From IUDs to the Pill: The Ultimate Guide to Birth Control

With so many contraceptive options available, pregnancy and sexually transmitted disease (STD) prevention is relatively easy. But figuring out the best birth control option for you? Not so much. Whether you're in a long-term relationship or are just here for the hook-ups, we're taking the stress out of choosing the right form of birth control. Because sex shouldn't feel like homework.

There are many more birth control options out there than you may have heard about. From barrier to hormonal, here is everything you need to know about your choices. (Image: Twenty20/@verakharlamovaphotography)

Barrier vs. Hormonal: Which Form of Birth Control Is Right for You?

Two of the most widely-used forms of birth control are the barrier and hormonal methods. The main difference is each method's primary function. Barrier methods block sperm from entering the uterus, while hormonal ones have the ability to stop or regulate ovulation. Unlike hormonal methods of birth control, barrier birth control, such as condoms, diaphragms and sponges, can be used on an as-need basis — and some provide varying degrees of protection against STDs.

"Barrier birth control is great for women who don't want to use hormonal methods or who can't use them (due to interactions with hormonal medications)," says Sheila Loanzon, MD, OB-GYN and author of Yes, I Have Herpes. "This also works for women who don't want to have a daily medical regimen or invasive device placed in the body."

Loanzon recommends using both forms of contraception unless you're in a monogamous relationship. "By doing this, you're decreasing your risk of an undesired pregnancy and protecting against STDs," she says.

It's also worth noting that barrier birth control methods are a better option for women who are breastfeeding, as not all hormonal forms of birth control are safe while nursing.

Before you take your pick, here is everything you need to know about all of your options.

Barrier hormonal birth control options include condoms, female condoms and the cervical cap. (Image: Stocksy/Suzanne Clements)

Barrier Birth Control Options

1. CONDOMS

How it works: Applied to an erect penis, condoms prevent semen from entering the vagina.

Advantages:

  • Very accessible
  • Affordable
  • No prescription required
  • Prevents STDs, including HIV and viral hepatitis
  • Can prevent the spread of other diseases that can be transmitted through sex, including Ebola and Zika

Disadvantages:

  • Can decrease sexual sensation
  • May cause a reaction in people who have a latex allergy (If this is you, try using condoms that are made from polyurethane, polyisoprene, or lambskin. Keep in mind, though, lambskin condoms do not prevent STDs.)
  • Can break or slip off

Effectiveness rate: When used correctly, condoms have a 98 percent effectiveness rate at preventing pregnancy. That said, people don't always use condoms perfectly, so, statistically-speaking, they're about 85 percent effective.

Where to get it: Condoms are available for an affordable price (about $1 each) at most convenient stores, grocery stores, health centers, doctor's offices and even vending machines. They are not covered by insurance.

2. FEMALE CONDOMS

How it works: Inserted in a similar manner to a tampon before sex, female condoms prevent semen from entering the vagina by catching it in a small pouch. After intercourse, it is removed and thrown away.

Advantages:

  • Protects against STDs
  • No prescription required
  • Can be inserted ahead of time, allowing for spontaneity
  • Safe for people with latex allergies

Disadvantages:

  • Potential irritation in the vagina
  • May become "dislodged" and slip into the vagina during intercourse
  • Can make intercourse "noisy"

Effectiveness rate: When used perfectly, there's a 5 percent chance of getting pregnant. Overall, though, there's a 21 percent chance of pregnancy with the female condom.

Where to get it: Although they're not as widely-accessible as regular condoms, female condoms are available at drug stores, grocery stores and health centers. No prescription is required for the female condom, and, unlike male condoms, they can be covered by insurance. The Affordable Care Act (ACA) covers all forms of female contraception that are approved by the Food and Drug Administration (FDA).

3. THE SPONGE

How it works: Before having sex, the sponge is wet with water, allowing suds to form. It is then inserted deep inside the vagina in front of the cervix to prevent sperm from entering the uterus. It's held in place by the vaginal muscles and can be easily removed after intercourse by using the strap that it's outfitted with on one side. The sponge needs to stay in the vagina for at least six hours after intercourse, but no longer than 24. It is discarded after each use.

Advantages:

  • No prescription required
  • Can be inserted up to 24 hours before sex, allowing for impulsiveness
  • More comfortable than male and female condoms
  • Can be used with other forms of birth control to increase effectiveness

Disadvantages:

  • Doesn't protect against STDs
  • Spermicide in sponges may cause vaginal irritation
  • May cause urinary tract infections, toxic shock syndrome, and an increased risk for STDs
  • Can make sex messy

Effectiveness rate: The Mayo Clinic estimates that 12 out of 100 women who have never given birth will get pregnant during the first year of using the sponge; and 24 out of 100 women who have given birth will get pregnant.

Where to get it: Contraceptive sponges are available in drug stores and online for about $15 for a pack of three. Planned Parenthood centers may have them at low-cost or for free. Like the female condom, sponges are covered under the ACA.

4. DIAPHRAGM

How it works: After spermicide is placed on the diaphragm, it is squeezed together and inserted into the vagina in order to cover the cervix to prevent sperm from reaching the uterus. It needs to remain inside the vagina for at least 6 hours after intercourse, and can be kept in for 24 hours maximum.

Advantages:

  • Long-term cost-effective (one diaphragm can be used for up to 2 years)
  • More comfortable than condoms or female condoms
  • Can be used in conjunction with other forms of birth control, such as condoms, to increase effectiveness
  • Can be inserted up to 6 hours before sex
  • Silicon makes it safe for people with latex allergies

Disadvantages:

  • Does not prevent STDs
  • Requires a prescription
  • May cause urinary tract infections
  • Needs to be used with spermicide, which may cause irritation

Effectiveness rate: When used perfectly, the diaphragm is 94 percent effective. Overall, though, it has an 88 percent effectiveness rate.

Where to get it: In order to get a diaphragm, a prescription is required. In the past, fittings were required, but one of the most common diaphragms available today is Caya, which is one-size-fits-most.

5. CERVICAL CAP

How it works: After filling the small bowl in the cervical cap with 1/4 teaspoon of spermicide, it is inserted into the vagina, tall side first. Similar to the sponge and diaphragm, it is pushed back to cover the cervix to prevent sperm from entering the vagina.

Advantages:

  • Cost effective in the long-term (one cervical cap can be used for 2 years)
  • Can be inserted up to 6 hours before sex, allowing for spontaneity
  • Can be left in up to 48 hours after sex
  • Generally considered more comfortable than condoms or female condoms

Disadvantages:

  • Does not prevent against STDs
  • Cannot be used during menstruation
  • Considerably less effective for women who have already given birth
  • Needs to be used with spermicide, which can be irritating
  • Not suitable for women with vaginal or cervical abnormalities
  • Requires a fitting and prescription

Effectiveness rate: It's estimated that 16 out of 100 women who have never been pregnant or given birth vaginally will get pregnant in the first year of typical cervical cap use. An estimated 32 out of 100 women who have been pregnant or given birth get pregnant within a year of use.

Where to get it: The cervical cap needs to be prescribed by a doctor. That said, up-to-date prescriptions allow for online purchase. Most insurance plans will cover FemCap, which is the only cervical cap approved by the FDA in the United States. For people without insurance, cervical caps can cost up to $275, including the price of an exam.

6. COPPER IUD (NON-HORMONAL IUD)

How it works: ParaGard is a small t-shaped device that's inserted into the uterus by a health care provider. It prevents fertilization by creating an environment that's toxic to sperm.

Advantages:

  • Low-maintenance: Can be effective for up to 10 years
  • Can be removed at any time by health care practitioner
  • Does not need to be inserted/removed before and after sex
  • Can be used as emergency contraception if inserted up to 5 days after sex
  • Long-term cost-effective

Disadvantages:

  • Does not protect against STDs
  • Can cause bleeding between periods
  • Can cause severe menstrual cramps and heavy bleeding
  • Needs to be inserted and removed by a health care professional

Effectiveness rate: ParaGard, the only FDA-approved copper IUD in the United States, has a rate of about 99 percent effectiveness.

Where to get it: Only health care providers can insert IUDs. Most insurance companies cover the cost of ParaGard. For those without insurance, the cost is between $500-$1,000.

Hormonal options include the pill, implants and the vaginal ring. (Image: Stocksy/Leandro Crespi)

Hormonal Birth Control Options

1. THE PILL

How it works: There are two types of birth control pills: Combination pills (COCs) and progestin-only pills (mini pills). With both types, a pill needs to be taken every day, but with the former, time isn't an issue. Mini pills need to be taken within the same 3-hour window each day in order to be fully effective.

Most pills come in 21- or 28-day packs. When using a 21-day pack, simply don't take any pills for the fourth week (which is when menstruation occurs). Twenty-eight day packs contain "reminder" pills that can or cannot be taken during the fourth week. With both types, a new pack of pills needs to be started every 28 days.

By releasing estrogen and progestin, COCs prevent pregnancy by stopping ovulation and thickening cervical mucus, which creates a barrier that prevents sperm from entering the uterus. Mini pills do the same thing, but by releasing progestin only.

Advantages:

  • Can regulate periods
  • Can help with cramps, bloating, and PMS
  • Can reduce the risk of endometrial and ovarian cancers
  • Can prevent anemia
  • Some pills allow women to skip periods altogether

Disadvantages:

  • Does not prevent STDs
  • Needs to be taken every day
  • Requires a prescription
  • Can cause nausea, breast tenderness, and spotting in between periods
  • Can lower libido

Effectiveness rate: When used correctly, birth control pills are 99 percent effective. Of course, not everyone remembers to take their pill every day, so the overall effectiveness of the pill is considered to be 91 percent.

Where to get it: In order to get the pill, a prescription is required. Insurance covers birth control pills, but some plans will only pay for certain brands or generic versions. For people without health insurance, there are government programs, such as Medicaid, which absorb some of the costs.

2. PROGESTIN IUD

How it works: As with the copper IUD, progestin IUDs are inserted at the doctor's office in a 5-10 minute procedure. Progestin IUDs also alter the environment of the uterus, so fertilization is prevented. The device releases a small amount of progestin, which thickens cervical mucus and creates a barrier between sperm and the uterus. IUDs can be effective between 3-7 years.

Advantages:

  • Low-maintenance
  • Long-term cost-effective
  • Estrogen-free
  • May lessen periods, as well as cramps, or stop periods altogether

Disadvantages:

  • Must be inserted and removed by a health care practitioner
  • Can cause irregular bleeding
  • Can cause cramping after insertion
  • Does not protect against STDs

Effectiveness rate: Hormonal IUDs generally have a 99 percent effectiveness rate.

Where to get it: IUDs need to be inserted at the doctor's office. Insurance usually covers the cost, but may be limited to certain brands. Without insurance, IUDs can cost up to $1,300, but may be more easily obtainable through government plans such as Medicaid.

3. IMPLANTS

How it works: A small, flexible plastic rod is inserted into the upper arm by a health care provider. The procedure takes about a minute, and is effective for up to three years. Birth control implants released a low-dose of progestin, which prevents ovulation and thickens cervical mucus, creating a barrier between sperm and the uterus.

Advantages:

  • Low-maintenance
  • Long-term cost-effective
  • Does not contain estrogen
  • Periods may become lighter

Disadvantages:

  • May cause changes in menstrual cycle
  • Does not protect against STDs
  • Potential decrease in sex drive
  • Potential nausea and back pain
  • Needs to be inserted and removed by a health care practitioner

Effectiveness rate: Birth control implants typically have a 99 percent effectiveness rate.

Where to get it: Implants need to be inserted at a doctor's office. Generally, they're covered by insurance, but for those without insurance, government programs such as Medicaid can help mitigate costs (which can be up to $1,300.)

4. THE PATCH

How it works: Just as combination birth control pills release progestin and estrogen, so does the patch. But rather than taking a pill each day, a thin, plastic patch is placed on the upper torso, upper arm, buttocks, or lower back. The patch is left in place for one week, and once the week is up, it is replaced with a new patch. During the fourth week, no patch is worn, which typically is when menstruation occurs. The primary way the hormones in the patch prevent pregnancy is by preventing ovulation.

Advantages:

  • Generally low-maintenance
  • Non-invasive
  • May improve acne
  • Can help alleviate menstrual cramps and heavy periods

Disadvantages:

  • Requires a prescription
  • Does not protect against STDs
  • Spotting between periods may occur
  • May cause occasional nausea
  • Contains estrogen

Effectiveness rate: Birth control patches have a 99 percent effectiveness rate.

Where to get it: Birth control patches can only be obtained through a prescription, which doctors, health clinics and Planned Parenthood can provide. The patch is usually covered by insurance, but those without can mitigate the cost (generally around $150) through government programs such as Medicaid.

5. VAGINAL RING

How it works: Through the hormones progestin and estrogen, the vaginal ring stops ovulation and creates a barrier between sperm and the uterus. It's a small flexible ring that's inserted into the vagina (at home) and left in for three weeks. During the fourth week (menstruation), the ring is removed. A new ring is used with each new cycle.

Advantages:

  • Generally low-maintenance
  • Can lighten period cramps
  • Can help acne

Disadvantages:

  • Requires office visit and prescription
  • Does not protect against STDs
  • Slight risk of toxic shock syndrome
  • May increase vaginal discharge
  • Contains estrogen

Effectiveness rate: The vaginal ring, often referred to as NuvaRing, is considered 99 percent effective.

Where to get it: NuvaRing can only be obtained through a prescription. Insurance covers the cost, which can be up to $200 a month. For people without insurance, government programs such as Medicaid can help.

6. BIRTH CONTROL SHOT

How it works: Depo-Provera is an injection in the upper arm, given every three months at the doctor's office. The shot contains progestin, which stops ovulation, as well as thickens the cervical mucus, creating a barrier in between sperm and the uterus.

Advantages:

  • Generally low-maintenance
  • Does not contain estrogen
  • May stop periods altogether
  • May decrease risk of endometrial cancer

Disadvantages:

  • Prescription/office visit required
  • Requires doctor visit every 3 months
  • Can take 6-10 months to get pregnant after stopping
  • May cause bone-thinning during use
  • Doesn't prevent against STDs

Effectiveness rate: The birth control shot, usually called Depo-Provera, is considered 99 percent effective.

Where to get it: The shot is only administered by health care practitioners. It's generally covered by insurance, but for people who don't have it, government programs, such as Medicaid, can help mitigate costs.

7. THE CALENDAR METHOD

How it works: The calendar method involves getting to know one's cycle — and fertile days — inside and out. It's generally recommended that, before employing this method, women chart their cycles for six months. This way, they'll know when they're ovulating and avoid sex on those days.

To determine the most fertile days, women should subtract 18 from the total number of days in their shortest cycle — this is the first fertile day in the cycle. They should then subtract 11 from the length of the longest menstrual cycle, which represents the last fertile day in the cycle.

Advantages:

  • Cost-effective
  • No external risks or side effects

Disadvantages:

  • Does not prevent STDs
  • Eliminates sex altogether on certain days
  • Requires months of research
  • Considered one of the least effective ways to prevent pregnancy

Effectiveness rate: According to Planned Parenthood, the calendar method — also known as the rhythm method — is between 76-88 percent effective.

Permanent Birth Control Options

1. TUBAL LIGATION

How it works: Tubal ligation, also known as "getting your tubes tied," permanently prevents pregnancy by cutting the fallopian tubes, tying them, clamping them and sealing them shut. This procedure can be done in a doctor's office or hospital, and involves being put to sleep. The procedure takes about 30 minutes and patients return home the same day.

Advantages:

  • Low-maintenance once performed
  • Extremely effective at preventing pregnancy
  • Doesn't affect hormones

Disadvantages:

  • Difficult to reverse
  • Does not prevent STDs
  • Possible infections from surgery
  • Rare risk of an ectopic pregnancy, which can be life-threatening

Effectiveness rate: Tubal ligation is over 99 percent effective.

Where to get it: Only doctors can perform tubal ligation, and the surgery can cost up to $6,000, including follow-up visits. Insurance may cover some or all of this procedure.

2. VASECTOMY

How it works: Vasectomies are out-patient surgeries that involve the small tubes in the scrotum being blocked off or cut, so sperm isn't able to leave the body. The two types of vasectomies are the incision method and the no-cut method. The latter lowers the risk of infection and usually makes for a speedier recovery.

Advantages:

  • Low-maintenance once performed
  • Extremely effective at preventing pregnancy
  • More affordable than tubal ligation

Disadvantages:

  • Difficult to reverse
  • Does not prevent STDs
  • Possible infections from surgery

Effectiveness rate: Vasectomies are over 99 percent effective.

Where to get it: Vasectomies, which can cost up to $1,000, can only be performed at doctor's offices, hospitals, or health centers. The ACA does not cover this procedure, but some insurance companies will cover some, or even all, of the cost.

In Case of Emergency

PLAN B

How it works: Emergency contraceptive pills are swallowed like any other pill after having unprotected sex. In order to be most effective, it should be taken within three days of intercourse. Depending on where a woman is at in her menstrual cycle, emergency contraceptive pills delay or prevent ovulation. And if fertilization has already occurred, it can prevent the egg from being implanted in the uterus.

Advantages:

  • Works as a backup
  • Easily-accessible

Disadvantages:

  • Does not protect against STDs
  • Not suitable for women who cannot take birth control pills
  • May cause nausea

Effectiveness rate: Plan B and other emergency contraceptive pills, are between 75 and 98 percent effective when taken within five days of unprotected sex.

Where to get it: Emergency contraceptive pills are available at drug stores, doctor's offices and health centers. If the emergency contraceptive pill is prescribed by a doctor, it is covered under the ACA. If it is bought at a drug store, it is paid for out of pocket, but may be available for reimbursement.

Hoping to rely on the pull-out method instead? You might want to reconsider. (Image: Stocksy/Michela Ravasio)

Does the Pull-Out Method Work?

"The pull-out method, also known as withdrawal, works ONLY if you don't mind being repeatedly sexually frustrated and having an unintended pregnancy!" says Donnica Moore, MD, host of the podcast In the Ladies' Room with Dr. Donnica. "And, to make matters worse, this method offers zero protection from STDs."

Moore also notes that it's extremely difficult to know when men's pre-ejaculate fluid (pre-cum) will be released. "While most sperm in pre-cum are dead or immotile, there may be live sperm in that fluid and that's when accidents happen."

How often? According to Planned Parenthood, for every 100 women who use the pull-out method perfectly, 4 will get pregnant every year.

Can You Get Pregnant From Having Sex on Your Period?

In short, yes. That said, it's pretty unlikely. "When looking at the physiology of the menstrual cycle, it is unlikely for someone to get pregnant when on their period because most people will ovulate approximately two weeks after their period starts," MD and OB-GYN Loanzon says.

"However, abnormal or irregular bleeding can be mistaken for a period and that is when someone is at risk for pregnancy if they are having unprotected sex. There may be different ovulation times occurring that are unreliable." Women also have a higher chance of conceiving during their period if their cycle is on the shorter side, and their period on the longer.

"Most women only have about 6 days during a cycle in which they're likely to conceive — their fertile window," Moore notes. "But when their cycle is short and their period is long, the fertile window could begin during their period."

How common is this? Estimates are that 2 percent of women are in their fertile window by day 4 of their cycle. Worth the risk? Probably not.

At the end of the day, sex should be a fun activity, filled with excitement and discovery. The last thing you should be worried about is an unwanted pregnancy or an STD — and with all the methods available, you should not have to. Happy bedroom fun time!

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