Although birth control can be an effective way to prevent unintended pregnancy, no method is 100 percent successful. Each type has pros and cons, including how effective it is.
Hormonal intrauterine devices (IUD) and hormonal implants are the most effective forms of reversible birth control. Once inserted, the hormonal implant and hormonal IUD are more than 99 percent effective at preventing pregnancy.
Other forms of birth control can be equally effective if used perfectly — which means correctly, consistently, and on time, every time.
Human nature, on the other hand, often means that this won’t always happen. For instance, a condom may be forgotten, a birth control pack started late, and a birth control shot skipped. So-called “typical use” ultimately makes the actual success rate of each method much lower.
Read on to learn more about each type of birth control, including the effectiveness and what you can do to make it more efficient.
| Type | Availability | Efficacy | |
|---|---|---|---|
| Combination pill | hormonal | prescription-only | about 9 in 100 users become pregnant |
| Progestin-only pill | hormonal | prescription-only | about 9 in 100 users become pregnant |
| Hormonal IUD | hormonal | prescription-only | fewer than 1 in 100 users become pregnant |
| Copper IUD | nonhormonal | prescription-only | fewer than 1 in 100 users become pregnant |
| Implant | hormonal | prescription-only | fewer than 1 in 100 users become pregnant |
| Depo-Provera shot | hormonal | prescription-only | about 6 in 100 users become pregnant |
| Patch | hormonal | prescription-only | about 9 in 100 users become pregnant |
| NuvaRing | hormonal | prescription-only | about 9 in 100 users become pregnant |
| External condom | nonhormonal barrier method | over the counter (OTC) | about 18 in 100 users become pregnant |
| Internal condom | nonhormonal barrier method | OTC | about 21 in 100 users become pregnant |
| Diaphram | nonhormonal barrier method | prescription-only | roughly 12–29 in 100 users become pregnant |
| Cervical cap | nonhormonal barrier method | prescription-only | roughly 12–29 in 100 users become pregnant |
| Sponge | nonhormonal barrier method | OTC | about 9 in 100 users become pregnant |
| Spermicide | nonhormonal barrier method | OTC | about 28 in 100 users become pregnant |
| Fertility awareness methods | nonhormonal | need an OTC basal body temperature thermometer | around 24 in 100 users become pregnant |
| Pull out method/withdrawal | nonhormonal | N/A | around 22 in 100 users become pregnant |
| Breastfeeding or chestfeeding | hormonal | N/A | around 74 in 100 users become pregnant |
| Tubal ligation | sterilization | surgical procedure | fewer than 1 in 200 users become pregnant |
| Tubal occlusion | sterilization | surgical procedure | fewer than 1 in 200 users become pregnant |
| Vasectomy | sterilization | surgical procedure | fewer than 1 in 100 users become pregnant |
Combination pill
The combination pill is about 99 percent effective with perfect use. With typical use, it’s about 91 percent effective.
The combination pill uses two hormones — estrogen and progestin — to prevent ovulation. It also thickens your cervical mucus. This may prevent sperm from traveling into the uterus and reaching an egg.
The combination pill may be less effective if you:
- don’t take it at the same time every day (delaying your dose by 3 hours or more is considered a missed dose)
- vomit within 2 hours of taking the pill
- take certain antibiotics or other medications
- have a weight or BMI that’s considered
overweight
Progestin-only pill
The progestin-only pill (or minipill) is about 99 percent effective with perfect use. With typical use, it’s about 91 percent effective.
JSYK, efficacy data are generally combined for the progestin-only and combination pills. In general, the minipill is considered to be less effective than the combination pill.
Like the combination pill, the minipill may suppress ovulation and also thicken your cervical mucus. It also thins your uterine lining.
The minipill may be less effective if you:
- don’t take it at the same time every day (delaying your dose by 3 hours or more is considered a missed dose)
- vomit within 2 hours of taking the pill
- take certain antibiotics or other medications
- have a weight or BMI that’s considered overweight
Hormonal IUD
The hormonal IUD is over 99 percent effective. Depending on the brand, it can last from
The efficacy, plus the fact that it’s a long-acting form of contraception, can make it the ultimate “set it and forget it” birth control method.
This T-shaped plastic device releases the hormone progestin to prevent ovulation, fertilization, and implantation.
It must be replaced on time to remain effective.
Implant
The implant is over 99 percent effective. It releases progestin to stop ovulation and thicken cervical mucus.
It must be replaced every 3 years to remain effective.
The implant may be less effective if you take certain antivirals or other medications.
Depo-Provera shot
The Depo-Provera shot is over 99 percent effective with perfect use — in other words if you get every shot on time without any variation. With typical use, it’s about 94 percent effective.
This injected form of birth control releases progestin to prevent ovulation and thicken cervical mucus.
You must receive a shot every 12 weeks to remain fully protected against unintended pregnancy.
Patch
The birth control patch is more than 99 percent effective with perfect use. With typical use, it’s about 91 percent effective.
Like the combination pill, the patch releases estrogen and progestin to prevent ovulation and thicken cervical mucus.
It must be replaced on the same day every week to remain effective.
The patch may be less effective if you:
- are unable to keep the patch in place
- take certain antibiotics or other medications
- have a weight or BMI that’s considered obese
NuvaRing
NuvaRing is about 98 percent effective with perfect use. With typical use, it’s about 91 percent effective.
Like the combination pill, the NuvaRing releases estrogen and progestin to prevent ovulation and thicken cervical mucus.
You should take the ring out after 3 weeks to give your body a 1-week break. You must replace the ring on the same day every fourth week for it to remain effective.
NuvaRing may be less effective if you:
- aren’t able to keep the ring in place
- take certain antibiotics or other medications
Copper IUD
A copper IUD is over 99 percent effective at preventing pregnancy. It interrupts the sperm’s ability to move and damages the sperm, ultimately preventing fertilization.
It must be replaced on time every 10 years to remain effective.
External condom
The external condom, which is placed over the penis, is about 98 percent effective with perfect use. With typical use, it’s about 82 percent effective.
This type of condom catches ejaculate in a reservoir, preventing semen from entering the vagina.
The external condom may be less effective if it:
- was stored improperly
- has expired
- is worn incorrectly
- is used with an oil-based lubricant
- isn’t worn before first penetration
Internal condom
The internal condom, which is placed inside the vagina, is about 95 percent effective with perfect use. With typical use, it’s about 79 percent effective.
This type of condom creates a barrier inside the vagina, preventing semen from entering the cervix and uterus.
The internal condom may be less effective if it:
- was stored improperly
- has expired
- is inserted incorrectly
- is used with an oil-based lubricant
- isn’t worn before first penetration
Diaphragm
The diaphragm is about 92 to 96 percent effective with perfect use. With typical use, it’s about 71 to 88 percent effective.
A diaphragm is a flexible, shallow cup that fits into the vagina and covers the cervix. Applying spermicide to the outside of the diaphragm may make it more effective.
It must be inserted correctly and left in for 6 to 8 hours after penis-in-vagina (P-in-V) sex to prevent pregnancy.
Cervical cap
The cervical cap is about 92 to 96 percent effective with perfect use. With typical use, it’s about 71 to 88 percent effective.
Like a diaphragm, a cervical cap covers the cervix to prevent sperm from reaching the uterus. Applying spermicide to the outside of the cervical cap may make it more effective.
It must be inserted correctly and left in for at least 6 hours after P-in-V sex to prevent pregnancy.
Sponge
The sponge is about 80 to 91 percent effective with perfect use. With typical use, it’s about 76 to 88 percent effective.
The sponge is a soft, round piece of foam that’s inserted into the vagina. It’s typically used with spermicide to prevent semen from reaching the uterus.
It must be inserted correctly and left in for at least 6 hours after P-in-V sex to prevent pregnancy.
The sponge may be less effective if you’ve given birth vaginally.
Spermicide
Spermicide is about 82 percent effective with perfect use. With typical use, it’s about 72 percent effective.
Spermicide is available as a gel, cream, or foam. It’s inserted into the vagina with an applicator. It works best if the spermicide is deep inside, closer to the cervix.
Spermicide may be less effective if:
- it wasn’t stored correctly
- it’s expired
- you don’t use enough
- it isn’t inserted deep enough
Fertility awareness methods (FAMs), such as the rhythm method, are up to 99 percent effective with perfect use. With typical use, they’re up to 76 percent effective.
With FAMs, you track your menstrual cycle to help predict when you’re most likely to be fertile. During this time period, you and your partner(s) may avoid P-in-V sex or use a backup method to reduce the chance of unwanted pregnancy.
FAM may be less effective if you:
- aren’t calculating your cycle correctly
- have an irregular cycle that’s difficult to track
- don’t abstain from P-in-V sex or use an effective backup method during fertile days
The pull-out method is up to 96 percent effective when it’s performed perfectly. With typical use, it’s up to 78 percent effective.
This method relies on you or a partner’s ability to remove the penis from the vagina before ejaculation so no semen enters the vagina or uterus.
Withdrawal may be less effective if:
- the penis is pulled out too late
- the penis isn’t pulled out far enough
- sperm is present in pre-ejaculate fluids
The lactational amenorrhea method (LAM) is up to
When you’re nursing, your body stops ovulation. If your ovaries aren’t releasing an egg, you can’t get pregnant or menstruate. However, you must nurse at least once every 4 hours for maximum efficacy.
LAM may be less effective if you:
- don’t breastfeed or chestfeed frequently enough
- pump instead of breastfeeding or chestfeeding
- are more than 6 months postpartum
Tubal ligation
Tubal ligation, or female sterilization, is a permanent procedure. It’s also referred to as “having your tubes tied.”
Although it’s possible to become pregnant after tubal litigation, it’s over 99 percent effective at preventing pregnancy.
During tubal ligation, your surgeon will cut or tie your fallopian tubes. This will prevent eggs from traveling from the ovaries into the uterus, where they could be fertilized by sperm.
You must use a backup contraceptive method, like condoms or other barrier methods, for the first 3 months after the procedure. A clinician will perform a follow-up exam to determine whether the surgery was effective or if you should continue using backup contraception.
Tubal occlusion
Tubal occlusion is another form of female sterilization. It’s over 99 percent effective.
Your surgeon will insert a small metal coil into both of your fallopian tubes. The coils are then unrolled to prevent passage between the tubes and your uterus.
Over time, tissue will grow into the gaps of the coil, permanently preventing eggs from getting into the uterus.
You must use a backup contraceptive method, like condoms or other barrier methods, for the first 3 months after the procedure. A clinician will perform a follow-up exam to determine whether the surgery was effective or if you should continue using backup contraception.
Vasectomy
A vasectomy, or male sterilization, is over 99 percent effective.
During a vasectomy, your surgeon will cut or seal the tubes that carry sperm into semen. You’ll still ejaculate semen, but it won’t contain sperm. This will permanently prevent pregnancy.
You must use a backup contraceptive method, like condoms or barrier methods, for the first 3 months after the procedure. A clinician will perform a follow-up exam to determine whether the surgery was effective or if you should continue using backup contraception.
When used properly, birth control is a highly effective way to prevent unwanted pregnancy.
Work with a doctor or other healthcare professional to pick the best method for your individual needs. They can walk you through any associated risks and help you understand how to use your chosen method correctly.
Condoms are the only method that protects against both unwanted pregnancy and sexually transmitted infections (STIs). Consider using condoms as a secondary method, and make STI testing a part of your regular health routine.