The two basic axes involved in picking a birth control method are lifestyle change and effectiveness. The bigger the lifestyle change, the more effective the method. Get surgery and stay pregnancy-free for a lifetime; take a pill and stay pregnancy-free for a day. The other complicating factors involved in picking birth control are the consistency of the lifestyle change (how often you’ll have to take time out of your everyday life to protect yourself from pregnancy) and side effects (your quality of life on birth control). Less intrusive birth control methods often require more frequent upkeep. More effective birth control methods often have more side effects. Choosing the right birth control is all about figuring out where you stand on this graph: how much and how often are you willing to change your lifestyle and/or quality of life for pregnancy protection?
Birth control shouldn’t have to feel like a sacrifice. People’s bodies respond differently to different methods, and it might take a little experimentation to find a form of contraception that fits with your lifestyle and needs. Here is a basic rundown of birth control methods you can choose from, beginning with the least intrusive and least effective and ending with the most intrusive and most effective.
- Withdrawal: Withdrawal, or “the pull out method” is when a man pulls out before orgasm, ejaculating away from the vagina so sperm cannot enter the woman’s body. It’s actually 78% effective when performed correctly, but doing this right can be tricky, as it involves exercising a high level of self-control in a short timeframe. However, it’s free and comes with no side effects (except a 22% pregnancy rate).
- Barrier Methods: Barrier methods include condoms, diaphragms, sponges, and cervical caps (the last three of which are often used in conjunction with spermicide). These methods provide a barrier that protects the cervix from entering sperm. Male condoms are 85% effective when used with some degree of human error (aka, normally), diaphragms are 88% effective on their own, while cervical caps and birth control sponges are about 70-85% effective without spermicide. Barrier methods are side effect free, but must be applied every time before sex. (Diaphragms can be kept in for 24 hours and cervical caps can be kept in for 48, but you’ll have to reapply spermicide before each instance of sex.) Condoms are also the ONLY method of birth control that prevents the spread of STIs.
- Hormonal Methods with Upkeep: The birth control pill, patch, and vaginal ring are three birth control methods that require daily, weekly, or monthly upkeep and work by emitting synthetic hormones into the body. These hormones (man-made estrogen and progesterone, called progestin) prevent ovulation and thicken the cervical mucus, making it more difficult for sperm to swim. Hormonal birth control has side effects, some of which can be annoying or painful, like headaches, nausea, low libido, breast tenderness, and moodiness, and some of which can be positive, like clear skin, light and regular periods, and protection from ovarian and cervical cancers. Some women choose to take hormonal birth control for its health benefits beyond pregnancy prevention; some women are highly sensitive to its negative side effects. It all depends on your body. Most birth control pills contain a combination of estrogen and progestin, and remain effective if taken every day, no matter what time of day. Progestin-only pills cause no estrogen-related side effects, but they must be taken every day within the same three hour window to remain effective. Birth control patches must be changed every week; vaginal rings must be changed every month.
- Hormonal Method with Less Upkeep: One birth control method that delivers pregnancy-preventing hormones for a long period of time but is not a Long Acting Reversible Contraceptive is the Depo-Provera shot. This shot delivers three months worth of hormones into the body and can be used like other hormonal methods to control periods. However, it is a large dose of hormones, and can produce more short-term side effects than lower dose hormonal methods that require less upkeep. The Depo-Provera shot is also the only form of birth control conclusively linked with some degree of weight gain.
- Long Acting Reversible Contraceptives (LARCs): Long Acting Reversible Contraceptives require a doctor’s insertion but last for years at a time. They include the hormonal implant and IUDs. Hormonal implants are rods full of synthetic hormones that are inserted into the arm and can protect you from pregnancy for up to five years. There are two kinds of IUDs (intrauterine devices): copper and hormonal. Copper IUDs contain no hormones, just copper—which naturally repels sperm. Hormonal IUDs contain the same synthetic hormones found in other hormonal birth control methods, just in a format that can keep delivering for up to twelve years. They come with side effects, just like any other hormonal method. Copper IUDs are hormonal side effect free, but can be more painful to insert and can result in temporarily painful periods. LARCs are the most effective form of birth control besides sterilization, with a success rate of 99%. If you can get past the initial doctor’s visit, they require the least amount of upkeep, too.
- Sterilization: Sterilization (a vasectomy for men or tubal ligation for women) is a surgery that permanently removes the option of pregnancy from the table. This method is the greatest lifestyle change (full elective surgery that might require days of recovery and results in a lifelong decision), in exchange for the greatest level of pregnancy protection.
No matter where you fall along the axes of lifestyle change and effectiveness, when it comes to your birth control, it’s all about what works best for you and your body. Talk to a doctor about your contraceptive options to start exploring the right fit.
If you want to try a hormonal birth control method with upkeep, like the pill, the patch or the ring, check out Simple Health—an online birth control prescription and home delivery service.