There are many factors to consider when looking for the best birth control technique for you, including The Ultimate Comparison: Which Birth Control Method is the Most Effective:
• How your chosen method impacts your menstrual cycle
• what potential side effects it may have
• length of time it will keep you from becoming impregnated
However, one of the most important factors is how effectively it inhibits pregnancy.
The Science behind Birth Control Effectiveness: Understanding the Criteria for Evaluation
According to Dr. Justine Wu, an assistant professor at the University of Michigan, the most effective methods are those that require minimal user involvement. The less dependent a method is on human input, the lower the chance of error, making it more effective. Dr. Wu, who is also the chair of the Association of Reproductive Health Professionals, suggests that methods that work autonomously are the most reliable. This implies that technology-based methods such as implants, intrauterine devices (IUDs), and sterilization procedures are among the most effective forms of contraception available to users.
Implant
The contraceptive implant, a progestin-releasing matchstick-sized device, boasts a typical use failure rate of only 0.1% according to the CDC. Inserted under the skin of the upper inner arm by a healthcare provider, the implant works by thickening cervical mucus to impede sperm movement and inhibiting the release of eggs from the ovaries. After the simple insertion procedure, the implant requires minimal effort from the user, making it an appealing option for those seeking a hassle-free contraceptive method. However, users should be aware of the potential systemic side effects associated with the hormones in the implant and consider their comfort level with having a foreign object under their skin.
Male Sterilization
Male sterilization, or a vasectomy, has a typical use failure rate of just 0.15% according to the CDC. The procedure involves blocking or cutting the vas deferens, the tubes that carry sperm from the testicles, making it impossible for sperm to leave a man’s body during ejaculation. Unlike female sterilization, which involves invasive abdominal surgery, vasectomies are less risky and can be performed in a doctor’s office using local anesthesia. While the procedure can sometimes be reversed, it is intended to be permanent, making it an ideal option for those who are sure they don’t want to father children in the future.
Hormonal IUD
With a typical use failure rate of 0.1-0.4%, the hormonal intrauterine device (IUD) is a long-acting and highly effective contraceptive option. Inserted into the uterus by a healthcare provider during a quick in-office procedure, this small T-shaped device can provide protection for up to 8 years. The device releases progestin, which thickens cervical mucus to prevent sperm from reaching an egg and may also halt ovulation. There are four types of hormonal IUDs approved by the FDA, including Mirena, which has an 8-year approval for use. The convenience and longevity of the hormonal IUD make it a popular choice among users seeking a low-maintenance form of birth control.
Female Sterilization
With a typical use failure rate of 0.5%, female sterilization, also known as tubal ligation, is a permanent form of birth control that involves removing, blocking, or cutting the fallopian tubes. This prevents an egg from traveling to the uterus and being fertilized by sperm. While the procedure is more complex than a vasectomy for men, once it is completed, there is nothing more that needs to be done to ensure its effectiveness. However, like all surgical procedures, there are risks involved, particularly since general anesthesia is administered. Unlike hormonal forms of birth control, sterilization does not have any effect on a woman’s menstrual cycle.
Copper IUD
With a typical use failure rate of 0.8%, the copper intrauterine device (IUD) is a non-hormonal form of birth control. Unlike hormonal IUDs, it uses the metal itself to prevent pregnancy by making the uterus hostile to sperm. The copper IUD can also be used as emergency contraception if inserted within a few days of unprotected sex. The insertion procedure is similar to that of hormonal IUDs, and once it’s in place, no further maintenance is necessary. The copper IUD is an excellent option for individuals who want long-term birth control and don’t plan on getting pregnant for the next decade, regardless of whether they’ve had a child before.
Hormone Injection
The hormone injection is an effective birth control method that uses progestin to thicken cervical mucus, preventing sperm from fertilizing an egg. It is administered by a healthcare provider every 12 weeks, requiring regular appointments to maintain effectiveness. According to Dr. Shirazian, it’s crucial not to delay your shot as you may become pregnant. The shot has a typical use failure rate of 4% per the CDC.Dr. Shirazian cautions that the shot can lead to weight gain, which may not be suitable for some individuals. However, it can be an excellent option for those who have trouble remembering to take a daily pill or prefer a more discreet method.
Pill
The pill, also known as oral contraception, is a popular birth control method with many types available. Different types include combination pills with estrogen and progestin, progestin-only pills, and extended-cycle pills to decrease the frequency of periods. Your healthcare provider can help you choose the best option for you. Most birth control pills prevent pregnancy by stopping ovulation and thickening cervical mucus, which makes it difficult for sperm to reach an egg. While some users may experience side effects such as spotting, lighter periods, or skin changes, estrogen-containing pills can increase the risk of certain health issues, particularly blood clots in smokers.
The patch
The birth control patch is a weekly method that contains both estrogen and progestin, which stops ovulation just like the pill. Instead of taking a daily pill, you stick on a new patch once a week for three weeks, then have a patch-free week for your period. It can be placed on several body parts like the belly, upper arm, back, or buttocks, and releases hormones through the skin. However, proper placement and timely replacement of the patch are essential to ensure effectiveness. You need to make sure it stays put and doesn’t come off accidentally, especially in hot weather or during physical activity, as this may compromise its efficacy, cautioned Dr. Shirazian
Ring
The vaginal ring is a hormonal birth control method that releases estrogen and progestin to prevent ovulation and thicken cervical mucus. It is inserted inside the vagina and left in place for three weeks, after which it is removed for a week to allow for a menstrual period. Both hormones are absorbed through the vaginal lining. To ensure the ring works properly, it is important to place it correctly and as far up into the vagina as possible. Dr. Shirazian notes that if it feels uncomfortable or comes out easily, it may not be inserted properly. Additionally, it’s crucial to keep track of when to insert a new ring and how long it has been in place.
Male condoms
Condoms are an affordable and easily accessible barrier method of birth control. Made of latex or polyurethane, they act as a physical barrier preventing sperm from fertilizing an egg. Condoms also offer protection against sexually transmitted infections (STIs), except for lambskin condoms, which do not prevent the spread of microbes. Despite being one of the oldest forms of contraception, incorrect usage of condoms still prevails today, reducing their efficacy. “A condom should not break if it’s been put on correctly,” said Dr. Shirazian, emphasizing the importance of using condoms correctly to prevent unintended pregnancies and STIs.
Phexxi
Phexxi is a newly approved contraceptive option that comes in the form of a non-hormonal vaginal gel. It works by reducing the pH in the vagina, which immobilizes sperm and prevents pregnancy. The gel must be applied immediately before each act of vaginal intercourse and is effective for up to 1 hour. However, it is not effective if applied after intercourse. The gel is composed of lactic acid, citric acid, and potassium bitartrate. A clinical trial of over 1300 women aged 18 to 35 showed a 13.7% pregnancy rate during six months of use, according to the American Association of Family Physicians.
Diaphragm
The diaphragm is a flexible silicone barrier that covers the cervix and blocks sperm from reaching the uterus. To ensure a proper fit, it should be sized by a healthcare provider, and it must be used with spermicide. Unlike hormonal birth control methods, the diaphragm does not release any hormones and is only inserted when you’re ready to have sex. However, it needs to stay in place for at least six hours after intercourse to prevent any remaining sperm from entering the uterus. Dr. Shirazian explains that some people may remove it prematurely, leading to a lower effectiveness rate compared to other methods.
Female condom
With a typical use failure rate of 21%, the female condom is inserted into the vagina up to eight hours before sexual activity to cover the cervix, blocking the sperm’s entry. Unlike the male condom, it is not as effective at preventing STDs. However, the female condom’s effectiveness largely depends on correct insertion and positioning, which can be complicated as it does not have anything to fit tightly over and may shift or feel uncomfortable. Although the package provides instructions for application, it remains a less popular and less successful contraceptive method. According to Dr. Shirazian, “The female condom is trickier than the male condom.”
Spermicide
Using spermicide in combination with a diaphragm or a condom can increase their effectiveness in preventing pregnancy. Spermicides come in various forms such as creams, gels, films, foams, and suppositories. While it can be used alone, it is one of the least effective methods of birth control. Inserting the spermicide before having sex is essential, but users should be aware of its limitations. If considering spermicide, Dr. Wu suggests using the film form as it dissolves in the vagina and is discreet. The small size of the sheet makes it virtually unnoticeable to partners during sex.
Withdrawal
The withdrawal method, or “pulling out,” involves a person removing the penis before ejaculation to prevent sperm from entering the vagina. However, it’s not a reliable form of birth control, earning the nickname “pull and pray.” Even if a small amount of ejaculate gets near the vagina during withdrawal, pregnancy is still possible. While there’s limited research on the effectiveness of the withdrawal method, some studies have found sperm in pre-ejaculate fluid. Therefore, Dr. Wu advises individuals to consider their pregnancy intentions and opt for more effective methods if avoiding pregnancy is a top priority.
Fertility Awareness
With the help of a period tracking app, you can practice the fertility awareness method, also known as natural family planning or the rhythm method. By closely monitoring your menstrual cycle and ovulation, you can determine the days when you’re most fertile and avoid sex (or use another method of birth control) on those days. The fertility awareness method involves measuring your temperature every morning, checking cervical mucus every day, or charting your cycles (or any combination of these three methods) to identify when you’re nearing ovulation. It’s important to note that this method works best if your menstrual cycle is regular and predictable, enabling you to track the changes and follow patterns, according to Dr. Wu. “If you have a regular cycle and are motivated to practice it, it can be a good method,” added Dr. Wu.
Sponge
The sponge is a squishy plastic contraceptive method that works by covering the cervix and releasing spermicide to immobilize or kill the sperm. It can be left in place for up to 24 hours, but must remain there for at least six hours after intercourse to be effective. The proper placement is crucial to ensure that it covers the cervix, and failure to do so may result in unintended pregnancy. The effectiveness of the sponge also varies depending on whether you have given birth before or not, with a higher failure rate in those who have given birth. As it is not widely used, finding a sponge may require extra effort, according to Dr. Wu, and may require purchasing it online or at a local pharmacy.