How to Find the Best Birth Control for You

Finding the best birth control for you can feel a little like finding a life partner: There’s some trial and error, maybe some bad experiences, and then finally (hopefully), a committed relationship. It may be surprising to learn that birth control options haven’t radically changed since 1960, when both the IUD and the pill became available, ushering in the modern era of contraception. But thankfully, the options we do have are effective.

So how do you know which method of birth control to choose? Allow us to break it down and help you find the best birth control for you.

The Pill

How the pill works: The pill is a hormonal contraceptive, meaning it prevents pregnancy by tinkering with your hormones—specifically by supplementing your levels of estrogen and progestin. “These hormones suppress ovulation and thicken the cervical mucus and thin the lining of the uterus,” which makes pregnancy highly unlikely, says Amy Bryant, MD, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine. 

Effectiveness of the pill: If you use birth control pills perfectly—meaning you take it at the same time every day—it’s about 99% effective. But since most people aren’t perfectly on point all the time, the actual effectiveness for typical use is really closer to 92%, Dr. Bryant says.

Side effects of the pill: Common side effects of the pill are pretty mild: nausea, breast tenderness, and headaches (especially in the first few months of use, Dr. Bryant says). If you miss a pill, you might also experience some breakthrough spotting. The side effects aren't all negative: Going on oral contraceptives can improve menstrual cramps, PMS, and heavy bleeding, and help rein in an irregular cycle. There are two types of pills: combination pills that contain progestin and estrogen, and progestin-only pills, or mini pills. The mini pill is slightly higher-maintenance because you have to take it at the same time every day. But it makes more sense for women who are breastfeeding or have a history of migraines or blood clots. And while it has fewer good side effects—the combination pill can make your skin better and even prevent certain cancers, including endometrial and ovarian cancer—it’s also less likely to cause negative side effects.

How to know whether the pill is right for you: “If you’re a person who doesn’t have trouble taking a pill daily—say, you have a very regular routine or you’re already taking pills daily—and you have no risk factors like heavy smoking, high blood pressure, or a history of blood clots, pills are very simple and straightforward and many women like them,” says Dr. Bryant. They’re also a good option if you struggle with acne. For many women, the pill can help clear up skin issues.

The Patch

How the patch works: The patch prevents pregnancy in a method similar to the pill (by using hormones), but instead of taking the estrogen and progestin orally, the hormones are absorbed through a small patch—like a super-sticky Band-Aid—that you place on your skin once a week.

Effectiveness of the patch: With perfect use, the patch is about 98% effective; typical use is closer to 92% effectiveness.

Side effects of the patch: Much like the pill, side effects of using the patch are typically no biggie: Some women experience nausea, breast tenderness, and headaches, especially in the first few months of use. There are some more-concerning side effects to watch out for, however. The patch, which typically has a higher dose of estrogen than the pill, can up your risk of blood clots, heart attack, stroke, and high blood pressure, says Dr. Bryant. 

How to know whether it's right for you: “If you don’t want to take a pill every day but also want to avoid a longer-acting method, this could work well for you,” says Dr. Bryant. “It’s not for women with [a history of] heavy smoking, high blood pressure, or a history of blood clots.”

IUDs

How IUDs work: Intrauterine devices, or IUDs, are implanted directly inside your uterus (it’s a quick in-office procedure similar to a Pap smear) to prevent pregnancy. With this type of birth control, you may still ovulate every month, unlike with the pill or the patch. Rather than blocking ovulation, the IUD works by preventing sperm from getting to your eggs.

One type of IUD, a hormonal IUD, accomplishes this by “releasing a small amount of hormone daily that thickens the cervical mucus and thins out the uterine lining,” says Dr. Bryant. The barrier makes it nearly impossible for sperm to get to an egg. It also may stop your ovaries from releasing an egg in the first place. No egg, no pregnancy.

There’s also a nonhormonal IUD available; instead of hormones, it uses copper to help prevent pregnancy. “The copper in the IUD causes a sterile, inflammatory reaction in the lining of the uterus,” which also makes it next to impossible for a sperm and egg to meet and implant, says Dr. Bryant.

Effectiveness of IUDs: IUDs are among the most effective form of birth control you can get—more than 99%. The best part? Since it’s just chilling in your uterus, there’s no room for user error, meaning the effectiveness of IUDs doesn’t decrease the way it would if you forgot a pill.

Side effects of IUDs: Side effects aren’t always a bad thing: Many women experience lighter (or no) periods over time after getting a hormonal IUD. While you might have a little spotting, breast tenderness, or acne flare-ups at first, the side effects are typically much lower than those of other types of birth control, Dr. Bryant says. “Most of the hormone in the hormonal IUD acts locally in the uterus, so some systemic side effects, like the breast tenderness, are possible, but usually not as pronounced as with methods like pills or the implant, which provide higher levels to suppress ovulation,” she says.

With nonhormonal IUDs, there are no systemic effects, but you might notice changes in your menstrual cycle. “Many women will experience heavy, slightly longer and crampier periods with this method, especially in the first few months,” Dr. Bryant says. You might also notice some spotting midcycle.

How to know whether an IUD is right for you: Women with IUDs tend to love them because they last for years—once the IUD is inserted, it's effective immediately and lasts for anywhere from 3 to 10 years. (This varies by brand so, ask your gyno which brand might be best for you and how long it lasts.)

If you have an especially heavy period or are prone to painful menstrual cramps, a hormonal IUD can help ease the monthly pain. “It’s also great for women who don’t want the hassle of a monthly period,” Dr. Bryant says.

If you’re looking for a nonhormonal birth control method, the copper IUD is the most effective. “This is great for women who are really motivated to avoid all hormones, don’t have superheavy periods to begin with, and would like to continue to have a regular monthly period,” says Dr. Bryant.

The Implant

How the implant works: The birth control implant falls in the same category as IUDs (long-acting reversible contraceptives, or LARCs), but instead of living in your uterus, the little piece of plastic (about the size of a matchstick) is inserted under the skin in your upper arm. “It releases a small amount of hormone daily that acts to suppress ovulation, thicken the cervical mucus, and thin the lining of the uterus,” says Dr. Byrant.

Effectiveness of the implant: More than 99% effective, it’s the most effective type of birth control you can get.

Side effects of the implant: The implant comes with the usual list of potential side effects, namely, breast tenderness and headaches related to the hormones. You may also notice mood swings and decreased sex drive, according to Planned Parenthood. “The most common side effect is unpredictable bleeding,” says Dr. Bryant. “Most women will overall have lighter bleeding in a month, but more days of spotting.” Some women—about a 25%, she says—stop having a period altogether, while around 20% actually experience more bleeding.

How to know whether it’s right for you: “This is great for women who want to avoid a pelvic exam, don’t like the idea of something in their uterus, and would like a really simple, forgettable form of birth control,” says Dr. Bryant. “It’s reversible, so if it turns out it’s not right for you, you can always have it removed and try something else.” The implant is effective for up to five years.

The Ring

How the ring works: Like the pill and the patch, the vaginal ring, a rubbery circle that looks a bit like a hair tie, works by blocking ovulation with estrogen and progesterone. “The patient puts the ring in her vagina once a month, and the hormones get absorbed,” says Heather Beall, MD, a board-certified ob-gyn in Illinois.

Effectiveness of the ring: If it's used perfectly, the ring is 99% effective. But for those who don't put in their ring on schedule, its effectiveness drops to about 91%. 

Side effects of the ring: The ring has similar side effects to the pill and other hormonal birth control methods—a little spotting or breakthrough bleeding in the first few months is common.

How to know whether the ring is right for you: The ring has a lower dose of estrogen (only 15 micrograms) than most versions of the pill, so if you’re worried about hormonal birth control, the ring might be a more attractive option. Plus, it’s effective immediately: “Once the ring is in, it is working,” says Dr. Beall.

Condoms

How condoms work: “Condoms work by providing a barrier to prevent the sperm from entering the uterus, thus preventing pregnancy,” says Dr. Beall. “Some condoms also have a spermicide coating that kills the sperm and adds more pregnancy prevention.” And—important—they're also the only form of birth control that helps prevent many STIs.

Effectiveness of condoms: Condoms leave a lot of room for user error: Slippage, breakage, and not using one every time are just a few top ways they can fail to be a perfect method. With that in mind, the Centers for Disease Control and Prevention (CDC) estimates they’re only 87% effective at preventing pregnancy.

Side effects of condoms: The upside? Male condoms can be bought over the counter (so they’re readily available) and are relatively side-effect-free. “They may decrease sexual pleasure for some and can interfere with intercourse to put it on,” says Dr. Bryant. “Some people have allergies or irritation from the materials or lubricants on condoms.”

How to know whether condoms are right for you: “For most young people who really don’t want to be pregnant, they should also use a second means of pregnancy prevention,” says Dr. Beall. In other words, unless you’re okay with an accident, don’t rely on condoms as your first line of defense against pregnancy.

You should always use them for protection from sexually transmitted infections, however. Speaking of STIs, female condoms can also prevent infections, but they’re considerably less effective in preventing pregnancy—79% effective with typical use.

The Morning-After Pill

How emergency contraception works: The “morning-after pill,” which is available at most pharmacies, works by preventing or delaying ovulation. It is not an abortion pill. If an egg has already been fertilized, emergency contraception won’t do anything.

Effectiveness of emergency contraception: With that in mind, time is of the essence with emergency contraception; the sooner you use it, the more effective it is, says Dr. Beall. It can be used up to five days after “unprotected sex or contraception failure (like a broken condom),” she says. In that window, it can be up to 89% effective. But certain factors can lower its effectiveness: The longer you wait to take it, for example, the less effective it will be. 

Side effects of emergency contraception: Nausea and vomiting are the most common side effects, according to Planned Parenthood. If you throw up within two hours of taking the pills, check in with your health care provider to see whether they recommend taking another dose.

How to know whether emergency contraception is right for you: Emergency contraception is not meant to be your main method of birth control. Like the name implies, it should be used only if your usual method fails.

Contraceptive Gel

How contraceptive gel works: You've probably heard of spermicide—chemicals that stop sperm from reaching an egg by slowing them down and blocking the entrance to the cervix. Like spermicide, contraceptive gel is inserted into your vagina before sex. But it works by lowering the pH in your vagina, creating a more acidic environment that makes it tougher for sperm to swim and lowers the chances they will reach an egg. Contraceptive gel needs to be inserted one hour before sex, and can be used with other birth control methods, such as the pill, diaphragms, or condoms. 

Effectiveness of contraceptive gel: Used perfectly, contraceptive gel can be 93% effective. But its real-world effectiveness—thanks to user errors, such as inserting it incorrectly or waiting too long to have sex after insertion—can be as low as 86%. You can increase its effectiveness by following its instructions carefully, and using a backup birth control method.

Side effects of contraceptive gel: The most common side effects of contraceptive gel are vaginal discharge, bacterial vaginosis, burning, itching, and irritation in your vagina, and yeast and UTIs—so experts recommend that women with a history of urinary tract problems shy away from it, as it could agitate existing issues. And contraceptive gel could irritate your partner too: If either of you are sore after using it, you may be sensitive. 

How to know whether contraceptive gel is right for you: Contraceptive gel is a nonhormonal birth control, which means that if you're worried about the side effects of hormonal birth control—such as mood changes or weight fluctuations—it could be a good option for you. It's also good for people who don't want to use birth control when they're not actively having sex; you only need to use it within an hour of the action. But if you're worried you might forget to use it, or have a history of urinary issues, it probably isn't right for you. And to prevent STI's, it should be used with condoms.

Emily Shiffer is a freelance writer in Pennsylvania, covering health, wellness, and nutrition. Follow her @emilyjshiffer. Additional reporting by Jillian Kramer. 

More on family planning and methods of birth control:

• The Birth Control Pill Only Works If You Remember to Take It, So It Didn’t Work for Me
• Access to Different Methods of Birth Control Allowed Me to Become a Mom When I was Ready, Not a Moment Before
• Because I Have Birth Control Options, I Won't Get Pregnant Again—Unless I Want To