There are so many different types of contraception, also known as birth control. And if you’re a human being having penis-in-vagina sex, preventing pregnancy may be desired for a good portion of your life.
Are you ready for some options?
Barrier methods, including internal and external condoms, diaphragms, cervical caps; spermicide gels; the sponge; pills (so many different types!); the patch; vaginal rings; the shot; pH-altering vaginal gel; the implant; intrauterine devices (IUDs); emergency contraceptives; Fertility Awareness Methods (FAM); breastfeeding (for postpartum moms); withdrawal (or “pulling out” — eek!); abstinence; permanent sterilization with either tubal ligation or vasectomy.
Whew! That’s a lot. All of these options can be very overwhelming. How do you choose what is best for you?
Let’s break down the basics of how you can make a decision.
1. Do I have access to a medical provider?
Access to health care is probably the biggest determinant of what type of birth control is available to you. Not everyone has a regular doctor or a nearby free clinic. Options that don’t require a prescription include condoms, spermicide or the sponge. That’s not very many, but they are easily accessible at almost any pharmacy or drug store.
With the advent of online pharmacies and online prescriptions, things like pills, patches, vaginal rings and emergency contraception have become more accessible and affordable. But to get the most reliable forms of birth control, an actual visit to a doctor is necessary for things like implants, IUDs and most certainly any surgical procedures for permanent sterilization.
Also, shoutout to the Affordable Care Act, which has made nearly all forms of contraception affordable (and often free) with most insurances.
2. Which method best prevents pregnancy?
Obviously, permanent forms of sterilization are extremely effective, but they are permanent and not feasibly reversible. You have to be 110% sure.
Most people are not there yet, but still want something just as reliable. This is where the LARCs, or Long-Acting Reversible Contraceptives, come into play. They are devices that are inserted into the body by your healthcare provider and can be extremely effective for many years. They are also low maintenance. Once they are placed, there is no need to remember to take or do anything. Both the implant and the IUD are over 99% effective, and are reversible with a return to baseline fertility as soon as they are removed.
Pills, patches and rings are all similar in effectiveness at 91%. And external condoms (sometimes referred to as male condoms) are about 85% effective. Combining condoms with other methods is also an option that can increase effectiveness (but by how much is unknown).
Withdrawal, aka the Pull-Out Method, is only about 78% effective. Bottom line: It’s not the best option if you really want to avoid pregnancy.
And finally, abstinence. Avoiding sex altogether is the only 100% effective method at preventing pregnancy, and is a reasonable choice for some. But for most people, it’s simply not realistic. Sex is a normal and healthy part of life and connection, which is why birth control choice and access is so important.
3. Do I also want to prevent sexually transmitted infections (STIs)?
This answer should be YES.
Condoms and dental dams are the only methods that can prevent infections such as gonorrhea, chlamydia, syphilis and HIV during sex. They can also decrease (but not completely prevent) transmission of herpes and HPV.
Adding a condom or dental dam to any of the prescription methods is an excellent addition for both additional birth control and prevention of STIs for all couples.
4. Do I want to improve my period, get rid of my period or maybe even improve my acne?
Many hormonal methods of birth control can also help to reduce bleeding and cramping with periods. Birth control pills, patches, rings, the shot, implant or hormonal IUDs can all improve and sometimes even eliminate periods. They all achieve this in different ways, so the best way to choose between them is to talk with your provider about your specific period concerns and goals.
One of the most pleasant side effects of many birth control pills that contain both estrogen and progestin (combined oral contraceptives) is an improvement in acne. The estrogen in combined birth control pills works to decrease the amount of free testosterone in the body. Testosterone is a frequent culprit of acne. So inc decreasing testosterone, there’s a decrease in the acne caused by it. But be patient — skin improvements aren’t often seen until around 3-6 months of being on the pill.
5. Do I want a hormonal method or should I avoid hormones?
Everyone reacts to supplemental hormones differently. Many bodies like the side effects of additional hormones (bye-bye, acne and heavy periods!). But some bodies don’t, getting side effects such as headache, nausea, bloating, mood changes and more. There are also risks associated with some hormones. It’s hard to know how hormones will affect you until you actually try them.
Some people have medical conditions, or are on medications, that don’t mix well with estrogen.
If you have migraines with aura, are a smoker over the age of 35, have a history of deep-vein blood clots or stroke, heart disease, liver disease, diabetes or high blood pressure, then you should avoid estrogen-containing birth control pills.
Choosing a birth control method can seem very overwhelming. Hopefully, asking yourself these five questions can help narrow down which options are best for you. And finally, always, always, always talk with your medical provider to discuss specific recommendations based on your medical history and goals.
If you found this article useful, learn what to expect ahead of your first gynecologist visit.
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