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We have to make choices of all sorts each and every day. These decisions range from simple things, like what to have for breakfast or which running route to take, to more serious things, like the best birth control to use. In fact, it can be totally overwhelming to sort through all of the information and advice out there when it comes to birth control.

That’s where this guide comes in handy. It will set you on the right path to making a solid decision about the best birth control method for you.

There are several types of contraception, which means many of them work differently. For the most part, there are four different types of birth control methods:

  • Lifestyle. This may mean that birth control is something that you, and potentially your partner(s), do to actively avoid an unwanted pregnancy. This method includes abstinence, outercourse, and fertility awareness.
  • Barrier. A barrier method typically means that you use contraception as needed. This means that you or your partner(s) are using something that goes into the body before sex to block sperm from fertilizing an egg. Some examples include external or internal condoms or spermicide.
  • Hormonal. Hormonal birth control methods are most often used on a regular basis. These include the birth control pill, the shot (Depo-Provera), the ring, and the patch. Intrauterine devices (IUDs) are another kind of hormonal birth control, although one form of IUD, the copper IUD, is nonhormonal. The levels of hormones differ based on the contraceptive. They may stop the ovaries from releasing eggs, thicken the mucus around the cervix, or thin the lining of the uterus.
  • Medical. Medical procedures like vasectomy or tubal ligation change the body and ultimately prevent it from fertilizing or getting pregnant.

Sit down and take some time for a little self-reflection to work through the following questions:

  • How reliable do you need your birth control to be? What level of pregnancy risk are you comfortable with?
  • Do you want your birth control to reduce sexually transmitted infection (STI) transmission risk, too?
  • What budget are you working with?
  • Do you want children in the future? How about the near future?
  • Are you trying to manage other symptoms too?
  • Can you realistically use something on a schedule?
  • How do you feel about receiving a pelvic exam?

These are big, important questions, but don’t worry! A healthcare professional can give you the information you need to answer them if you’re feeling anxious or nervous. It’s a great idea to make an appointment with your doctor to run through these questions. Then, they can help address any concerns you might have.

First, breathe! You do have options.

“There are birth control options that you can purchase without insurance at the pharmacy,” Dr. Felice Gersh says. Gersh is the author of “PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness.”

Many family planning clinics and health centers have programs that can help you pay for the options. Some examples are:

Many telehealth services offer birth control as well. This can be super convenient if you live far from a clinic or health center or otherwise can’t get to one, or if you simply prefer a virtual meeting. Some of these services include:

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Illustration by Maya Chastain

There are ways to avoid getting pregnant that don’t involve taking, wearing, implanting, sticking, or blocking anything!

Abstinence

The birds and the bees 101 says that for pregnancy to take place, a sperm has to meet an egg.

But that can’t happen if the sex acts that allow that to happen, don’t happen.

Enter: abstinence.

“Abstinence means something different to everyone,” Gersh says. “The most common definition is abstaining from sexual intercourse.”

“If you’re looking to avoid pregnancy, that means specifically avoiding vaginal sexual intercourse,” adds Gersh. “It’s incredibly effective for folks who are actually committed to never have intercourse.”

Avoiding vaginal sexual intercourse allows for a 100% effectiveness rate.

Outercourse

“Outercourse” is definition-wiggly. For some, outercourse means no penetration of any kind, including fingers, sex toys, and anal sex.

But to avoid pregnancy, that means at least no P-in-V penetration.

“It’s [almost] impossible to get pregnant via just anal sex, oral sex, and hand sex,” Gersh says. Almost impossible because pregnancy can happen whenever sperm gets near the vaginal canal.

The effectiveness rate of outercourse will depend on how you and your partner(s) define it. If you choose to avoid any type of penetration (include anal, oral, and hand sex), it also has a 100% effectiveness rate.

Fertility awareness methods

Also known as the rhythm method, fertility awareness involves tracking your menstrual cycle and symptoms in an attempt to avoid intercourse on your most fertile days.

Tracking can be done via the:

  • calendar method, which helps you predict when you’re fertile by tracking your menstrual cycle time frames over several months
  • temperature method, which helps you predict when you’ll ovulate by tracking body temperature changes throughout your period
  • cervical mucus method, which helps you predict when you’ll ovulate by tracking your cervical mucus, or vaginal discharge, changes during your period

While they’re cost-free, low-risk, and a great way to learn more about your body, fertility awareness methods have a high failure rate.

“Usually, fertility awareness methods are a far better route if you are actively trying to become pregnant,” Dr. G. Thomas Ruiz says. Ruiz is the OB-GYN Lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

According to Planned Parenthood, fertility awareness methods are up to 76 to 88 percent effective. This means that about 24 out of every 100 people using fertility awareness methods become pregnant.

Birth control may be a touchy subject for some, but that doesn’t change how important a sound method is if you’re trying to avoid getting pregnant.

So, even though it might be tempting to use the age-old pull out method, this is by far one of the least effective birth control options. You might want to believe it will work for you. But with a 22 percent typical-use failure rate, rest assured it likely won’t.

Luckily, there are plenty of other “use when you need” options. You can find some of them for free at your local healthcare center.

Internal condom

What is it? Internal condoms are latex-free, hormone-free polyurethane pouches that can be worn inside the vagina. They also greatly lower the risk of pregnancy and STI transmission. Win-win.

Effectiveness: Perfect use: 95 percent. Typical use: 79 percent.

Average cost: $2 to $4 each.

Pros: Know you’re getting laid later? You can pop this baby in up to 8(!) hours ahead of intercourse.

Another perk: Even if your partner doesn’t wanna wear a condom, you can protect yourself from STI transmission and unwanted pregnancy.

“It puts the vagina-owner in control of their body,” Gersh says.

Internal condoms also fit less snugly around the penis — some users enjoy this freedom, but others say the extra bit of material interferes with sensation.

Cons: In addition to being 2 to 4 times the average cost of external condoms, these babies also have a bit of a learning curve. They aren’t hard to use, necessarily, but they do take some practice.

How to use them: Pinch the smaller, inner ring at the closed end of the condom while pulling back the folds of your labia around the vagina with your other hand. Insert the squeezed inner ring into your vagina. Slide your forefinger, middle finger, or both into the open end of the condom until you feel its closed end.

Carefully push the condom further until you reach the cervix. Rest the outer ring of the condom on your external hole and hold it in place during intercourse. If the outer ring goes into the hole during penetration, pull it out.

External condom

What is it? As far as birth control options go, the rubber is a classic. An external condom snugly covers the penis during intercourse and is designed to catch any fluid that comes out of the penis, including pre-ejaculate, come, and semen.

Effectiveness: Perfect use: 95 percent. Typical use: 86 percent.

Average cost: Free to $2 each.

Pros: The external condom works double-duty, protecting you from STIs and unwanted pregnancy. Woot! And because they’re available in latex and latex-free options, the risk of allergy is very low. Also, postcoital clean-up is a breeze.

Cons: They’re not fool-proof. Oh and, like the internal condom, while some people say they boost pleasure, those used to barrier-free sex may find the opposite.

Remember: Internal and external condoms are the only birth control options that also reduce the risk of STI transmission!

Sponge

What is it? The contraceptive sponge is a squishy (latex-free) plastic disk that’s saturated in spermicide. You place it deep inside the vagina where it covers the cervix and blocks sperm from entering the uterus, killing them if they make an attempt.

Effectiveness: Perfect use if you’ve never given birth: 91 percent. Typical use if you’ve never given birth: 80 percent. If you have given birth, the perfect use rate is 80%, while the typical use rate is 76%.

Average cost: $4 to $6 each.

Pros: You can pop this bad boy in up to 24 hours ahead of intercourse. It can also be left in for as many rounds of sex as you can fit in that 24-hour window.

Cons: You have to leave the sponge in the vagina for 6 hours after sex, which some folks say feels messy (think: dripping ejaculate). There’s also a slightly increased risk for toxic shock syndrome with this method.

Some folks find it hard to pop in place. If you hate using tampons, this method isn’t for you.

Diaphragm

What is it? A form of reusable prescription birth control, a diaphragm is a soft, silicone disk. You saturate it with spermicide, then insert it into the vagina where it acts like the cervix’s bodyguard (er, baby guard), keeping sperm out.

Effectiveness: Perfect use: up to 96 percent. Typical use: 88 percent.

Average cost: Free to $80, depending on health insurance coverage. You also need to factor in the cost of the doctor’s visit and the cost of the spermicide, which ranges from about $0.60 to $3 per dose.

Pros: Hormone- and latex-free, the diaphragm is a decent pick if you want a nonhormonal option or are allergic to latex. It can also be left in for 24 hours of hanky panky (so long as you add more spermicide every 6 hours!).

Cons: For those of you into fast and furious fun, this option isn’t for you. Diaphragms can get knocked out of place with aggressive thrusting.

It’s also not a great option for folks who know they won’t be able to stay on top of reapplying spermicide or who are prone to urinary tract infections.

Cervical cap

What is it? A cervical cap is a reusable, prescription silicone covering that you fill with spermicide and place over your cervix to prevent sperm from entering your uterus.

Effectiveness: People who have never given birth: 86 percent. People who have given birth vaginally: 71 percent. The difference here is because vaginal births stretch the vagina and cervix, which can cause the cervical cap to fit poorly or not as well as it should.

Average cost: Free to $90, depending on your health insurance coverage, plus the cost of the doctor’s visit and the cost of the spermicide.

Pros: Don’t want the hormonal effects of the pill, implant, shot, or patch? Maybe want to get pregnant in the near future? Cervical caps got your back. They’re also a good pick for folks looking to save money. They can be left in for multiple acts of intercourse over the course of 48 hours. You only need to replace them every year or so, so the cost-per-use is pretty dang low. Another win: You don’t have to worry about reapplying spermicide.

Cons: Some folks are sensitive to spermicide, which is a MUST for this method to work. The cap also has to be left in place for 4 hours after sex, which some find bothersome.

It also requires a prescription and must be replaced every 12 months. So, there’s a little bit of legwork involved with getting and up-keeping them.

Spermicide

What is it? In addition to working with sponges, diaphragms, and cervical caps, spermicide can also be used by itself. Squirt or insert the substance into your vagina before sex. During sex, the chemicals in the goop will kill sperm.

Effectiveness: When used alone, it’s 72 percent effective.

Average cost: $6 to $18 per bottle, or 60 cents to $3 per use.

Pros: You don’t need a prescription for this hormone-free option! It’s available over the counter at most stores.

Cons: There are LOTS of different spermicide options on the market, so finding one that you like best can take some trial and error.

Spermicide is also time-sensitive — it needs 10 to 15 minutes to dissolve before intercourse, and after an hour you’ll need to apply more.

Emergency contraceptive pills ≠ birth control

Emergency contraceptive pills are highly effective when taken properly, within 72 hours after intercourse. But you shouldn’t use them as routine birth control.

“It’s an effective fallback, but it’s nowhere near as effective as the birth control options,” Ruiz says.

Plus, he says, “It’s a very high dose of hormones, so taking it regularly probably won’t make you feel very good.”

Babes who are always on time, type A perfectionists, and GoogleCal aficionados, these options are for you.

Everyone else? Know that the four options below need to be administered on a very precise schedule.

“Even 1 or 2 days off schedule could mess with their effectiveness,” Ruiz says.

Shot

What is it? The birth control method known as “the shot” — surprise, surprise — requires an injection. Specifically, an injection of the hormone progestin every 90 days in a doctor’s office. It prevents pregnancy by preventing ovulation from taking place. No ovulation = no pregnancy.

Effectiveness: Perfect use: 99 percent. Typical use: 94 percent.

Average cost: Free to $150 every 3 months, depending on your health insurance coverage plus the cost of the doctor’s visit.

Pros: It’s super effective… so long as you remember to go to the doctor every 12 to 13 weeks like clockwork. Many users report that the shot lessens menstrual flow and menstrual pain, or stops periods altogether.

Cons: Nausea, headaches, dizziness, weight gain, and depression have been reported.

If you end up wanting to get pregnant after being on the shot, know that the inability to conceive could last up to 12 months after your last dose.

Ring

What is it? This is a 2-inch wide plastic ring prescribed by a doctor, containing estrogen and progesterone. By stopping ovulation, the ring stops you from getting pregnant. No ovulation = no egg = no pregnancy. You insert a ring yourself and leave it there for 3 weeks, then remove it for 1 week to have a period. Then, you swap it out for a new one.

Effectiveness: Perfect use: 99 percent. Typical use: 91 percent.

Average cost: Free to $200 per ring, per month, depending on your health insurance coverage plus the cost of the initial doctor’s visit.

Pros: You get to put it in and forget about it for 3 weeks! Many people report that it reduces flow, helps with acne, and makes periods more regular.

Cons: Breast tenderness and headaches are the most commonly reported side effects. Although you should be protected from pregnancy the week you aren’t wearing a ring, pregnancy is a risk if you had any slip-ups.

Patch

What is it? Think of the patch as a fake tattoo that stops pregnancy. You stick it on your upper arm, butt, or back, and it releases estrogen and progestin into the body. These hormones stop ovulation, which means pregnancy isn’t possible. You apply a new patch every week for 3 weeks, then use no patch for a week so you can have your period.

Effectiveness: Perfect use: 99 percent. Typical use: 91 percent.

Average cost: Free to $50 per month, depending on your health insurance coverage plus the cost of the initial doctor’s visit.

Pros: You put it on, then don’t have to deal with it for a week! And most users report no side effects.

Cons: When side effects are reported, they include nausea, headaches, breast tenderness, and skin irritation. It also requires weekly diligence, which means there’s a high risk of human error.

Combination pill

What is it? The combination pill got its name because it combines estrogen and progestin to prevent ovaries from releasing eggs, and thus prevents pregnancy from taking place. A prescription option, the pill must be taken every single day at the same time to work.

Effectiveness: Perfect use: 99 percent. Typical use: 91 percent.

Average cost: Free to $50 per month, depending on your health insurance coverage plus the cost of the initial doctor’s visit.

Pros: It doesn’t have to be inserted or implanted! It can also reduce the severity of period symptoms.

Cons: You have to take it every (!) single (!) day (!) at the exact same time. Forget to take it and the effectiveness goes way down. In other words, the risk of human error is high.

Minipill

What is it? Also known as progestin-only pills, the prescription-only minipill is a great pick for folks who wish to avoid estrogen. The pill suppresses ovulation, which means no pregnancy.

Effectiveness: Perfect use: 99 percent. Typical use: 93 percent.

Average cost: Free to $50 per month, depending on your health insurance coverage plus the cost of the initial doctor’s visit.

Pros: Because it doesn’t contain estrogen, it’s a good option for those who are breastfeeding, over 25 years old, less than 1 month postpartum, or who have had a bad reaction to the combination pill. It’s also been reported to help reduce the severity of period symptoms.

Cons: Mainly, it needs to be taken every day at the exact same time. Some people report breast tenderness and acne flare-ups.

Not a planner? Don’t plan on getting preggo anytime soon? These lower maintenance, long-term options may appeal to you.

Implant

What is it? A plastic rod about the size of a matchstick, the implant is implanted under the skin where it releases the hormone progestin, which blocks ovulation and therefore pregnancy.

Effectiveness: More than 99 percent.

Average cost: Free to $800 for implanting, depending on your health insurance coverage. Plus, around $300 for removal and cost of initial appointment.

Pros: One of the most effective options available, the implant lasts up to 3 years and can be removed at any time. It doesn’t have estrogen, making it a good option for folks who need or wish to avoid it. “A major perk is that it doesn’t require a pelvic exam, which is why it’s the option most used by younger menstruators,” Ruiz says.

Cons: The implantation isn’t a huge deal. But it does require local anesthetic and a big-ish needle, and you may be sore for a few days after. It may also disrupt periods and can cause minor side effects such as acne, breast tenderness, and weight gain.

Copper IUD

What is it? An IUD is a small, T-shaped instrument that gets placed in your uterus during a doctor’s visit. There are two main types of IUDs. Copper IUDs, sometimes called nonhormonal IUDs, work by deterring sperm. Fun fact: Sperm don’t like copper! So when they run into the copper IUD, they swim in the opposite direction, which keeps them from meeting up with the egg. If sperm never gets to an egg, pregnancy can’t happen.

Effectiveness: Over 99.9 percent.

Average cost: Free to $1,300, depending on your health insurance coverage, plus the cost of the doctor’s visit and removal.

Pros: Your doctor can put it in and you can forget about it for up to 12 years. And if you decide you want to get pregnant, you can take it out and start trying immediately after. “You also still get a period every month, which some menstruators find comforting,” Ruiz notes.

Cons: Side effects include random spotting during early use, more cramps during your period, and heavier flows. Also, some people experience discomfort, including cramps, during or after the insertion process. The good news is it’s short-lived and Ibuprofen can provide relief.

Hormonal IUD

What is it? Hormonal IUDs are also inserted into the uterus by a doctor. They release a small amount of progestin, which intercepts ovulation and therefore makes pregnancy impossible for 3 to 7 years at a time.

Effectiveness: More than 99 percent.

Average cost: Free to $1,300, depending on your health insurance coverage plus the cost of the initial doctor’s visit and removal.

Pros: It can be left in place for 3 to 7 years! And, Ruiz says, “The progestin only circulates in the genital region and is much, much lower than the amount found in hormonal birth control pills.”

Cons: During the hormonal IUD procedure, it’s typical to experience cramping, dizziness, fainting, or a slower heart rate. The hormonal IUD can make you stop having periods, which some users may consider a “pro,” or make them much lighter or irregular. You might also experience side effects like spotting or cramping after getting a hormonal IUD. But once your body gets used to the IUD, you should find this goes away in about 3 to 6 months.

Weighed the pros and cons of permanent sterilization and ready to do the deed? Here are your quick-and-dirty need-to-knows.

Vasectomy

What is it? For people with testicles, a vasectomy is an outpatient surgery that involves blocking or cutting the tubes that carry sperm from the testicles to the penis. This keeps sperm from being added to ejaculate. Remember: no sperm = no pregnancy.

Effectiveness: More than 99 percent.

Average cost: Free to $1,000, depending on your health insurance coverage plus the cost of the doctor’s visits.

Pros: While a vasectomy can be reversed, it’s considered a permanent birth control solution.

Cons: After you get it, the doctor has to verify that no semen is able to pass into ejaculate. So for the first 3 months after you get a vasectomy, you’ll need to use other birth control options.

Also: While it’s an outpatient surgery, a vasectomy still requires local anesthetic.

Tubal ligation

What is it? A procedure that folks with fallopian tubes can get, tubal ligation involves blocking, tying, or cutting the fallopian tubes, which transport the egg from the ovaries to the uterus. And when the egg cannot reach the uterus? Pregnancy is impossible!

Effectiveness: More than 99 percent.

Average cost: Free to $6,000, depending on your health insurance coverage plus the cost of the doctor’s visits.

Pros: Tubal ligation is a permanent birth control method. And while you may (a very small chance!) be able to reverse the procedure or get pregnant via in vitro fertilization afterwards, there’s no guarantee.

Cons: Mainly, it’s a surgery. Although it’s a same-day procedure, doctors will occasionally use a method that requires incision.

There’s also a common misconception that tubal ligation will stop your period completely — it doesn’t!

“There’s a common misconception that people assigned female at birth who are taking testosterone can’t get pregnant, but that’s not always true,” says trauma-focused therapist and sexuality educator Aida Manduley, LCSW.

If you haven’t undergone bottom surgery, pregnancy is still possible.

“Unless a medical provider has told you you’re sterile or unable to get pregnant, assume pregnancy is a risk,” Manduley says.

In other words, depending on the anatomy of your partner and the type of sex you’re having, you may want to look into birth control.

Any of the above birth control methods are an option — including the hormonal methods. Hormone replacement therapy and hormonal birth control can be used together.

Depending on the symptom you’re trying to manage, there’s birth control for that. The chart below can help.

SymptomBest birth control option
hormonal acnecombination birth control pill
gender dysphoriaimplant
heavy periodhormonal IUD
polycystic ovary syndrome (PCOS)combination birth control pill
crampsring, patch, or combination pill

The kitschy line “Smile baby, you’re alive. You’ve got options” is apt here. And even better: There are no bad options. It just comes down to your personality, lifestyle, objectives, priorities, and concerns.

And remember, you don’t have to figure it out all on your own. A doctor can help.


Gabrielle Kassel is a New York-based sex and wellness writer and CrossFit Level 1 Trainer. She’s become a morning person, tested over 200 vibrators, and eaten, drunk, and brushed with charcoal — all in the name of journalism. In her free time, she can be found reading self-help books and romance novels, bench-pressing, or pole dancing. Follow her on Instagram.