Contraception

Contraception refers to a woman's chosen form of birth control, including hormonal, barrier, chemical and natural methods.

Among all the decisions we must make in life, our birth control choice is one of the most personal. In nearly four decades of childbearing years, your need for birth control—and preference for method—will most likely change multiple times based on your life stage. But no matter if you are at the beginning or end of your childbearing years, you can make the most informed decisions by learning about all your contraceptive options and selecting the ones that best fit your current reproductive health needs.

There are many factors to consider as you choose a birth control method, including cost, side effects, and future pregnancy plans. You'll also want to think about safety and effectiveness. As you choose the best method for you, you will have to weigh risks and benefits. No birth control method is perfect. Unfortunately, many women are not adequately protected from an unwanted pregnancy by their choice of birth control method. In fact, according to the Guttmacher Institute, about one-half of all pregnancies in the United States are unplanned.

There are several reasons birth control methods fail, including inappropriate use (for example, not inserting a diaphragm the right way or not using enough spermicide); failure to consistently use the method chosen (for example, forgetting to take your birth control pills); and failure of the contraceptive method itself (a broken condom, for example).

Failure to correctly and consistently use birth control methods is an important reason they fail. Among women who experience unplanned pregnancies each year in the United States, 41 percent use birth control, but (and this is a big "but") these women use birth control inconsistently. Of the women who use birth control consistently and correctly, only 5 percent become pregnant each year. This illustrates the importance of consistent birth control use.

One reason some women fail to use birth control methods effectively is concern about the risks and safety of certain birth control options. Women may use a particular method only occasionally, for example, thinking it's safer to use it now and then rather than all the time. Or they may stop using a certain method because of bothersome side effects.

In addition, age-related changes can lead women to believe they no longer need to use birth control. For example, women nearing menopause may mistakenly think they are no longer fertile because their menstrual cycles are no longer regular. However, according to the American Congress of Obstetricians and Gynecologists (ACOG), about 75 percent of pregnancies in women over 40 are unintended. Although menopause does mark the end of a woman's childbearing years, you have not gone through menopause until you've had 12 consecutive months without a period. You can get pregnant in the peri-menopausal window even if your periods aren't regular.

Good news is, American women have more contraceptive options to choose from than ever before. So you should have no trouble finding one that works well for you and fits your lifestyle.

There are some things you should consider before making a contraception choice:

You can probably think of many more questions about birth control. Learn as much as you can about your options to make an informed decision about which method is the best and safest for you. Consider your needs and discuss them with your health care professional during your next visit.

To get you started, here is some basic information about contraceptive options approved by the U.S. Food and Drug Administration (FDA), as well as resources you can use for more in-depth research.

For a comparison of how effective each type of contraception is for preventing pregnancy, please see the chart, "Contraceptive Failure Rates" at the end of this article.

Contraceptive Options
The contraceptive options women have to choose from are:

The Effectiveness of Contraceptives

The statistics below represent the percentage of women who experienced unintended pregnancy during one year of using the contraceptive method indicated, according to the FDA. Rates given for each method are for typical use:

Method Failure Rate
Permanent Contraception:(Sterilization)
Male Sterilization
Female Sterilization
Less than 1%
Less than 1%
Hormonal Methods:
Hormone Shot (Depo-Provera)

Combined Pill (Estrogen/Progestin)

Minipill (Progestin only)

Three-month pill (Seasonale, Seasonique)

Cervical Cap (no previous births)(**)

17-23% (higher rate after childbirth)

*used without spermicide
**used with spermicide

Birth Control Pills (BCPs)

There are three types of birth control pills on the market today: the combination pill, the mini-pill and the emergency contraceptive pill. The combination pill is the most widely prescribed. It contains two hormones: estrogen and progestin. It works by suppressing ovulation each month, thinning the uterine lining and changing the consistency of the mucus in a woman's cervix to make it harder for sperm to move into contact with an egg.

Low dose combination birth control pills contain less than 35 mcg of estrogen, a lower dose (one-fourth or less) than the birth control pills marketed 30 to 50 years ago. Ultra low-dose birth control pills contain 10 mcg. They come in different formulations. Some require taking a constant dose of both medications for 21 days followed by one week of placebo tablets. Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle (multiphasic) or add additional days (tablets) of estrogen at the end of the 21- or 24-day cycle. Continuous birth control pills: Continuous-use birth control pills contain ethinyl estradiol and levonorgestrel. Brand names include Lybrel, Alesse, Lessina, Nordette, and others. Continuous birth control pills are monophasic (containing the same levels of estrogen and progestin throughout the entire pill-taking schedule) that comes in a 28- or 21-day pack a woman takes continuously, with no break between pill packets. That means you won't have a period if you take these pills. You may have some spotting or breakthrough bleeding, particularly when you first start using continuous birth control pills. But most women will have no bleeding (or hardly any) by the end of one year.

Seasonale is a 91-day oral contraceptive regimen also designed to reduce the number of months you have a menstrual cycle. Tablets containing progestin and estrogen are taken for 12 weeks (84 days), followed by one week of placebo tablets. Therefore, the number of expected menstrual periods is reduced from once a month to about once every three months, or four times a year. Seasonique is the same as Seasonale except with Seasonale, women take inactive pills during their four yearly periods and with Seasonique, they take a low dose of estrogen during their periods. Lo-Seasonique is similar to Seasonique but with lower doses of hormones.

If and when you decide to get pregnant and stop taking birth control pills, you may get pregnant immediately—there are no long-term effects on your fertility from birth control pills.

Benefits. Birth control pills are now also prescribed by health care professionals because of their long- and short-term health benefits for women. Birth control pills can help:

Risks. Women with certain health conditions may not be able to use birth control pills. These include:

Smoking cigarettes while taking birth control pills dramatically increases risks of heart attack and stroke for women over age 35. Smoking is far more dangerous to a woman's health than taking birth control pills, but the combination of oral contraceptive pill use and smoking has a greater effect on heart attack and stroke risk than the simple addition of the two factors.

Some women worry that birth control pills may increase their risk for cancer, particularly breast cancer. Newer low-estrogen birth control pills do not carry the risk of increased breast cancer that higher-dose estrogen pills did. However, there is still a slightly increased risk for pill users compared with women who have never used a form of hormonal birth control. A December 2017 study published in The New England Journal of Medicine found birth control pills and other hormonal birth control methods, such as the birth control patch, ring, and injections, slightly increase risk for breast cancer. However, the study authors emphasize that the increased risk is very small and if you stopped using hormonal birth control years ago, your risk is probably about the same as women who never used it at all.

Bottom line: Discuss the risks and benefits of birth control pills with your health care professional.

There is some evidence that long-term use of birth control pills may increase the risk of cancer of the cervix (the narrow, lower portion of the uterus). There is also some evidence that birth control pills may increase the risk of certain benign (noncancerous) liver tumors.

Side effects and warnings. Nausea, breast tenderness and bleeding are the most common side effects of all birth control pills. Most side effects decrease or disappear after three months of continuous use. Switching to another pill formulation can also relieve side effects.

A serious issue often overlooked by both women and health care professionals is that interactions with other medications can make birth control pills less effective. Medications known to interact with birth control pills are rifampin (an antibiotic) and some anticonvulsants. If you take these drugs regularly but are still interested in using the pill as your birth control method, talk with your health care professional.

Vaginal Contraceptive Ring

One of the newest contraceptives on the market, NuvaRing, is available by prescription only and consists of a soft, flexible, transparent ring that measures about 2 inches in diameter. It contains a combination of estrogen and progestin hormones (ethinyl estradiol and levonorgestrel). You insert NuvaRing into your vagina like a tampon, where it slowly releases hormones on a continual basis. You need to insert a new ring each month for continuous contraception. The ring stays in place for three weeks, then you remove it for one week, during which time you have your period.

Benefits. You only need to insert NuvaRing once a month, making it a convenient form of birth control. And, like oral contraceptives, NuvaRing is highly effective if you follow label directions. For every 100 women using NuvaRing correctly for an entire year, only one will become pregnant.

Side effects and warnings. Side effects of the NuvaRing may include vaginal discharge, vaginitis and irritation. Like oral contraceptives, NuvaRing may increase the risk of blood clots, heart attack and stroke. Women who use NuvaRing are strongly advised not to smoke, as it may increase the risk of heart-related side effects.

Skin Patch

The contraceptive birth control patch (Xulane) is a transdermal (through the skin) patch approved by the FDA in 2014 that contains ethinyl estradiol and the progesterone norelgestromin. The one-and-three-quarter-inch patch is applied to the skin (abdomen, buttocks or upper torso, but not breasts) where it slowly releases hormones for a week. You must replace the patch with a new one once a week. After three weeks (and three new patches), you have one week that is patch-free, during which you get your period.

Benefits. The patch is 99 percent effective in preventing pregnancy when used correctly. It also removes the problem of having to remember to take a pill every day or insert a device before intercourse.

Side effects and warnings. In clinical trials, the patch was less effective in women weighing more than 198 pounds. Also, some women experienced breast symptoms, headache, a reaction at the application site, nausea and emotional changes. Other risks are similar to those from using birth control pills, including an increased risk of blood clots, heart attack and stroke. Women who use the Xulane are strongly advised not to smoke, as it may increase the risk of heart-related side effects.

The Xulane label carries an FDA-required warning that the birth control patch delivers a higher dose of estrogen than the birth control pill and therefore may increase the risk of blood clots and other serious side effects. Women taking or considering the birth control patch should talk to their health care professional about these risks.

The "Mini-Pill"

A second birth control pill option is referred to as the "mini-pill." You take the mini-pill, which contains progestin only, daily. These pills work by preventing ovulation and reducing and thickening cervical mucus to prevent sperm from reaching the egg. They also keep the uterine lining from thickening, which prevents a fertilized egg from implanting in the uterus. However, with progestin-only birth control pills, ovulation isn't consistently suppressed, so the actions on cervical mucus and the endometrium are the important factors. They may not be as effective as combined birth control pills. You must take progestin-only pills at exactly the same time, every day.

However, the progestin-only pill is an option for women who want to use oral contraception but can't take estrogen. If you are breastfeeding or experience uncomfortable side effects from estrogen, such as headaches, this could be the best option for you.

It's also important to note that mini-pills aren't as effective at preventing ectopic pregnancy as combination pills. The main side effect from mini-pills is menstrual irregularity; you may not have any bleeding for months, or you may have some spotting between periods. As with combined birth control pills, the mini-pill does not protect you from sexually transmitted diseases, so condoms are necessary if you or your partner is at risk.

Emergency Contraception

Emergency contraception is meant to be used after unprotected intercourse. Emergency contraceptive pills contain the same hormones as birth control pills, but you take them differently. In fact, you can use some birth control pills as emergency contraception with a health care professional's guidance.

Commonly called "the morning after pill," there are several FDA-approved emergency contraception pills in the United States: Plan B, Plan B One-Step, Next Choice One Dose, and generic levonorgestrel tablets, all of which contain the progestin levonorgestrel, and ulipristal acetate tablets, sold under the brand name "ella" and “ellaOne."

ella can prevent pregnancy when taken orally within five days (120 hours) after unprotected sex. It is a progesterone agonist/antagonist whose likely main effect is to inhibit or delay ovulation. ella cuts the chances of becoming pregnant by about 85 percent for at least 120 hours after unprotected sex.

Plan B One-Step and other levonorgestrel pills a should be taken within 72 hours of unprotected sex. Recent research shows that the levonorgestrel pills may be effective up to 120 hours after unprotected sex but are more effective the sooner they are taken. Next Choice and generic levonorgestrel tablets work similarly to Plan B One-Step. .

If you need emergency contraception, the best thing you can do is talk to your health care provider about your options. In some areas, you can get emergency contraception (including ulipristal and levonorgestrel) through online services such as PRJKT RUBY (www.prjktruby.com/emergency-contraception) and Nurx (www.nurx.com).

You can buy the levonorgestrel emergency contraceptive pills over the counter without a prescription. You must ask for them at the pharmacy counter. ella is available only by prescription, but women could keep a supply at home.

For information on emergency contraception, visit or call Planned Parenthood at 1-800-230-PLAN to locate a health care professional who can help you. The website and hotlines also provide information about which pharmacies sell emergency contraceptives because not all pharmacies carry them.

Side effects and warnings. Emergency contraceptive pills should not be used regularly as birth control because they can disrupt your menstrual cycle. They are also not 100 percent effective and can cause side effects such as nausea and vomiting, headaches, breast tenderness, dizziness and bloating. Your health care professional may prescribe medication with emergency contraceptive pills to minimize nausea and vomiting. Emergency contraceptive pills that contain only progestin cause fewer side effects.

Because emergency contraceptive pills are intended to be used only as their name implies—during an emergency, when other contraceptives failed or were not used—women who might otherwise not be able to take birth control pills on a regular basis may be able to use emergency contraceptive pills. Discuss your options with a health care professional.

And if you waited longer than 72 hours after unprotected sex, you have another option. You can have an IUD inserted by a health care professional up to 120 hours (five days) after unprotected sex; this should prevent a fertilized egg from implanting in most cases. The same precautions apply for using an IUD as an emergency contraceptive as for choosing it as a birth control method: If you are at risk for sexually transmitted diseases (if you have multiple sexual partners) or if you have a recent history of pelvic inflammatory disease (PID), you aren't a good candidate for this type of emergency contraception.

Long-Acting Hormonal Methods

There are several options for women who want long-term, but not permanent, protection against pregnancy. These options rely on estrogen-progestin or progestin alone to prevent ovulation. They include:

You should not use Nexplanon if you are pregnant or think you may be pregnant, have or have had blood clots, have unexplained vaginal bleeding, have liver disease, have or have had breast cancer, or if you are allergic to anything in Nexplanon. You should tell your health care provider about any medications you are taking (prescription, over-the-counter or herbal). Implanon may change your menstrual periods. They may be irregular and unpredictable throughout the time you are using the device. You may have more bleeding, less bleeding, no bleeding or spotting, and the time between your periods may vary.

Benefits. Nexplanon is more than 99 percent effective in preventing pregnancy when used correctly. It removes the problem of having to remember to take a pill every day or insert a device before intercourse.

Side effects and warnings. Failure to remove Nexplanon at the end of three years may result in infertility, ectopic pregnancy or inability to stop a drug-related adverse event. Like oral contraceptives, Implanon may increase the risk of blood clots, heart attack and stroke. If you use Implanon, you are strongly advised not to smoke, as it may increase the risk of heart-related side effects. Nexplanon and other progestin-only hormonal contraceptives have been associated with higher risk of ectopic pregnancy and ovarian cysts.

Barrier Methods

Barrier methods are less effective than hormonal methods but cause fewer side effects and are associated with less risk. The effectiveness of barrier forms of contraception can be increased when used with spermicide.

Condoms made of lambskin, however, do not offer such protection because they have microscopic holes that may stop sperm but are large enough to allow viruses to pass through.

Both the diaphragm and the cervical cap can be inserted up to six hours before intercourse and should remain in place for six to eight hours after intercourse. You must remove a diaphragm after this period of time, but you can leave a cervical cap in place for up to 24 hours.

These devices are easy to insert and remove for most women, although some women can't use the cervical cap because they have an irregularly shaped cervix. Proper fit of either device is important. If you choose one of these options, see your health care professional once a year to have it replaced. Pregnancy and childbirth can change how these devices fit. You should also carefully examine your diaphragm or cervical cap before each use to be sure it is not punctured or torn.

Benefits. One benefit of the barrier method is availability: Condoms and spermicides can be purchased over the counter (without a prescription).

Natural Family Planning

Couples using this method identify a woman's most fertile period by tracking her menstrual cycle. A calendar, body temperature and physical symptoms, such as the consistency of cervical mucus, are used to determine when ovulation is likely, and you avoid intercourse during this time.

Benefits and risks. The most obvious benefit to natural family planning is that no artificial devices or hormones are used to prevent pregnancy. Little to no cost is involved. But, experts say, while these methods can work, a couple needs to be extremely motivated to use them effectively and accurately to prevent pregnancy.

Permanent Contraception (sterilization)

Permanent contraception is the most common type of contraception overall, and it is a particularly common choice for women age 35 and older. Female sterilization closes a woman's fallopian tubes by blocking, tying or cutting them so an egg cannot travel to the uterus. There are two primary forms of female sterilization: a fairly new nonsurgical implant system (sold under the brand name Essure), and the traditional tubal ligation procedure (done via laparoscopy or minilaparotomy), often called "getting your tubes tied."