (Lactation Amenorrhea)
Comparing Birth Control Options
| Method | Effectiveness: Actual Use | Effectiveness: Perfect Use* | How it Works | Timing/ Maintenance |
Estimated Cost | Prescription Required? | Reduces/ Eliminates Period |
Manages Period Symptoms |
|---|---|---|---|---|---|---|---|---|
| Combination Pills | 93% | 99% | Hormones block ovulation, thickens cervical mucus | Daily | $0-$50 a month, depends on insurance and whether it’s generic or name brand | ✓ | X | ✓ |
| Progestin-only pills, aka Mini-pill | 93% | 99% | Hormone thickens cervical mucus, thins the endometrium, and blocks ovulation | Daily (within 3 hours of the same time) | $0-$50 a month, depends on insurance and whether it’s generic or name brand | Most require a prescription, O Pill does not* | X | ✓ |
| Patch | 93% | 99% | Hormones block ovulation and thicken cervical mucus | Weekly | $0-$50 a month, depends on insurance and whether it’s generic or name brand | ✓ | X | ✓ |
| Ring | 93% | 99% | Hormones block ovulation, thicken cervical mucus | Monthly | $0-$200 a month, depending on insurance | ✓ | it depends | ✓ |
| Shot | 96% | >99% | Hormone thickens cervical mucus, blocks ovulation, and thins the endometrium | 3 months | $0-$150 per injection, depending on insurance | ✓ | ✓ | ✓ |
| Implant | >99% | >99% | Hormone thickens cervical mucus, blocks ovulation, and thins the endometrium | 3 years | $0-$2300 per implant, depending on insurance | ✓ | ✓ | ✓ |
| Hormonal IUD | >99% | >99% | Hormone thickens cervical mucus, blocks ovulation, and thins the endometrium | 3-8 years | $0-$1800 per IUD, depending on insurance | ✓ | ✓ | ✓ |
| Copper IUD | >99% | >99% | Copper creates a hostile environment for sperm to stop implantation | Up to 12 years | $0-$1800 per IUD, depending on insurance | ✓ | X | X |
| Vasectomy | >99% | >99% | Permanent severing of the tubes that carry sperm | None: Permanent. In some cases a vasectomy may be reversed, but it is meant to be permanent | $0-$1,000 one time fee, depending on insurance | Surgical procedure, requires a visit to a doctor | N/A | N/A |
| Sterilization | >99% | >99% | Permanent blockage of the fallopian tubes | None: Permanent | $0-$6000 one time fee, depending on insurance | Surgical procedure, requires a visit to a doctor | X | X |
*Calculated using number of expected pregnancies per 100 women, factors in user error, liked missed dosages
*Perfect use assumes no missed doses or user error
*The OPill is the first and only over-the-counter birth control pill available in the United States
| Method | Effectiveness* | How it Works | Timing/ Maintenance |
Protects Against STIs | Affects Your Period/Fertility | Prescription Needed? |
|---|---|---|---|---|---|---|
| Condom | 82% | Barrier to catch sperm | Before sex | ✓ | X | X |
| Internal Condom | 79% | Barrier to prevent sperm from reaching the egg | Before sex | ✓ | X | X |
| Spermicide | 72% | Impairs the swimming of sperm, blocks sperm from reaching the egg | Before sex | X | X | X |
| Diaphragm | 88% | Barrier to prevent sperm from reaching the egg | Before sex | X | X | ✓ |
| Vaginal Gel | 86% | Chemicals create a hostile environment for sperm | Lasts ~1 hour | X | X | ✓ |
| Sponge | 76-88% | Contains spermicide which creates a hostile environment for sperm | Before sex | X | X | X |
| Withdrawal aka Pulling out | 78% | Pulling out requires that the penis be pulled out or withdrawn from the vaginal canal and ejaculating away from the vulva and vagina. It keeps semen away from the vagina. However, there may be sperm in pre-ejaculatory fluid, which can cause pregnancy | During sex | X | X | X |
| Natural Family Planning | 76% | Monitor or track fertile days and avoid having sex during ovulation | Every cycle | X | X | X |
| Breastfeeding | 98% | Fertility and ovulation remain low in the 6 months after giving birth | None | X | X | N/A |
*The sponge may actually slightly increase your risk of contracting a sexually transmitted infection.
Birth Control Method Bios
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The birth control pill is a pill taken once every day that contains the hormones estrogen and progestin. It is one of the most common and well-researched forms of birth control*. Birth control pill packs often involve a certain number of active pills as well as a 7-day set of placebo, or inactive pills, that are timed to allow for bleeding to occur. The placebo pill week is not actually a true menstrual period, but withdrawal bleeding due to the absence of hormones*. On monophasic birth control pills, skipping the placebo week and simply starting the next pack of active pills may allow users to skip their period, but it’s important to consult with a doctor first to ensure this is possible on your birth control of choice and so that they can adjust your prescription. How frequently bleeding occurs depends on the pill pack, as some extended dose pill packs have fewer placebo pills to reduce bleeding*. Please note that the pill, also known as the combination pill, is separate and distinct from the mini-pill, also known as the progestin-only pill (See: The Mini-pill).
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*Britton et al., “An Evidence-Based Update on Contraception.” -
The mini-pill, or progestin-only pill, is a birth control tablet that is taken once a day every day, and contains a hormone that prevents pregnancy. The mini-pill is similar to “the pill” mentioned above but contains a lower level of hormone and does not contain estrogen*. Therefore, the mini-pill may be a better option for those at risk for estrogen-related side effects or who prefer an estrogen-free birth control, but who still want the schedule of a daily pill.**
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The patch is a sticky plastic square containing the same hormones as the pill, estrogen and progestin, but delivered through the skin. The patch, once applied onto the skin, can be left on for a full week. The patch is applied and replaced once a week for three consecutive weeks, then left off for a full week so that bleeding can occur, similar to the schedule of your typical period*. People using the birth control patch can skip their period by applying a new patch during the fourth week instead of taking a week off, but they should consult with their doctor before making any changes to their routine.
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The vaginal ring is a small, flexible circular ring worn inside the vagina. The ring contains a reservoir of the hormones estrogen and progestin which are released gradually over a three-week period. After three weeks of use, it is removed for a full week to allow for your period to occur*. People using the vaginal ring can skip their period by inserting a new ring immediately after removing the old one, without taking the usual ring-free week, but they should check with their doctor before making any changes to their schedule. The ring must be prescribed by a healthcare provider, but is inserted and removed by the user**. After a month, the vaginal ring should be thrown away and a new ring should be inserted. Annovera is the only currently available vaginal ring that is reusable, and can therefore be reinserted after a month of use.
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*Britton et al., “An Evidence-Based Update on Contraception.”
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The birth control shot, or Depo-Provera, is a form of birth control where progestin, a hormone that prevents pregnancy, is injected into the skin by a healthcare provider. There is enough progestin in the shot that it protects against pregnancy for 12 weeks, or three months*. After three months, you will need to go get another dose in order for the shot to remain effective as a birth control*. The shot doesn’t require any upkeep in between injections, and may be preferred for those who don’t want a daily pill requirement or who prefer estrogen-free birth control.
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*Britton et al., “An Evidence-Based Update on Contraception.”
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The implant is a small, thin rod typically implanted into the arm which contains the hormone progestin to prevent pregnancy*. After being inserted by a healthcare provider, the implant slowly releases hormone over time, and can prevent pregnancy for up to 3 years based on current FDA approval**. The implant does not require the user to follow any regularly scheduled action like other methods, and may be a fit for those who want an estrogen-free, hormonal option that is effective long-term.
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The hormonal intrauterine device (IUD) is a small T-shaped device that is inserted into the uterus and slowly releases the hormone progestin over long periods of time to prevent pregnancy*. The IUD must be inserted and removed by a healthcare provider*. The IUD is one of the most effective reversible forms of birth control, and is useful for those who want a low-maintenance, long-term birth control method that does not contain estrogen**. The four brands of hormonal IUD and how long they are effective for use are listed below.
Mirena: up to 8 years***
Liletta: up to 6 years***
Kyleena: up to 5 years***
Skyla: up to 3 years***
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*“Hormonal IUD - How It Works, Pros & Cons, More | Kaiser Permanente,” accessed May 23, 2023, https://healthy.kaiserpermanente.org/health-wellness/birth-control/types/hormonal-iud.**“Intrauterine Device (IUD): Birth Control, Use & Side Effects,” Cleveland Clinic, accessed May 3, 2023, https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud.
***Emily L. Lanzola and Kari Ketvertis, “Intrauterine Device,” in StatPearls (Treasure Island (FL): StatPearls Publishing, 2023), http://www.ncbi.nlm.nih.gov/books/NBK557403/. -
The ParaGard IUD is a small T-shaped device inserted into the uterus that provides long-term pregnancy prevention. The Copper IUD does not contain hormones, but it is wrapped in copper wire which blocks sperm from implanting in the uterus, thus preventing pregnancy*. The IUD is one of the most effective reversible forms of birth control, and the Copper IUD may be the ideal method for those who want a non-hormonal birth control method that is low maintenance, reversible, and effective long-term**. The Paraguard Copper IUD is effective for up to 12 years***.
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*Horvath, Schreiber, and Sonalkar, “Contraception”; Oluyemisi A. Adeyemi-Fowode and Jennifer L. Bercaw-Pratt, “Intrauterine Devices: Effective Contraception with Noncontraceptive Benefits for Adolescents - ClinicalKey,” September 1, 2019, https://www-clinicalkey-com.proxy.library.vanderbilt.edu/#!/content/playContent/1-s2.0-S108331881930227X?returnurl=null&referrer=null.
**“Intrauterine Device (IUD)”; Natalia E. Birgisson et al., “Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review,” Journal of Women’s Health 24, no. 5 (May 1, 2015): 349–53, https://doi.org/10.1089/jwh.2015.5191; Anita L Nelson and Natasha Massoudi, “New Developments in Intrauterine Device Use: Focus on the US,” Open Access Journal of Contraception 7 (September 13, 2016): 127–41, https://doi.org/10.2147/OAJC.S85755.
***Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Wu, Justine P. et al., Contraception, Volume 89, Issue 6, 495 - 503
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Male sterilization, or a vasectomy, is a surgical procedure in which the vas deferens (the tubes that carry sperm) are cut or sealed to prevent sperm from entering the semen*. This is a one-time, non-reversible procedure that is safe, quick, and has minimal side effects. A vasectomy does not involve hormones and does not affect sexual function or the ability to ejaculate. It requires little to no ongoing management after recovery, making it a highly effective, low-maintenance option for those who are certain they don’t want any/additional children.
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*“Male Vasectomy Procedure,” Planned Parenthood, accessed April 17, 2025, https://www.plannedparenthood.org/learn/birth-control/vasectomy.
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Female sterilization, or a tubal ligation, is a surgical procedure in which the fallopian tubes are permanently tied off to prevent pregnancy*. This is a one-time, non-reversible procedure that is safe and has minimal side effects. Getting your tubes tied does not involve any hormones and will not impact your period*. It does not require any management after the procedure, and therefore may be a good low maintenance, highly effective option for those who are sure that they don’t want any/additional children.
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*“Tubal Ligation | Kaiser Permanente,” accessed September 27, 2023, https://healthy.kaiserpermanente.org/health-wellness/birth-control/types/tubal-ligation.
