Birth Control Options - Medication and Long-acting Reversible Contraception

How do I choose a birth control or contraception option?

Many factors go into choosing a birth control option, ranging from personal comfort, life goals, health conditions, and the thoughts and opinions of your sexual partner(s). Thinking about your lifestyle and speaking with a health care provider may help provide you with more information so you can make a more informed decision. 

Some questions to consider before choosing a birth control option may include: 

• What are your goals with starting birth control? Is it to prevent pregnancy, STIs, both, or maybe something else entirely? 
• Do you have health conditions that may be affected by any of the birth control options? 
• What are the potential side effects of each option? 
• How much effort is involved in using specific options? How much effort are you willing to put in to prevent pregnancy or STIs? 
• What is the effectiveness of the birth control option in preventing pregnancy? In preventing STIs? 
• If it’s pregnancy you’re trying to prevent, how often do you engage in penile-vaginal sex? 
• If you would like to become pregnant now or in the future, how soon would you like that to occur? 
• What are you most comfortable with? 
• How many sex partners do you have? What are your sex partners comfortable with? 

The various birth control methods have their benefits and disadvantages, and often these depend on peoples’ different perspectives and lifestyles. What works for someone else may not work for you and vice versa. That said, some trial and error may be involved in finding the best fit for you.

How do medication and long-acting reversible contraception (LARC) work?

There’s a plethora of birth control options to choose from when it comes to medication and LARCs. What is available in these categories differs based on whether they contain hormones, how often they must be taken or renewed, and their effectiveness rate. Hormonal options might contain estrogen, progestin (a form of progesterone), or a combination of the two. Estrogen prevents an egg from leaving the ovaries during ovulation. Progestin can also prevent ovulation and thickens the mucus in the cervix to prevent sperm from reaching the egg. However, it’s important to recognize that medications and LARCs do not prevent STIs. 

Generally, these options have similar effectiveness rates, but speaking with a health care provider may clear up additional questions or concerns that you may have. 

What are the medication and LARC options? 

The following sections describe the methods from most to least effective in preventing pregnancy. 

Implant

• Hormonal method 
• Thin rod is inserted under the skin on your upper arm by a health care provider 
• Releases progestin, which thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Works for three to five years before needing to be replaced 
• Some potential side effects: light bleeding or spotting, headaches, nausea, jaundice 
• Effectiveness rate: 99.95 percent 

Intrauterine device (IUD) 

• Hormonal or non-hormonal method 
• Small T-shaped plastic or copper device is inserted into the uterus by a health care provider 
• There are five different brands approved for use in the United States, four of which are hormonal 
• Hormonal IUDs release progestin into the body and work for between three to eight years 
  • Progestin thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Non-hormonal IUDs are wrapped in copper and work for around 10 to 12 years 
  • Copper lowers sperm motility, making it difficult for the sperm to meet and fertilize an egg 
  • Copper IUDs can also be inserted as emergency contraception within five days of unprotected sex to function as emergency contraception 
• Some potential side effects: pain or cramping when inserted, light bleeding or spotting, irregular periods, and increased risk of ectopic pregnancy if birth control fails 
• Effectiveness rate: depends on the brand or type used, but ranges between 99.2 to 99.9 percent 

Injectable shot 

• Hormonal method, also known as the “depo shot” 
• Injection is given by a health care provider in the arm or buttocks once every 12 to 13 weeks (once every 90 days) 
• Releases progestin, which thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Some potential side effects: irregular periods or absence of period, nausea, weight gain, headaches, bruising at area of shot, increased risk of bone thinning, low sex drive, and hair loss 
• Effectiveness rate: 94 to 96 percent 

Vaginal ring 

• Hormonal method 
• Inserted into the vagina by the individual and replaced at varying intervals (example: inserted once every 21 to 35 days and replaced once per year) 
• Two types, one (NuvaRing) which lasts up to five weeks and another (Annovera) which lasts up to one year 
  • NuvaRing is placed in the vagina for 21 to 35 days, then removed for 7 days before a new one is inserted 
  • Annovera is placed in the vagina for 21 days, then removed for 7 days, and used for 13 reproductive cycles 
• Releases estrogen which prevents the egg from leaving the ovary during ovulation 
• Also releases progestin which thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Take caution with inserting, removing, and cleaning the ring and be careful storing the ring when not actively trying to prevent pregnancy 
  • Wash your hands with soap and water thoroughly before inserting or removing the ring to prevent infection 
  • Clean the ring properly with soap and water after removal to help prevent infection 
  • Avoid exposing the ring to direct sunlight or high temperatures as this may reduce its effectiveness in preventing pregnancy 
• Don't use with lube containing oil or silicone, and don't use with the Phexxi vaginal gel 
  • Using oil or silicone lubes or the Phexxi gel might interact with the hormones in the ring and decrease effectiveness in preventing pregnancy 
• Some potential side effects: headaches, nausea, sore breasts, irregular periods or absence of period, light bleeding, or increased risk of blood clots, stroke, and heart attack 
• Effectiveness rate: 91 to 93 percent 

Patch 

• Hormonal method 
• Releases estrogen which prevents the egg from leaving the ovary during ovulation 
• Also releases progestin which thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Applied to the skin by the individual, either on the abs, buttocks, or upper body (not the breasts) 
• Two brands, Xulane and Twirla 
  • Usually applied once for 21 days, then removed for 7 days 
• May be less effective in individuals who weigh more than 198 pounds 
• Some potential side effects: headaches, nausea, irritation at location of patch, irregular periods, sore breasts, or increased risk of blood clots, stroke, and heart attack 
• Effectiveness rate: 93 percent 

Birth control pill (oral contraceptives) 

• Hormonal method 
• There are two types: combined (estrogen and progestin) or progestin-only 
• Estrogen prevents the egg from leaving the ovary during ovulation 
• Progestin thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Take one by mouth at the same time every day 
• Some potential side effects: headaches, nausea, sore breasts, irregular periods or absence of period, light bleeding, or increased risk of blood clots, stroke, and heart attack, low sex drive 
• Effectiveness rate: 93 to 97 percent 

What is the emergency contraception pill? 

Barrier methods and hormonal or LARC methods are intended to be used as regular, consistent birth control methods. However, if these methods fail during sex there is also an emergency contraception pill that can be used as a preventative measure. This pill can be prescribed by a health care provider or bought over the counter. It may also be covered by health insurance depending on your plan. 

Emergency contraception pill 

• Hormonal method 
• There are two brands: levonorgestrel (“Plan B”) or ulipristal ("ella”) 
• If you take Plan B, don’t take ella, and vice versa 
• Plan B contains levonogestrel and ella contains ulipristal
• Progestin thickens the mucus in the cervix to prevent sperm from reaching the egg or prevents the egg from leaving the ovary during ovulation 
• Plan B is most effective when taken within 72 hours (3 days) after unprotected sex or when barrier method fails, but is more effective if taken sooner than later. Ella can be taken up to 120 hours (5 days) after unprotected sex or when barrier method fails 
• Plan B is less effective for those who weigh more than 165 pounds. If you weigh between 165 and 195 pounds, ella may be a more effective option than Plan B 
• Alternatively, ella is less effective for people who weigh more than 195 pounds. These people may find that an intrauterine device (IUD) is more effective than either ella or Plan B 
• Some potential side effects: headache, nausea, tender breasts, irregular period 
• Effectiveness rate: up to 85 percent for ella, around 75 to 89 percent for Plan B