• Also called natural family planning, fertility
awareness means avoiding sex when the woman is
most fertile. The most reliable way to do this is to
watch for changes in cervical mucus and body
temperature. To use this method correctly, it's best
to get training from a health care professional.
• Pros: No drugs or devices, inexpensive.
• Cons: Limits spontaneous sex, 25% of typical users
• Spermicide contains a chemical that kills sperm. It
comes in the form of foam, jelly, cream, or film that
is placed inside the vagina before sex. Some types
must be put in place 30 minutes ahead of time.
Frequent use may cause tissue irritation, increasing
the risk of infections and STDs. Spermicides are most
often used along with other birth control methods.
• Pros: Easy to use, inexpensive ($1 per use).
• Cons: May increase the risk of STDs, 29% get
• The latex condom is the classic barrier method. It
prevents sperm from entering the woman's body,
protecting against pregnancy and STDs. Of couples
who rely only on male condoms, 15% get pregnant
in a year.
• Pros: Widely available, protects against STDs,
inexpensive (under $1 each).
• Cons: Only effective if used correctly every time.
Can't be reused.
• Female Condom
• The female condom is a thin plastic pouch that lines
the vagina and can be put in place up to 8 hours
before sex. Users grasp a flexible, plastic ring at the
closed end to guide it into position. It's somewhat
less effective than the male condom.
• Pros: Widely available, some protection against
STDs, conducts body heat better than a male
• Cons: Can be noisy, 21% of users get pregnant, not
reusable. Should not be used with a male condom,
to avoid breakage.
• The diaphragm is a rubber dome that is placed
over the cervix before sex. It is used with a
spermicide. Effectiveness compares to the male
condom – 16% of average users get pregnant,
including those who don't use the device correctly
• Pros: Inexpensive (a $15-$75 device lasts two years.)
• Cons: Must be fitted by a doctor, no STD protection.
Can't be used during your period due to a risk of
toxic shock syndrome.
• A cervical cap is similar to a diaphragm, but
smaller. The FemCap slips into place over the cervix,
blocking entry into the uterus. It is used with
spermicide. The failure rate for the cervical cap is
15% for women who have never had children and
30% for those who have.
• Pros: Can stay in place for 48 hours, inexpensive.
• Cons: Must be fitted by a doctor, no protection
Birth Control Sponge
• The birth control sponge, sold as the Today Sponge,
is made of foam and contains spermicide. It is
placed against the cervix up to 24 hours before sex.
The sponge is about as effective as the cervical
cap, with a failure rate of 16% for women who have
never had children and 32% for those who have.
But unlike the diaphragm or cervical cap, no fitting
by a doctor is required.
• Pros: No prescription, effective immediately.
• Cons: Difficult to insert correctly, no STD protection.
Can't be used during your period.
Birth Control Pill
• The most common type of birth control pill uses the
hormones estrogen and progestin to prevent ovulation.
When taken on schedule, the pill is highly effective.
About 8% of typical users get pregnant, including those
who miss doses. Like all hormonal contraceptives, the pill
requires a prescription.
• Pros: More regular, lighter periods, or no periods,
depending on the type of pill. Less cramping.
• Cons: Cost ($15-$50 per month), no STD protection. May
cause side effects, including breast tenderness, spotting,
serious blood clots, and raised blood pressure. Some
women should not use birth control pills.
Birth Control Patch
• Women who have trouble remembering a daily pill
may want to consider the birth control patch. The
Ortho Evra patch is worn on the skin and changed
only once a week for three weeks with a fourth
week that is patch-free. The patch releases the
same types of hormones as the birth control pill and
is just as effective.
• Pros: More regular, lighter periods with less
cramping, no need to remember a daily pill.
• Cons: Cost ($15-$50 per month), may cause skin
irritation or other side effects similar to birth control
pills. Doesn't protect against STDs.
• Vaginal Ring
• The NuvaRing is a soft plastic ring that is worn inside
the vagina. The ring releases the same hormones as
the pill and patch and is just as effective. But it only
needs to be replaced once a month.
• Pros: Lighter, more regular periods, only replaced
once per month.
• Cons: Cost ($30-$50 per month), may cause vaginal
irritation or other side effects similar to pills and the
patch. Doesn't protect against STDs.
Birth Control Shot
• The birth control shot, known as Depo-Provera, is a
hormonal injection that protects against pregnancy
for three months. For the typical couple, it is more
effective than the birth control pill -- only 3% of users
get pregnant in a year.
• Pros: Only injected four times per year, highly
• Cons: Cost (about $240 per year), may cause
spotting and other side effects. Doesn't protect
Birth Control Implant
• The birth control implant (Implanon) is a matchstick-
sized rod that is placed under the skin of the upper
arm. It releases the same hormone that's in the birth
control shot, but the implant protects against
pregnancy for 3 years. The failure rate is less than
• Pros: Lasts three years, highly effective.
• Cons: More expensive upfront ($400-$800 for exam,
implant, and insertion), may cause side effects,
including irregular bleeding. Doesn't protect against
• IUD stands for intrauterine device, a T-shaped piece
of plastic that is placed inside the uterus by a
doctor. The copper IUD, ParaGard, works for as long
as 12 years. The hormonal IUD, Mirena, must be
replaced after 5 years. Both types make it more
difficult for sperm to fertilize the egg. Fewer than
eight in 1,000 women get pregnant.
• Pros: Long-lasting, low-maintenance.
• Cons: Irregular or heavier periods. More expensive
upfront, may slip out, may cause side effects.
• If you're sure you won't want biological children in
the future, you may be ready for permanent birth
control. The traditional method for women is called
tubal ligation or "having your tubes tied." A surgeon
closes off the fallopian tubes, preventing eggs from
making their journey out of the ovaries. (The
banding method is shown here.)
• Pros: Permanent, nearly 100% effective.
• Cons: Requires surgery, may not be reversible,
expensive. Doesn't protect against STDs.
• Besides condoms, a vasectomy is the only birth
control option available to men. It involves
surgically closing the vas deferens – the tubes that
carry sperm from the testes, through the
reproductive system. This prevents the release of
sperm but doesn't interfere with ejaculation.
• Pros: Permanent, cheaper than tubal ligation,
almost 100% effective.
• Cons: Requires surgery, not effective immediately,
may not be reversible.
• A newer procedure makes it possible to block the
fallopian tubes without surgery. Small implants of
metal or silicone are placed inside each tube. Scar
tissue eventually grows around the implants and
blocks the tubes. Once an X-ray confirms the tubes
are blocked, no other form of birth control is
• Pros: Permanent, no surgery, almost 100% effective.
• Cons: Takes a few months to become effective.
May raise the risk of pelvic infections, irreversible,
• Emergency contraception works after sex to help
avoid pregnancy. This is an option if no birth control
was used or if a woman suspects her usual method
failed. Plan B, Plan B One-Step, and a generic
version of Plan B called Next Choice all contain a
high dose of a hormone found in many birth control
pills. No prescription is needed for women aged 17
and older. These types must be used within 72 hours.
Ella uses a non-hormonal drug and requires a
doctor's prescription. It can be taken up to five days
Options for Older
• Age and lifestyle are important factors in choosing
a form of birth control. If you're over age 35 and
smoke or are obese, the combination birth control
pill, patch, and ring are not recommended. It's best
to consult your doctor about safe alternatives. If
you're approaching the age of menopause, the
birth control shot has an added benefit: It may
relieve some of the symptoms of perimenopause.
• Nearly six in 10 American women report that a
partner has used "pulling out," the age-old method
that relies on the man withdrawing his penis from
the vagina before ejaculation. Newer reviews show
that when it's done correctly every time, about 4%
of users get pregnant in a year. With more typical
use, about 18% get pregnant.
• Pros: Free, no need for devices or
Least Effective Methods
• Without using any form of birth control,
85% of sexually active couples will get
pregnant within a year. Even the least
effective birth control options reduce
that number considerably.
Most Effective Method?
• Although barrier methods, such as the condom or
diaphragm, are moderately effective with typical
patterns of use, hormonal contraceptives have a
better track record for effectiveness. There are also
several options for couples that prefer the lowest
possible odds of getting pregnant. Two of these are
reversible -- the IUD and hormonal implant. Of
course, the only birth control method that is 100%
effective is……………………. abstinence.