13 Birth Control Options Ranked by Effectiveness

Choosing the right birth control method is about understanding your options and finding what works best for your body, lifestyle, and future plans. While effectiveness is a key factor, it's just one part of the decision. Other considerations include ease of use, potential side effects, cost, and whether you want protection against sexually transmitted infections (STIs).

This guide breaks down 13 birth control methods, ranked by their effectiveness at preventing pregnancy when used correctly. For each option, we'll explore how it works, possible side effects, and key factors to consider. Remember that what works well for one person may not be ideal for another and the considerations mentioned aren’t exhaustive, so consulting with your OBGYN is always recommended.

Implant (99%+ effective)

What it is: The birth control implant (Nexplanon) is a small, flexible rod about the size of a matchstick that's inserted under the skin of your upper arm. It releases progestin, a hormone that prevents pregnancy by stopping ovulation and thickening cervical mucus.‍

Protection against STIs: No‍

Duration: Up to 3 years‍

Considerations: Can cause irregular bleeding patterns (longer or shorter periods, spotting, or no bleeding at all). It’s reversible, and fertility returns quickly after removal. The implant can be felt under the skin.

Hormonal IUD (99%+ effective)

What it is: Hormonal intrauterine devices (Mirena, Kyleena, Skyla, Liletta) are small T-shaped devices placed in the uterus. They release small amounts of progestin locally, which thickens cervical mucus, thins the uterine lining, and often even suppresses ovulation, making pregnancy extremely unlikely. Certain brands, like Mirena and Liletta, can serve as emergency contraception if inserted within 5 days of unprotected sex.‍

Protection against STIs: No‍

Duration: 3-8 years‍

Considerations: Hormonal IUDs often lighten or even stop menstrual cycles over time, so they can be beneficial for people who have painful or heavy periods. They tend to be well-tolerated among all ages and can be preferred to the Copper IUD in people who haven’t given birth or have a smaller uterus, as these devices are generally smaller.

Copper IUD (99%+ effective)

What it is: A non-hormonal T-shaped device (Paragard) that uses copper's natural sperm-fighting properties to prevent pregnancy. It can also serve as emergency contraception if inserted within 5 days of unprotected sex.‍

Protection against STIs: No‍

Duration: Up to 10 years‍

Considerations: This is a good option for people who prefer or need to avoid hormonal birth control. Due to its larger size, though, it can be more challenging and/or painful to insert in people who haven’t given birth. It can also cause heavier, more painful, or longer periods.

Birth control shot (94% effective with typical use)

What it is: An injection of progestin (Depo-Provera) given every three months. It works by preventing ovulation and thinning the uterine lining, so there’s less chance an egg will attach to it.‍

Protection against STIs: No‍

Duration: 3 months per shot‍

Considerations:  Low-maintenance and minimizes user error. Can cause irregular bleeding and is associated with delayed return of ovulation and/or menses after stopping. Long-term use may lead to reversible bone density loss.

Birth control pills (93% effective with typical use)

What it is: Daily pills that come in two main types: combination pills (containing estrogen and progestin) and progestin-only pills (mini-pills). They prevent pregnancy by stopping ovulation and thickening cervical mucus.‍

Protection against STIs: No‍

Duration: Daily pill‍

Considerations: Many people prefer the pill as it’s non-invasive and can help control your cycle (i.e. skipping menstruation). Missing or taking pills at inconsistent times reduces protection, so consistent, daily use is important. Estrogen-containing pills should be avoided in people with certain health conditions, including history of blood clots, stroke, high blood pressure, migraine with aura, and people who smoke cigarettes.

Birth control patch (92% effective with typical use)

What it is: A thin patch (Xulane, Twirla, Zafemy) worn on the skin that releases estrogen and progestin. It's changed weekly for three weeks, followed by a patch-free week.‍

Protection against STIs: No‍

Duration: Weekly replacement needed‍

Considerations: Some brands could be less effective for individuals weighing over 198 lb. Also can cause skin irritation at the site of the patch. Shares the same estrogen-related risks as the pill and vaginal ring.

Vaginal ring (91% effective with typical use)

What it is: A flexible ring (NuvaRing, Annovera, EluRyng) inserted into the vagina that releases estrogen and progestin. It's worn for three weeks, followed by a ring-free week for menstruation.‍

Protection against STIs: No‍

Duration: 3 weeks‍

Considerations: Requires consistent timing for removal and insertion to be most effective. Shares the same estrogen-related risks as the patch and pills.

Male (External) condoms (87% effective with typical use)

What it is: A thin sheath worn over the penis during sexual activity, creating a barrier that prevents sperm from reaching an egg.‍

Protection against STIs: Some but not all (herpes, genital warts, syphilis, and mpox can be spread from skin-to-skin contact).‍

Duration: Single use‍

Considerations: Available without a prescription. Latex condoms are most common, but options are available for people who have a latex allergy or sensitivity. Must be applied correctly every time, stored properly, and be unexpired to be effective. Latex condoms can be broken down by oil-based lubricants, making them more likely to tear or rupture during use. 

Diaphragm (87% effective with typical use)

What it is: A shallow silicone cup inserted into the vagina before sex. Must be used with spermicide and left in place for at least 6 hours after sex.‍

Protection against STIs: No‍

Duration: No more than 24 hours‍

Considerations: Insertion and removal can be challenging. Increase risk of UTIs, especially when used with spermicide. Should be replaced every 1-2 years, or sooner if there are changes such as pregnancy or weight fluctuations.

Internal condoms (79% effective with typical use)

What it is: A polyurethane pouch inserted into the vagina before sex, creating a barrier that prevents sperm from reaching an egg.‍

Protection against STIs: Some but not all.‍

Duration: Single use‍

Considerations: May be more expensive and less widely available than male/external condoms. Should not be used with external condoms due to friction and breakage risk.

Spermicide (72% effective with typical use)

What it is: A chemical product that comes in various forms (foam, film, gel) and works by killing or immobilizing sperm and blocking the cervix.‍

Protection against STIs: No‍

Duration: Needs to be applied shortly before each act of intercourse‍

Considerations: May cause vaginal irritation. Frequent use of certain spermicides (containing an ingredient called nonoxynol-9) could actually increase risk of transmitting HIV. Less effective if used more than an hour before sex or not reapplied with repeated intercourse.

Fertility awareness methods (77-98% effective with perfect use)

What it is: Tracking fertility signs like basal body temperature and cervical mucus to avoid pregnancy during fertile days.‍

Protection against STIs: No‍

Duration: Ongoing daily tracking required‍

Considerations: Less effective with irregular ovulation and/or menstrual cycles. Things like stress, illness, and travel can impact ovulation and therefore effectiveness. 

Withdrawal method (78% effective with typical use)

What it is: Removing the penis from the vagina before ejaculation, also known as "pulling out."‍

Protection against STIs: No‍

Duration: Used during each act of intercourse‍

Considerations: Pre-ejaculate can still contain sperm. Free and always accessible. 

Making your choice

The effectiveness rates listed above refer to perfect use conditions. In real life, many factors can affect how well a method works, including user error, medication interactions, and timing. When choosing a birth control method, consider your lifestyle, health history, and comfort level with different options.

Consider talking with your OBGYN about:

• Your overall health and any medical conditions
• Current medications that might interact with certain methods
• Your menstrual cycle and any related concerns
• Your ability to follow the method's specific requirements
• Whether you need protection against STIs
• Your plans for future pregnancies
• Cost and insurance coverage

Remember that you can always switch methods if your first choice doesn't work well for you, and many people try several options before finding their ideal match. The best birth control method is one that you'll use consistently and correctly, fits your lifestyle, and helps you feel confident about your reproductive health.