Birth Control Methods Ranked by Effectiveness

When you're shopping around for the best birth control method for you, there are lots of things to take into consideration:

• How your method of choice affects your monthly cycle
• What side effects it might cause
• How long it will prevent you from getting pregnant

But one of the biggest considerations is how well it prevents pregnancy.

How Birth Control Effectiveness Is Determined

The most effective methods are the ones that don't require much from users, said Justine Wu, MD, MPH, assistant professor in the department of family medicine at the University of Michigan and chair of the board of the Association of Reproductive Health Professionals. "Anything working on its own is going to be [more effective] because there's no human error."

When it comes to measuring effectiveness, experts use data based on "typical use," or how real people use each method. The effectiveness rate is calculated by counting the number of people out of 100 who experience an unintended pregnancy during the first year of typical use.

Since effectiveness is so important, it's a good idea to use effectiveness rates as a guide for what birth control to go with.

We've laid details on each method as well as failure rates (based on Centers for Disease Control information and some from the Office on Women's Health) for every method out there—from the most reliable to the iffy.

Implant

Typical use failure rate: 0.1% per the CDC

This matchstick-size progestin-releasing implant is placed by a healthcare provider under the skin high up on your inner arm.

The progestin thickens cervical mucus, making it tougher for sperm to reach an egg. That is, if one is released. Progestin can also halt eggs from leaving the ovaries to begin with.

Once the implant is in (it takes just minutes), there's really not much you need to do.

The implant's effects are systemic, meaning the hormones travel through your whole body, and that could cause side effects.

Another thing to consider is how comfortable you are with this tiny implant placed just under your skin.

"Some [people] feel uncomfortable with or don't like the idea of having something in the uterus," so they prefer an [arm] implant to an IUD," said Taraneh Shirazian, MD, assistant professor in obstetrics and gynecology at NYU's Langone Medical Center.

Like an IUD, the implant is "one of the options that you don't have to think about, that don't require ongoing maintainence," said Dr. Shirazian.

Male Sterilization

Typical use failure rate: 0.15% per the CDC

Otherwise known as a vasectomy, male sterilization involves cutting or blocking the vas deferens, the tubes sperm travel through from the testicles.

If sperm are blocked from leaving a man's body, you can't get pregnant.

While a vasectomy can be reversed in many cases, the procedure is meant to be permanent. It's also less invasive than female sterilization, which involves abdominal surgery and has a greater potential for complications, said Dr. Shirazian.

"Vasectomy is much less risky because it's done in the doctor's office with local anesthesia," said Dr. Shirazian.

As long as you and your partner are sure—really sure—that babies are not in your future, your partner is a candidate for this method. Once it's done, there's nothing more you need to.

Hormonal IUD

Typical use failure rate: 0.1-0.4 %, per the CDC

This tiny, T-shaped device is placed in the uterus by a healthcare provider during a 15-minute or so office procedure and can potentially last for up to 8 years. The hormonal IUD Mirena is approved by the Food and Drug Adminstration for 8 years.

Four types of hormonal IUDs have been approved by the FDA; each works by releasing progestin (just like the implant and some birth control pills).

The hormone thickens cervical mucus, making it harder for sperm to reach an egg, and it may also stop ovulation, so no egg is released.

Like an implant, once you have an IUD, there's little for you to do to make sure it's smooth sailing. But you need to be sure about the method before having one inserted. There is a slight possibility that it may dislodge.

To get a sense of if it's right for you, talk with an ob-gyn about when, if ever, you plan on becoming a parent.

Describe your periods each month, and ask about the potential side effects (such as breakthrough bleeding and breast tenderness).

Female Sterilization

Typical use failure rate: 0.5% per the CDC

Female sterilization (or tubal ligation) means removing, blocking or cutting the fallopian tubes, which prevents an egg from traveling to the uterus and being fertilized by sperm.

This is also a permanent form of birth control (though in some cases people have had it reversed and gone on to get pregnant), and it's a somewhat more complicated surgery than a vasectomy is for a man.

There's nothing you need to do to make sure this method is effective once you wake up from the operating room. But all surgical procedures come with risks (especially since you'll be given general anesthesia.)

Unlike the implant or hormonal IUD, sterilization won't affect your cycle.

"If a [person] had severe anemia from heavy menstrual cycles, sterilization is going to prevent [them] from getting pregnant but it not help with [their] bleeding problem," said Dr. Wu, "whereas with a hormonal IUD, some [people] will experience decreased bleeding."

Copper IUD

Typical use failure rate: 0.8% per the CDC

Like hormonal IUDs, the copper device is also placed in the uterus and left alone—this time for up to 10 years. The difference is, the copper version doesn't contain any hormones.

It's the metal itself that prevents pregnancy by making the uterus inhospitable to sperm.

The copper IUD can also be inserted in the first few days after unprotected sex as emergency contraception.

Once it's in—it involves the same insertion procedure as the hormonal IUD—you won't need to worry about maintenance.

The copper IUD, like all IUDs, is a good option for people who know they don't want to be pregnant in the next decade, whether they've already had a baby or not.

"It used to be that [people] felt they had to have had a baby [before getting an IUD], and that has slowly shifted," said Dr. Shirazian. "IUDs are good methods for [people] of any age regardless of partners and pregnancies."

Some people prefer the copper IUD because it's totally hormone-free, said Dr. Wu. Dr. Wu is less likely to recommend it to people with heavy or painful periods, said Dr. Wu, since it may make those period side effects worse.

Hormone Injection

Typical use failure rate: 4% per the CDC

Hormone injection is another method that relies on the hormone progestin to thicken cervical mucus and prevent sperm from ever reaching an egg. Progestin may also stop ovulation, so no eggs reach the uterus at all.

The shot is administered by a healthcare provider every three months.

It's important that you'll be able to make regular appointments so this method can work its magic, said Dr. Shirazian. "Don't delay your shot, because some women can get pregnant in the interim."

Dr. Shirazian said the shot may be more likely to result in weight gain than other hormonal birth control methods, and will often recommend another choice, but the shot "might be a good option if you have trouble remembering to take the pill."

Pill

Typical use failure rate: 7% per the CDC

The pill, aka oral contraception, may still be what many people think of first when they think of birth control.

But there are more types of birth control pills than ever before: combination pills that contain estrogen and progestin, progestin-only pills, and extended-cycle pills that reduce the frequency of your period.

A conversation with a healthcare provider can help you find the one that's right for you.

Most birth-control pills work by stopping ovulation, so no egg is released at all. They also thicken cervical mucus.

And while side effects range from breakthrough bleeding to way lighter periods to skin changes, pills that contain estrogen can raise the risk of certain health conditions, such as blood clots (if you also smoke).

The tricky thing about the pill is that in order for it to work, you have to remember to take it every single day around the same time, give or take an hour or two, said Dr. Shirazian.

If you have trouble remembering to take the pill, you might want to enlist the aid of a daily reminder in your phone—or try an app that can help keep you on schedule, like Bedsider or myPill.

The Patch

Typical use failure rate: 7% per the CDC

The birth control patch also contains estrogen and progestin and halts ovulation, same as oral contraception.

But instead of having to remember to take a pill every day, you just stick on a new patch once a week (you take it out the week of your period), and you're covered.

Usually placed on the belly, upper arm, back, or butt, the patch emits hormones that are absorbed through your skin.

The downside of the patch is that you're in charge of placing it correctly (it can't go on your breast), remembering to slap on a new one, and checking periodically to make sure it hasn't fallen off accidentally.

"It has to be well-applied—the corners can't be coming up—in order to make sure you're getting the targeted amount of hormones," said Dr. Shirazian.

Ring

Typical use failure rate: 7% per the CDC

Another hormonal birth control option is the vaginal ring, which you wear inside your vagina for three weeks and take out for a week to have your period.

It releases estrogen and progestin to stop ovulation and thicken cervical mucus; both hormones are absorbed through the vaginal lining.

Placing it correctly helps the ring work best, said Dr. Shirazian. "Sometimes people say they feel it or it comes out easily. That usually means it's not really well-applied. Make sure you push it up into the vagina as far as possible."

You'll also need to keep track of when it's time to put in a new one and how long you've gone without it.

The ring can stay in during sex or an annual pap smear, though if you prefer, you can take it out for up to three hours.

"You can technically take it out for sex," said Dr. Wu. "It works by releasing hormones in a very slow, steady state, so 20 to 30 minutes of sex is not going to make a difference.

That being said, it's not recommended to take it out for more than three hours at any time. You need to remember to put it back in."

Male Condom

Typical use failure rate: 13% per the CDC

These latex or polyurethane sleeves act as a barrier preventing sperm from coming anywhere near your unfertilized egg.

Worn properly, condoms also protect against STIs–unless you're using a lambskin condom, which isn't as effective at preventing microbes from spreading.

Condoms are one of the oldest types of contraception, but even after centuries of use, people still place them on incorrectly, said Dr. Shirazian, which is why they aren't as effective as they should be theoretically.

"I hear all the time that a condom breaks! A condom should not break if it's been put on correctly," said Dr. Shirazian.

Make sure it's unrolled all the way down the shaft of the penis with a little room at the top—and wait until the penis is erect to do so, said Dr. Shirazian.

"Condoms used well, work well," said Dr. Wu.

Phexxi

Typical use failure rate: 14% per the American Association of Family Physician (AAFP)

Phexxi (pronounced FEX-ee) is a new non-hormonal prescription vaginal gel used to prevent pregnancy. Phexxi is an FDA-approved on-demand method of birth control but is effective when used immediately before (or up to 1 hour before) each act of vaginal sex. Phexxi is not effective when used after vaginal sex but must be applied before each act of vaginal intercourse.

Phexxi is made up of lactic acid, citric acid, and potassium bitartrate which lower the pH in the vagina and immobilize sperm.

According to the AAFP, in a trial of over 1300 women 18 to 35 years of age, 13.7% of women became pregnant during six months of use.

Diaphragm

Typical use failure rate: 17% per the CDC

This rubbery barrier fits inside your vagina and covers your cervix, preventing pregnancy by locking sperm out of your uterus. They come in different sizes (just as people do), so you'll need to be fitted for one at a healthcare provider's office.

And they should always be used with spermicide, which immobilizes or kills sperm as they try to sneak through the diaphragm on their mission to fertilize an egg.

A diaphragm emits no hormones, and you only use it when you're ready to have sex (you just pop it in, and you're good to go). But it has to stay in for at least six hours after sex, or else any waiting sperm might get inside your body.

"It can be tricky to not remove it prematurely," said Dr. Shirazian. Perhaps this is why it's effectiveness rate isn't as high as it should be.

Female Condom

Typical use failure rate: 21% per the CDC

Inserted into the vagina somewhat like a diaphragm (and up to eight hours before sex), the female condom covers the cervix to prevent sperm from entering.

It's not as effective as a male condom—and it's not as effective at preventing STDs, either.

A lot of that is because it's a little complicated to insert and position correctly. Unlike a male condom, it doesn't have anything to fit tightly over, and it can shift around and feel uncomfortable.

"It's much trickier than putting on a male condom," said Dr. Shirazian. "The package does describe application, but it's not easy, honestly. Female condom rates of success are lower and not a very popular method for that reason."

Spermicide

Typical use failure rate: 21% per the CDC

Spermicide should always be used with a diaphragm, and it can increase the effectiveness of condoms (which is why many condoms are coated with spermicide already).

But it can also be used on its own to slow down sperm and help block the cervix. You can find spermicide in creams, gels, films, foams, or suppositories.

No matter what form you go with, you'll need to insert the spermicide right before having sex—and be comfortable with the fact that on its own, it's one of the least effective birth control methods available.

If you're going to use spermicide, Dr. Wu recommends choosing the film form. The tiny sheets dissolve in the vagina. "It's really small, partners won't even know it's there," said Dr. Wu.

Withdrawal

Typical use failure rate: 22% per the Office on Women's Health)

The birth control method most of us know as pulling out is officially called the withdrawal method—a person withdraws the penis right before ejaculation, so no sperm enter the vagina.

But it's not exactly effective, hence its other nickname, "pull and pray."

If just a little bit of ejaculate gets in or near the vagina during the withdrawal process, pregnancy is possible—which means your partner has to display some serious control to pull out at the right time.

While there isn't exactly great research on the topic of getting pregnant from pre-ejaculate, at least one study found sperm in pre-ejaculate fluid, said Dr. Wu.

"I try to counsel people based on their current emotions about pregnancy and becoming a parent," said Dr. Wu.

If pregnancy isn't in the cards for right now, "I move toward more effective methods," said Dr. Wu.

If people are more open to becoming pregnant and are happy using the withdrawal method (and aren't at risk for STDs),"I just may emphasize the best way to use withdrawal." And that means, said Dr. Wu, doing it right—every single time.

Fertility Awareness

Typical use failure rate: 2-23% per the CDC

If you're super organized and ultra-committed to your period tracking app, you might consider a fertility awareness method, also sometimes called natural family planning or the rhythm method.

This involves keeping close track of your period and ovulation so you know when you're most fertile—and not having sex (or using another method of birth control) on those days.

Opting for a fertility awareness method (or FAM) means taking your temperature every morning, checking cervical mucus every day, or charting cycles (or use any combination of these three methods) to determine when you're near ovulation.

Keep in mind that this works best when your cycle is pretty predictable, so you can track these changes and follow the patterns, said Dr. Wu. "I think it can be a good method for people with a regular cycle who are motivated to do it."

Sponge

Typical use failure rate: 27% in people who have given birth before; 14% in people who have never given birth before, per the CDC

Like a diaphragm, the sponge, made of squishy plastic, covers your cervix and blocks sperm. It also contains spermicide to immobilize or zap those swimmers if they happen to get close.

You can leave it in for up to 24 hours—but it has to stay in place for at least six after having sex to be effective.

Like other methods that you insert yourself, this one has to be placed properly. As evidenced by the effectiveness stats, it might not fit so perfectly if you've given birth in the past.

Because the sponge isn't among the most popular forms of contraception, said Dr. Wu, it might also require a little extra work to track one down online or at a local pharmacy.