Birth control

What is birth control?

Birth control helps keep you from getting pregnant. Examples of birth control include intrauterine devices (also called IUDs), implants, the pill and condoms. Birth control also is called contraception or family planning.

If you’re not ready to get pregnant, use birth control until you’re ready. Other than abstinence (not having sex), no birth control method is 100 percent effective (prevents pregnancy all the time). But some methods come close. For example, less than 1 in 100 women (less than 1 percent) who use implants or IUDs get pregnant.

Implants and IUDs work well at preventing pregnancy because they’re low maintenance. This means that once you get them from your health care provider, they work for a long time and you don’t have to worry about or remember how or when to use them. Once you have an IUD or implant, you don’t have to worry about getting pregnant until you have it removed. Using simple, worry-free birth control like an implant or IUD can help reduce your chances of getting pregnant.

If you’ve already had a baby, use birth control until you’re ready for your next pregnancy. It’s best to wait at least 18 months (1½ years) between giving birth and getting pregnant again. Your body needs this time to recover from one pregnancy before it’s ready for another. Getting pregnant again too soon increases your next baby’s chances of being born prematurely (before 37 weeks of pregnancy) or too small. Talk to your provider about getting an IUD or implant to help reduce your chances of getting pregnant again too soon.

What are IUDs and implants?

IUDs and implants are birth control that a provider places in your body. They help prevent pregnancy for a long time, up to several years. Once you get an IUD or implant, you don’t have to remember to do anything to help it work. Once it’s in, you’re all set. And when you’re ready to get pregnant, your provider removes it and you’re good to go!

An IUD is a small, plastic T-shaped device that your provider puts in your uterus. Hormonal IUDs release progestin into the uterus. Progestin is a man-made form of the hormone progesterone. Hormonal IUDs can prevent pregnancy for 3 to 5 years, depending on what brand you get. Hormonal IUDs help prevent fertilization, when a man’s sperm gets inside a woman’s egg to make her pregnant.

Hormonal IUDs mainly work by:

• Thickening the mucus in your cervix so it’s hard for sperm to enter your uterus and fertilize an egg to make you pregnant. The cervix is the opening to the uterus that sits at the top of the vagina.
• Thinning the lining of your uterus so a fertilized egg has trouble attaching to it.  

Hormonal IUDs also may stop ovulation in some women. Ovulation is when your ovaries release an egg each month. 

Some IUDs have copper on them. Copper IUDs are called non-hormonal because they don’t contain progestin. The copper on the IUD prevents pregnancy because it makes it harder for sperm to move so that it’s more difficult to enter the uterus and fertilize an egg. Copper IUDs also make it harder for a fertilized egg to attach to the uterus lining. A copper IUD can prevent pregnancy for up to 10 years.

For some women, IUDs can cause side effects, like spotting between periods, cramps and back aches. But for others, it’s just the opposite—an IUD reduces cramps and may make your period lighter or make it stop completely. You can breastfeed with an IUD.

An implant is a tiny rod that has progestin in it. Your provider puts the rod in your arm. The rod is so small that most people can’t see it once it’s in your arm. Implants can last for about 3 years. Side effects are similar to those for IUD. You can breastfeed with an implant.

If you’re pregnant, talk to your provider before you give birth about getting an IUD or implant right after you have your baby. This can help prevent pregnancy until you’re ready to get pregnant. It’s best to have at least 18 months between having a baby and getting pregnant again. If you don’t get an IUD or implant when you give birth, talk to your provider about getting one at your postpartum checkup. This is a medical checkup you get about 6 weeks after you have your baby.   

IUDs and implants can prevent pregnancy for a long time, so you may hear them called LARC. LARC stands for long-acting reversible contraception. Long-acting doesn’t mean forever! So don’t worry if you think you may want to get pregnant down the road. You can have an IUD or implant removed any time.

What are other kinds of birth control?

When it comes to birth control, IUDs and implants are just some of your choices. Others include:

• Abstinence. This means you abstain from (don’t have) sex. Abstinence is the only birth control that’s 100 percent effective. This means it prevents pregnancy all the time.
• Hormonal methods. These methods, like implants, non-copper IUDs, the pill and the patch, contain hormones that prevent you from releasing an egg. Without the egg, you can’t get pregnant.
• Barrier methods. Barrier methods, like condoms and diaphragms, work by blocking or killing your partner’s sperm so it can’t reach your egg. Some help protect you from sexually transmitted infections and diseases (also called STIs and STDs). STIs, like HIV and syphilis, are infections you get from having unprotected sex with an infected person. Some STIs can cause problems for you and your baby during pregnancy.
• Natural family planning (also called fertility awareness). This is when you track your menstrual cycle to figure out when you ovulate to help you know when you can get pregnant. Your menstrual cycle is the process of your ovaries releasing an egg (ovulating) every month. The egg moves through your fallopian tubes to the uterus. If the egg is not fertilized by sperm, it passes through the vagina along with blood and tissue from the uterus. This is called your period.

Here are some questions to ask when deciding which birth control to use:

• How well does it work to prevent pregnancy? If you’re having sex, IUDs and implants work best to prevent pregnancy. The next best are other hormonal methods and barrier methods. Natural family planning is the least effective method.
• How much effort does it take from you? IUDs and implants are low maintenance. You don’t have to do anything to make them work. Other methods take more effort from you. For example, if you’re taking the pill, you have to remember to take it every day. If you’re using condoms, you need them handy when you’re ready to have sex. Learning how to use birth control, like condoms and diaphragms, correctly can take time and practice. If you use them incorrectly, they may not work.
• Do you want to have children soon? If you think you’re ready to get pregnant soon, you may want to use birth control, like a barrier method, that’s easy to start and stop using. If you’re not ready to get pregnant for a while, IUDs and implants work for several months and even years.  
• Does it prevent STIs? If you think you or your partner is at risk for STIs, you may want to choose a barrier method of birth control.
• Does it have side effects? For example, some methods of birth control may cause spotting or bleeding between periods.  

What are hormonal methods of birth control? 

Hormonal methods of birth control contain progestin and/or estrogen. Estrogen, like progestin, helps prevent you from ovulating, thickens mucus in your cervix and thins the lining of the uterus. Your provider prescribes hormonal birth control for you—you can’t buy it on your own without a prescription. Hormonal methods don’t protect you from STIs.

Hormonal methods of birth control include:

• Implants and IUDs (not copper IUDs)
• The patch. The patch has progestin and estrogen in it. Your body absorbs the hormones through the patch on your skin. You change the patch every 3 weeks. About 9 in 100 women (9 percent) who use a patch get pregnant.
• The pill (also called birth control pill or oral contraceptive). You take one pill every day. Some pills are progestin-only and some have both progestin and estrogen (called a combined pill). If you’re older than 35, smoke or have blood clots, you may not be able to take combined pills because you may be at risk for heart disease and thrombophilias. Heart disease is when your blood vessels are narrow or blocked. Thrombophilias are health conditions that put you at risk for having abnormal blood clots. About 9 in 100 women (9 percent) who use the pill get pregnant.
• Progestin shots. Your provider gives you a shot of progestin every 3 months. About 6 in 100 women (6 percent) who get shots get pregnant.
• Vaginal ring. This is a plastic ring with progestin and estrogen that you place in your vagina. You change the ring every 3 weeks. Each year, about 9 in 100 women (9 percent) who use a vaginal ring get pregnant.

Hormonal methods of birth control may cause side effects, including:

• Changes in your mood
• Headache
• High blood pressure. This is when the force of blood against the walls of your blood vessels is too high.
• Spotting or bleeding between periods
• Weight gain

IUDs and implants are safe to use when you’re breastfeeding, but other hormonal methods may affect your breast milk. If you use a hormonal method with estrogen in it, you may make less breast milk. If you’re breastfeeding or planning to breastfeed, talk to your provider about the best birth control for you.

What are barrier methods of birth control?

Barrier methods work by blocking or killing sperm so it can’t reach your egg. Some help protect you from STIs. Barrier methods include:

• Diaphragm or cervical cap. These are cups that you put inside your vagina to cover your cervix and block sperm. A diaphragm is shaped like a shallow cup. The cervical cap looks more like a thimble. They come in different sizes, so you need to see your provider to get the right one for you. Each year, about 12 in 100 women (12 percent) who use a diaphragm get pregnant, and about 23 in 100 women (23 percent) who use a cervical cap get pregnant.
• Male and female condoms. Condoms help prevent pregnancy by keeping your partner’s sperm from getting into your body. They also help protect you from STIs. A male condom goes on your partner’s penis. Most male condoms are made of latex (rubber), but some are made of other things, like lambskin and other kinds of plastic. Condoms made of lambskin (also called natural condoms) may not prevent STIs. A female condom (also called an internal condom) is made of plastic or rubber and goes inside your vagina. If you use condoms, don’t use oil-based lubricants, like massage oil or hand lotion, because they can tear or break the condom. About 18 in 100 women (18 percent) whose partners use male condoms get pregnant. Each year, about 21 in 100 women (21 percent) who use female condoms get pregnant.
• Spermicide. Spermicide kills sperm. It comes as foam, gel, cream, a thin sheet of film and as a suppository. A suppository is a tablet that dissolves after you put it in your vagina. You can use spermidice with a male condom, a diaphragm or cervical cap. Each year, about 28 in 100 women (28 percent) who use spermicides get pregnant.
• Sponge. The sponge is a piece of plastic foam that you put inside your vagina to block your cervix. The foam has spermicide in it to help block and kill sperm. Each year, about 24 in 100 women (24 percent) who use a sponge get pregnant.

Barrier methods do require some effort by you or your partner. You have to have the method available when you’re ready to have sex. And you have to use it correctly for it to prevent pregnancy.

Barrier methods may have side effects, like:

• Irritation, like vaginal burning
• A latex allergy. An allergy is a reaction to something you touch, eat or breathe in that makes you sneeze, itch, get a rash or have trouble breathing. If you’re allergic to latex and you use a barrier method made of latex, you may have mild allergy symptoms, like a rash or hives (red, itchy bumps on the skin). If you have a severe reaction to latex, you may have trouble breathing or pass out. If you think you have a latex allergy, talk to your provider.
• A condom may break or slip. This can increase your chance of getting pregnant.
• If you use spermicide that has nonoxynol-9 in it, it may increase your risk of getting HIV. Nonoxynol-9 is a substance in some spermicides that, if you use it a lot, can cause changes in your vagina that may make you more likely to get HIV.

What is natural family planning?
Natural family planning (also called fertility awareness) is when you track your menstrual cycle to figure out when you’re ovulating. If you know when you’re ovulating, you know when not to have unprotected sex.

Natural family planning has no side effects. It doesn’t protect you from STIs, and it doesn’t prevent pregnancy as well as other kinds of birth control. Each year, about 24 in 100 women (24 percent) who natural family planning get pregnant.

If your periods are irregular (the number of days apart varies from month to month), it may be hard to figure out when you ovulate. You can get pregnant up to 5 days before and the day of ovulation. So if you’re preventing pregnancy with natural family planning, don’t have unprotected sex on these days.

Natural family planning includes:

• Basal body temperature method. Your basal body temperature is your temperature when your body’s at rest. Use a basal body thermometer to take your temperature every day before you get out of bed. This is a thermometer that can measure really small changes in your temperature. For most women, your temperature rises slightly (0.5 to 1°F) when you ovulate. The 2 to 3 days before your temperature rises are the best days to try to get pregnant, so if you’re using this method of birth control, don’t have sex on these days. This method tells you when ovulation has already happened, but if you track it over a few months, you may be able to predict when you’ll ovulate in the future. Note that things other than ovulation, like having a fever, drinking alcohol or getting a good night’s sleep, can affect your temperature.
• Cervical mucus method. Pay attention to the mucus in your vagina. It increases and gets thinner, clearer and slippery just before ovulation. You’re most likely to get pregnant when your mucus is the most thin, slippery and clear. So for birth control, don’t have sex on these days and for a few days after.
• Ovulation calendar, like the March of Dimes Ovulation Calendar. Use our tool to help you figure out when you ovulate. If you’re preventing pregnancy, don’t have unprotected sex. 
• Ovulation prediction kit. Ovulation prediction kits test urine for a substance called luteinizing hormone (also called LH). This hormone increases each month during ovulation and causes the ovaries to release eggs. The kit tells you if your LH is increasing so you know when not to have sex if you’re trying to prevent pregnancy.

Additional versions of this article are available in: Arabic, Chinese Simplified, Hindi, and Urdu

Translated documents are courtesy of the employees of CooperSurgical Inc.

More information

• American Congress of Obstetricians and Gynecologists (ACOG)
• Bedsider
• Centers for Disease Control and Prevention (CDC)
• Show Your Love Campaign
• womenshealth.gov

Last reviewed: August, 2019