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If there’s anything harder than figuring out what to eat at Cheesecake Factory or which vibrator to add to your collection, it’s figuring out which birth control option is right for you.

That’s where this birth control crib sheet comes in.

Turn on your noodle and grab your journals. It’s time for a little self-reflection.

Take some time to think through your answers to the following questions:

  • What failure rate are you willing to accept?
  • Do you want your birth control to reduce STI transmission risk, too?
  • What budget are you working within?
  • Do you want children in the future? How about the near future?
  • Are you trying to solve for other symptoms?
  • Can you realistically use something on a schedule?
  • How do you feel about receiving a pelvic exam?

Don’t worry, you don’t have to answer these all by your lonesome! A healthcare provider can help.

First, breathe! You do have options.

“There are birth control options that you can purchase without insurance at the pharmacy,” says Dr. Felice Gersh, 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 subsidize the options. Some examples are:

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Illustrations 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 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,” says Gersh. “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.”

Translation: Many folks aren’t actually committed.

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,” says Gersh. Almost impossible because pregnancy can happen whenever sperm gets near the vaginal canal.

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:

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

“Usually, fertility awareness methods are a far better route if you are actively trying to become pregnant,” says Dr. G. Thomas Ruiz, 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 FAM methods become pregnant.

So… your high school crush is visiting the area for a few days and you’re both single.

Please, for the love of Beyoncé, don’t trick yourself into believing the pull out method is your best option. With a 22 percent typical-use failure rate, rest assured it’s not.

Luckily, there are plenty of other ‘use when you need’ options. Some of which you can find 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 decrease the risk of pregnancy and STI transmission. Win-win.

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

Average cost: $2–4 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 (*eye roll*), you can protect yourself from STI transmission and unwanted pregnancy.

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

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.

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

External condom

What is it? As far as birth control options go, the rubber is a classic. Basically a baggie that goes over a penis during intercourse, an external condom is designed to catch any fluid (e.g. pre-ejaculate, come, semen) that comes out of the penis.

Effectiveness: Perfect use: 97 percent. Typical use: 86 percent.

Average cost: Free–$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 non-latex 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 option that also reduces the risk of STI transmission!

Sponge

What is it? The contraceptive sponge is a squishy (non-latex) 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: 91 percent. Typical use: 80 percent.

Average cost: $4–6 each.

Pros: You can pop this bad boy in up to 24 hours ahead of intercourse. And it can 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 prescription, reusable 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: 88 percent.

Average cost: Free–$80, depending on health insurance coverage, plus the cost of the doctor’s visit and the cost of the spermicide.

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? What looks like a lil’ baby sailor cap but is actually a reusable, prescription silicone covering that you fill with spermicide and plop over your cervix to prevent sperm from entering your uterus? A cervical cap!

Effectiveness: People who have never given birth: 86 percent. People who have given birth: 71 percent.

Average cost: Free–$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. They only need to be replaced 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 leg work 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: $6–18 per bottle, or 60 cents–$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

While highly effective when taken properly (within 72 hours after intercourse), EC pills shouldn’t be used as routine birth control.

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

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 one or two days off schedule could mess with their effectiveness,” says Ruiz.

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–$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, menstrual pain, or stops your period altogether. Cramps, who?

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? Very different than a mood ring or wedding band, this is a 2-inch wide plastic, doctor-prescribed ring that contains 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–$200 per ring, per month, depending on your health insurance 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–$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–$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.

Mini pill

What is it? Also known as progestin-only pills, the prescription-only mini pill 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–$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, 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–$800 for implanting, depending on your health insurance coverage. Plus, ~$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,” says Ruiz.

Cons: The implantation isn’t a super major 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 intrauterine device (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–$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,” notes Ruiz.

Cons: Side effects include random spotting during early use, more cramps during your period, and heavier flows.

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–$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: The hormonal IUD can make you stop having periods (which some users may consider a “pro”), or make them much lighter.

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

Vasectomy

What is it? Available 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, which keeps sperm from being added to ejaculate. Remember: No sperm = no pregnancy.

Effectiveness: More than 99 percent.

Price: Free–$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, it’s still a surgery that 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.

Price: Free–$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 IVF 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,” says Manduley.

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 BC 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.