If you are not satisfied with your current method of birth control, you’re not alone. According to the Centers for Disease Control and Prevention, almost half of the pregnancies in the United States each year are unplanned, and a recent Emory University survey found that 43 percent of new and expecting mothers were considering using a different method of birth control.
The pill may be the most popular method of contraception, but is it the most effective? One of the latest studies in The New England Journal of Medicine found that contraceptives such as IUDs and implants were more effective at preventing pregnancies than birth control pills, patches and rings. The reason? IUDs and implants are inserted by health-care practitioners, and thus remove the chance of human error, a major cause of unintended pregnancies.
But not every method of birth control is for every woman. Here are some options.
Birth Control Pill
Best for sexually active women who don’t mind remembering to take a pill every day.
How it works: You take a daily pill that contains estrogen and progestin. It prevents ovulation and thickens the cervical mucus, which prevents sperm from entering the uterus.
Failure rate: About 5 out of 100 women will get pregnant while on the pill, according to the U.S. Office on Women’s Health.
Cost: $5 to $90 a month, depending on your insurance, says Dr. Susan Rothenberg, associate director of obstetrics at Beth Israel Medical Center in New York.
Upsides: It’s highly effective when taken as directed, and it may give you shorter, lighter, less painful periods.
Downsides: “You need to remember to take them,” says Katrina Schmell, nurse practitioner at University of Colorado Hospital in Denver. They require a prescription, they can be relatively expensive, and they are not recommended if you’re over 35 and are a smoker: “There is a risk of blood clots and heart attacks, but the risk of getting one while pregnant is even higher,” says Schmell.
Best for breast-feeding moms and anyone who doesn’t want, or can’t, take estrogen.
How it works: Unlike the combined pill, the mini pill contains only progestin. “We don’t recommend estrogen for breast-feeding moms,” says Rothenberg. “Progestin is OK but it’s best to wait till the milk supply has fully come in till you start it,” usually three or four days after giving birth.
Failure rate: About 5 out of 100 women will get pregnant on the pill, according to U.S. Office on Women’s Health.
Cost: $15 to $35 a month.
Upside: It is a good option for breast-feeding women.
Downside: “You have to be very committed to taking it at the same time every day,” says Schmell. If you’re more than three hours late, you’ll need to use another form of contraception for the next 48 hours.
Best for women who don’t want to become pregnant.
How it works: The second most popular form of birth control in the United Sates, female sterilization is a relatively simple outpatient procedure that can be performed in a clinic, doctor's office or hospital, using local or general anesthesia. There are several methods of sterilization; all block the fallopian tubes so eggs cannot reach the uterus.
Failure rate: Fewer than one woman out of 100 will get pregnant after sterilization, according to U.S. Office on Women’s Health.
Cost: It ranges from $1,500 to $6,000, according to Planned Parenthood.
Upside: Sterilization is permanent, so you will not have to worry about birth control again.
Downsides: “I’m not a huge fan of sterilization,” says Rothenberg. “It’s very difficult to reverse if you decide you want a biological child in the future. Everyone is absolutely positive at the time that they don’t want more kids, yet I have so many people who change their minds down the line. They’re in a new relationship, something happens to one of their kids—you never know what life is going to hand you.”
The Implant (Brand names: Implanon and Nexplanon)
Best for people who cannot risk getting pregnant, and breast-feeding moms.
How it works: A matchstick-sized rod is inserted in the arm by a health-care practitioner. It releases progestin, which prevents ovulation and makes the cervical mucus thicker so sperm can’t penetrate. It lasts for three years.
Failure rate: Fewer than 1 woman out of 100 will get pregnant while using the implant, according to U.S. Office on Women’s Health.
Cost: The cost of the exam, the implant and insertion ranges from $400 to $800. Removal by a health care practitioner costs between $100 and $300, according to Planned Parenthood.
Upsides: “It’s extremely effective,” says Schmell. “Insertion involves a very simple in-office procedure” that’s relatively painless (about the equivalent of a shot), she adds. A bonus, she says, is that many users experience lighter, shorter periods.
Downsides: “It should not be inserted less than 21 days postpartum,” says Schmell. “It can cause irregular bleeding as well as weight gain.” It also may not work as well for women who are overweight or obese.
Best for older women and women who have sex infrequently: “They’re often the choice for women in their 40s who are done with childbearing and don’t have sex that often,” says Rothenberg.
How they work: Known as barrier methods, diaphragms and caps are devices that you insert into the vagina before intercourse to prevent sperm from entering the uterus. They must be used with spermicide, which must be reapplied before each act of intercourse.
Failure rate: Fifteen women out of 100 will get pregnant while using a diaphragm, according to the U.S. Office on Women’s Health. Between 17 to 23 women out of 100 will get pregnant while using a cervical cap, the agency estimates.
Cost: Both diaphragms and caps must be fitted by a doctor to ensure that you’re getting the correct size; exams can range from $50 to $200. Diaphragms can cost from $15 to $75, caps from $60 to $75. Both last about two years.
Upsides: They can be inserted hours ahead of time, so you don’t have to interrupt sex. And they are also non-hormonal and immediately reversible if you decide you want to get pregnant.
Downside: “Patients love or hate them,” says Rothenberg, “They can be messy and people can be intimidated by touching themselves.” Also, “There is also an increased risk you can develop UTIs, as it puts pressure on the urethra,” points out Schmell.
Birth Control Patch (Brand name: Ortho Evra)
Best for women who don’t want to take a pill everyday.
How it works: The patch looks like a square-shaped bandage. It releases progesterone and estrogen through the skin, which prevents ovulation. It’s placed on the butt, arm or upper torso for three weeks, then removed for a week.
Failure rate: Fewer than five woman in 100 will get pregnant while using the patch, according to U.S. Office on Women’s Health.
Cost: $15 to $80 a month
Upsides: It lets you be very spontaneous. Many women have shorter, lighter periods on the patch. It’s also a great choice if you want to get pregnant again soon.
Downsides: “The patch has fallen out of favor because it was found to have a modest increased risk for VTE (venous thromboembolism, aka blood clots),” says Schmell. But as she points out, “The risk is much lower with the patch than in pregnancy," adding that the risk of a clot increases if you are obese, over age 35 or smoke. And stay away from it if you are breast-feeding: "[The patch] is a combination of estrogen and progestin, so it’s not for breast-feeding moms,” she says.
IUD (Brand names: ParaGard and Mirena)
Best for women who don't want to get pregnant for at least a couple years: “My favorite form of birth control is the IUD, the Mirena in particular,” says Rothenberg. “I don’t understand why everyone doesn’t have one, unless if you want to get pregnant in the next couple of years; then it’s not cost-effective.”
How it works: An IUD is inserted into the uterus by a doctor or other health care practitioner. It prevents sperm from reaching an egg and also thickens the cervical mucus so sperm can’t penetrate into the uterus.
There are two types of IUDs. ParaGard is non-hormonal and lasts 12 years, says Schmell. Mirena, which releases progestin, lasts five years. “The dose of progestin is very low,” Rothenberg points out. “Most of the progestin hangs out in the uterus, so you don’t feel like you’re on hormones.” Many women on Mirena stop having their periods altogether, she adds.
Failure rate: An IUD is one of the most effective birth control methods. Fewer than 1 out of 100 women will get pregnant while using an IUD, according to the U.S. Office on Women’s Health.
Cost: The price of an IUD and the required doctor visits range from $500 to $1000 (or from $41 to $200 a year), according to Planned Parenthood.
Upsides: “Physicians can insert it right after vaginal or Caesarean birth—before you leave the hospital,” Schmell says. “Plus there’s nothing you have to do before sex.
Downside: “IUDs are not a great choice if you have super-heavy periods,” says Schmell, because they can worsen cramping.
Best for women who want a convenient, easily reversible form of birth control and who don’t want to take a pill every day.
How it works: You insert a small, flexible ring into your vagina for three weeks of each month. It’s taken out the fourth week. “Or you can leave it in place the fourth week if you don’t want to have your period,” says Schmell. The ring contains estrogen and progestin; it works by preventing ovulation.
Failure rate: About 5 women out of 100 will get pregnant while using the ring, according to the U.S. Office on Women’s Health.
Cost: You need a doctor’s prescription for NuvaRing. Exams cost $35 to $250, and the ring itself costs $15 to $80 a month, according to Planned Parenthood.
Upsides: “A lot of women like it because you can put it in and leave it for three weeks,” so you can have a more spontaneous sex life, says Schmell. You may also experience lighter and shorter periods.
Downsides: “The ring contains estrogen, so it can’t be used when you’re breast-feeding,” says Schmell. “You also shouldn’t use it if you’re over 35 and smoke, or if you’re obese.”
The Birth Control Shot (Brand name: Depo-Provera)
Best for people who want highly effective birth control; breast-feeding moms.
How it works: You go to your doctor’s office every three months to get this prescription-only shot. Like the pill, it prevents ovulation, and makes the cervical mucus thicker so sperm cannot penetrate. Depo-Provera contains progestin, but not estrogen, so it can be used by breast-feeding moms, once the milk supply has come in, says Rothenberg.
Failure rate: Fewer than one woman in 100 will get pregnant while using Depo-Provera, according to the U.S. Office on Women’s Health.
Cost: $35 $75 per injection, plus doctor’s fees, Planned Parenthood estimates.
Upsides: It’s super-effective, and it can be a good choice if you want to keep your method of birth control private, or not have to worry about pregnancy every time you have sex.
Downsides: “A lot of times, you have to pick it up at the pharmacy and then go to the doctor’s office to have it injected,” says Schmell. That can be a pain if you don’t live close to your doctor’s office.
“It may cause a loss of bone density and irregular bleeding,” she adds. “And it may cause weight gain, as much as 10 pounds.”