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How to choose the right birth control for you

How to choose the right birth control for you

11 min read

Figuring out the right method of birth control for your body is no small feat. Get this: Most sexually active women ages 15–44 have tried 3+ birth control methods, and nearly 30% of have tried 5+ methods. That's a lot of trial and error.

Half of women report not receiving *any* contraceptive counseling before starting their method. In other words, there’s a huge birth control education gap. In this article, we’re breaking down some of the things you should consider when choosing a birth control method.

First, here’s an important disclaimer: You should always talk through your birth control options with a healthcare provider. They can help you make the right decision for you in the context of your medical history. This article will give you tools to prep for that conversation.

Ready to dig into some birth control education? Let's do it. First, here are some of the most important things to know:

  • When it comes to birth control, there are plenty of options to choose from — and they each have pros and cons.
  • Methods vary on a range of factors — including how they are used, how often you have to think about them, and the side effects that they can cause. Thinking through about what is important to you about your method in will help you choosing the right method for you.
  • Some forms of birth control are more effective at preventing pregnancy than others. But, it’s important to think through your goals and priorities when deciding which method is right for you, since less effective methods may have other characteristics that you are looking for. Also, half of people who take birth control do so for reasons outside of preventing pregnancy.
  • The only form of birth control that protects against sexually transmitted infections (STIs) is condoms.
  • Even with long-term use, hormonal birth control doesn’t have a negative impact on your future fertility. (One caveat here: injectable birth control can cause a *slight* delay in return to fertility.)
  • Some side effects are normal when starting certain types of birth control, and they typically go away after the first two to three months of use. That said, there are some side effects that are red flags and can indicate a serious reaction to birth control.
  • Most health insurance plans are required to fully cover the cost of prescription birth control, but it’s a good idea to check with your plan for more details. If you don’t have insurance, there are resources for getting free or reduced-cost birth control.

What are the options? A high-level overview of birth control methods

There are a lot of birth control options. Need a refresher on the main ones? Below, we’ve grouped them by their effectiveness in preventing pregnancy.

Of course, pregnancy prevention is only one of the factors to consider when choosing birth control. For example, condoms are less effective at preventing pregnancy than other methods, but they’re are the only method that offers protection from sexually transmitted infections (STIs).

A quick note: While we cover the most popular methods, this is not an exhaustive list of all the options out there.

How well different methods prevent pregnancy

According to CDC data

Most Effective: Fewer than 1 pregnancy per 100 women in a year

Tubal ligation: Also called “getting your tubes tied” or “female sterilization” tubal ligation is a surgical procedure to close off the fallopian tubes, which cuts off the pathway for egg to meet sperm.*

Vasectomy: A vasectomy is a surgical procedure for people with testes that blocks the release of sperm from the testes. Sperm are still produced but are reabsorbed into the body.*

Intrauterine device (IUD): IUDs are small T-shaped plastic devices that are inserted into the uterus. There are two main types: hormonal IUDs and copper (non-hormonal) IUDs. Depending on the type you get, they can last between 3-12 years.

Implant: The birth control implant is a matchstick-sized plastic rod that’s inserted in the upper arm. The implant releases hormones that help prevent pregnancy. The implant can last for up to five years.

*Permanent birth control methods like tubal ligation and vasectomy are suited for people who are sure they don’t want to have biological kids in the future.

6-12 pregnancies per 100 women in a year

Shot: The contraceptive shot is an injectable method of birth control that protects you from pregnancy for three months. It comes in two forms: one that’s administered by a healthcare provider, and another that you can administer yourself at home.

Pill: Birth control pills are oral contraceptives which use either a combination of hormones (progestin + estradiol) or just one (progestin) to prevent pregnancy. Birth control pills come in a pack and you take one pill every day.

Patch: The birth control patch is a sticky piece of fabric you apply to the skin each week. It works by releasing hormones into your skin to prevent pregnancy.

Ring: The vaginal birth control ring is a flexible plastic circle placed inside the vagina that releases a combination of hormones (progestin + estradiol).

Diaphragm: A diaphragm is a flexible, dome-shaped cup that’s inserted into the vagina before sex. To be effective at preventing pregnancy, diaphragms need to be used with spermicide.  

18+ pregnancies per 100 women in a year

External condom: External condoms (sometimes called “male condoms”) are thin, stretchy coverings worn on the penis during sex.

Internal condom: Internal condoms (sometimes called “female condoms”) are worn inside of the vagina.

Sponge: The birth control sponge is a small, round sponge that is inserted deep in the vagina before sex. It covers the cervix, and is coated with spermicide to help prevent pregnancy.

Least effective: 24+ pregnancies per 100 women in a year

Fertility Awareness Methods (FAMs): Fertility awareness methods are ways to track your cycle to understand when you’re in your fertile window and when you’re not — and time unprotected sex accordingly to avoid pregnancy. FAMs can include tracking ovulation, temperature, cervical mucus, and cycle length. These are often used together to increase effectiveness.

Spermicides & contraceptive gel: Spermicides and contraceptive gels are put into the vagina before intercourse (the exact timing depends on the brand) and work by damaging sperm, making it less likely that they make it past the cervix and on to fertilize an egg.

Other ways to prevent pregnancy

Emergency contraception*

“The morning after pill”: If you’ve had unprotected penis-in-vagina sex or your contraceptive (like a condom) failed, the “morning after pill” is an option that can help prevent pregnancy. Taken within three to five days after sex (the sooner the better) the morning-after pill can help reduce the chance of pregnancy.

IUD placement within 5 days of unprotected sex: While IUDs are highly effective at preventing pregnancy on an ongoing basis, another upside of them is that they can act as emergency contraception when inserted into the uterus within five days of unprotected sex.

*While emergency contraception can help prevent pregnancy in the case of unprotected sex (or if another method fails) it’s not a first-line defense against pregnancy.

How do you choose the option that’s best for you?

Start by thinking through your goals and priorities

There’s no such thing as a universal “best” birth control. It’s true that some methods are better than others at preventing pregnancy. But, pregnancy prevention is only one piece of the equation.

Our take? The best birth control *for you* is one that fits your lifestyle, helps you reach your reproductive goals, and allows you to feel your best. So besides effectiveness rates, what else should you consider?

Think about how these statements reflect your goals:

  • Preventing pregnancy is essential to me. I don’t want to take any chances, and I’m not planning on having kids for years, or ever If this sounds like you, a highly effective long-term birth control (like the IUD or implant) could be a good match.
  • Preventing pregnancy is important to me right now, but kids are on the horizon in the near future. If this sounds like you, shorter-term hormonal methods (like the pill, patch, or ring) could be a good fit, along with barrier methods like condoms. Depending on how long you have before you start trying IUDs and implants can also be good methods (just keep in mind that you’ll need to schedule appointments for insertion and removal with these these methods.)
  • I want to prevent pregnancy, and I also want to be protected against sexually transmitted infections (STIs)Condoms are the only form of birth control that also protect against STIs. If you and your partner(s) haven’t been tested, using condoms correctly and consistently is key for preventing the spread of STIs. And of course, you can always use condoms with other methods of birth control that provide more protection against pregnancy.
  • I’m looking to manage period symptoms. If you’re looking to control period-related symptoms like acne, heavy menstrual bleeding, or severe PMS, hormonal birth control (including the hormonal IUD) might be able to help. It’s highly dependent on the individual and the symptoms in question, so make sure to discuss this with your healthcare provider.
  • Preventing pregnancy is really important to me, but I’m not interested in using hormonal methods. Some folks would rather not use hormonal methods, and that’s ok. If hormones are off the table for you, consider the copper IUD, condoms, FAMs, spermicide + diaphragms, and the sponge.

Consider hormonal vs. non-hormonal methods

What is hormonal birth control?

Like the name implies, “hormonal” birth control methods contain one or more hormones. These methods include the pill, the shot, the patch, the implant, and some IUDs. Once in your body, the hormones alter certain body processes to help prevent pregnancy. For example, some forms of hormonal birth control prevent ovulation entirely. Others work by thickening the cervical mucus (which makes it harder for sperm to get into the uterus).

Is hormonal birth control appropriate for everyone?

There’s a lot of chatter on the internet about avoiding hormonal birth control, supposedly because of health effects. But, hormonal methods have been proven to be appropriate for the majority of women. In fact, pregnancy is more likely to cause a serious health condition than the pill.

However, there are women who should not take combined hormonal birth control (that’s birth control that contains both estrogen + progestin), because the estrogen in the method is not compatible with certain health conditions. If you have one of these conditions, taking combined hormonal birth control lead to an increased risk of deep vein thrombosis (DVT), heart attack, or stroke.

Here’s a list of the most common conditions and lifestyle factors that are not compatible with combined hormonal birth control:

  • Women over 35 who smoke 15+ cigarettes per day
  • Women who have multiple risk factors for cardiovascular disease, such as high cholesterol, high blood pressure, and diabetes
  • Women who have history of stroke, heart attack, or deep vein thrombosis (DVT)
  • Women with a history of migraine headaches with aura

Note: This list is not exhaustive — you should always discuss risk factors with a doctor.

In some cases, progestin-only birth control methods (like the mini-pill) are appropriate for people who can’t take combined hormonal birth control because of a contraindication to estrogen. For example, since estrogen increases blood levels of compounds that make your blood clot, people who have medical conditions that put them at an increased risk of blood clots are then at an even higher risk of blood clots if they take birth control with estrogen in it — which rules out methods that contain estrogen, but doesn’t rule out progestin-only methods.

Does hormonal birth control have a negative effect on fertility?

No form of birth control (other than sterilization) has a long-term impact on fertility. It is true that fertility declines over time with age – but birth control itself doesn’t cause reduced fertility. (One more time for the people in the back!)

If you’re currently on (or thinking of starting) a hormonal birth control method like the pill (either type), patch, or ring, the research tells us that there’s no delay in return to fertility after you stop using it. If you’re going off injection-based methods, it can take slightly longer for ovulation to resume after stopping.

On the flip side, you also don’t “save” eggs by being on a birth control method that prevents ovulation. Hormonal birth control isn’t good or bad when it comes to your fertility — it’s neutral.

Sometimes people who come off birth control experience irregular periods or lack of ovulation (called “anovulation”) and think that their birth control is to blame for “causing” these symptoms. It’s more common that these conditions were present all along, just masked by birth control. After all, birth control is commonly prescribed to help manage these symptoms in the first place.

For all birth control methods, if you haven’t gotten a period within 90 days of stopping, be sure to discuss this with your healthcare provider.

Weigh the effectiveness rates of different methods with their potential for user error

If preventing pregnancy is one of your priorities, thinking through the effectiveness rate (aka, how well a method helps prevent pregnancy) is essential.

There are two ways to talk about the effectiveness of a method: “perfect use” and “typical use.”

  • “Perfect use” is how well a birth control method works when used exactly as instructed.
  • “Typical use” takes into account how most people actually use a method. In other words, typical use takes into account the human error that can lead to a method not working as well as it would when used perfectly. (For example, forgetting to take a pill.)

Are you someone who has a hard time remembering to do things daily? If this sounds like you, and preventing pregnancy is a top priority, using lower maintenance birth control (or one that has less potential for user error) could be helpful.

Consider non-contraceptive benefits

You might be surprised to learn that half of people who take birth control do so for reasons outside of preventing pregnancy. Why?

Some non-contraceptive benefits of hormonal birth control can include:

  • Regulating the menstrual cycle (including reducing pain during menstruation, lighter periods, suppressing menstruation completely, or limiting the number of bleeds to a few per year)
  • Reducing risk of endometrial and ovarian cancer
  • Controlling acne and hirsutism (excess hair growth)
  • Managing symptoms of PCOS

If one or more of these benefits are important to you, make sure to bring it up with your healthcare provider when discussing your options.

It’s also worth noting that birth control isn’t always the first-line treatment for these conditions. For example, though birth control may help with acne, the first-line treatment for acne is topical treatment (aka, medications you apply directly to the skin).

Know about side effects

Some side effects can indicate a serious health issue. If you have any of the following side effects, seek out in-person care immediately:

  • Severe chest/abdominal pain or pressure
  • Sudden shortness of breath
  • Severe leg pain or swelling
  • Numbness in the lower half of the body
  • Slurred speech
  • Vision changes
  • Extremely severe headaches that do not improve with over-the-counter medications
  • Change in blood pressure


Some side effects are bothersome, but not indicative of a medical emergency. If you’re experiencing other side effects you think may be connected to your birth control, it’s a good idea to bring them up with your healthcare provider.

For some people, side effects take around three to five months to subside as your body adjusts to birth control. If yours don’t go away (or they’re severe right from the start) that can be a sign you should try a different birth control type. If your birth control method is significantly impacting your daily activities during the first two or three months, it’s worth discussing your options for switching with your healthcare provider.

When it comes to side effects, everyone responds to birth control differently. If you and a friend are on the same birth control, you might have totally different experiences with side effects.

Consider costs and learn about your insurance coverage

If you have insurance:

  • Most health insurance plans are required to fully cover the cost of prescription birth control (with no copays or coinsurance, and even if you haven’t met your deductible.)
  • Insurance does not cover over-the-counter methods, like condoms or spermicides.
  • Some plans require you to pay some of the cost for certain birth control brands. You can call your insurance company and ask if the brand of birth control you need is covered by your plan.
  • Certain employers (like religious organizations) can opt out of birth control coverage for employees.

If you don’t have insurance:

  • You may need to pay the full cost for your birth control. It’s worth shopping around to see where prices may be lowest.
  • You can also call your local Planned Parenthood to see if they have programs to help you get free or reduced-cost birth control.

The bottom line

Like so many aspects of reproductive health, there’s no “one size fits all” when it comes to birth control. This means it can take some research and reflection to get to the right method for you.

As you're sorting through the options, know this: there's no reason to compromise if something doesn't suit your body. You have every right to ask questions, seek out education, and keep trying things out until you find out what works.


This article was medically reviewed by Christine Dehlendorf, MD, MAS.

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Jen Lehr

Jen is a member of Modern Fertility's content team. She's a distance runner, outdoor adventure enthusiast, and humbly claims to have mastered the art and science of snacking.

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