A Guide To The Best Birth Control Options (2024)

A variety of birth control methods are available, each of which work to prevent pregnancy in a different way.

“At a fundamental level, birth control works by blocking sperm from getting to eggs, and there are various ways that’s done,” explains Jessica Horowitz, a family nurse practitioner and the chief clinical officer at Tia, a network of online and in-person women’s health clinics offering primary care, mental health, gynecology, and wellness services.

Barrier methods, such as condoms, diaphragms and cervical caps, physically block the passage of semen into the vagina. These products are the only birth control options that protect individuals against sexually transmitted infections (STIs). Hormonal contraception, on the other hand, contains estrogen, progestin or a combination of the two. This type of contraception works to inhibit ovulation, the process by which the ovaries release eggs into the fallopian tubes, and creates an inhospitable environment for sperm, explains Horowitz. Other devices, such as an intrauterine device (IUD), similarly create an environment where sperm is unlikely to survive.

Natural birth control methods are also common. For instance, fertility awareness-based methods (FABMs) rely on tracking the most fertile days of one’s menstrual cycle. During those days, individuals often either abstain from sex or utilize a barrier method when actively preventing pregnancy.

“There are a lot of reasons why an individual may opt for what we colloquially call birth control,” says Christy Evans, M.D., a board-certified OB-GYN based in Los Angeles. Beyond pregnancy prevention, many people use hormonal birth control to manage symptoms and conditions like heavy bleeding, painful periods, endometriosis, polycystic ovary syndrome (PCOS) or fibroids.

According to research and experts, several factors may determine which birth control suits the needs and preferences of an individual, including:

• Effectiveness of the chosen method
• User friendliness and maintenance (daily pill vs. multi-year implant)
• Preference for a long-term or short-term solution
• Concerns about potential side effects
• Existing health conditions
• Frequency of intimacy and number of partners
• Ability to protect against STIs
• Religious considerations
• Reversibility (considering future plans for children)
• Accessibility and availability

“When deciding on the best birth control, it’s really about finding the one that fits well into someone’s life,” emphasizes Horowitz. There is no single best option, and it’s important to remember that if one method doesn’t work for someone, a different method may be a better fit, she says.

Long-Acting Reversible Birth Control Methods

Clinical studies often use the terms “perfect use” and “typical use” when evaluating birth control effectiveness. “Perfect use” refers to the ideal application of a given treatment while “typical use” considers the realities of daily life, including real-world factors can affect a method’s efficacy. Long-acting reversible contraceptives (LARCs), such as IUDs and subdermal (beneath the skin) implants, are particularly effective because they don’t require taking a daily pill, and therefore are not compromised if a day is missed, notes Dr. Evans. Common LARCs include the hormonal and copper IUDs, which are both highly effective methods of birth control, with fewer than one in 100 users becoming pregnant while using them^[1]Birth Control. U.S. Food and Drug Administration. Accessed 10/4/2023. .

Hormonal IUDs are small, T-shaped devices a health care provider inserts into one’s cervix. This type of IUD releases a synthetic progestin called levonorgestrel, which mimics the naturally occurring hormone progesterone, and provides protection from pregnancy for up to five years. The release of levonorgestrel prevents pregnancy in various ways, including inhibiting ovulation and thickening cervical mucus, which impedes sperm movement and passage.

According to experts, other potential benefits of hormonal IUDs include:

• Hormones localized to the uterus, potentially minimizing systemic side effects
• Potentially lighter menstrual periods
• Full reversibility
• Ease of use (they do not require daily attention)

While many patients seek non-hormonal birth control, Dr. Evans emphasizes IUDs contain significantly lower hormone levels than other hormonal methods, such as the pill. She nevertheless advises that women with certain health concerns, such as a history of blood clots, should avoid hormonal IUDs. She also flags the following additional considerations for those considering hormonal IUDs:

• Insertion requires a pelvic examination and procedure.
• There’s potential for cramping and discomfort during and after insertion.
• Removal must be performed by a health care provider.
• Use may lead to irregular bleeding or cessation of periods (amenorrhea).
• They don’t protect against STIs.

Copper IUDs are similar to hormonal IUDs in that they’re T-shaped and require insertion by a health care provider. The copper causes an inflammatory response in the uterus, ultimately preventing sperm from reaching or fertilizing an egg.

Horowitz says copper IUDs have the following benefits:

• They provide birth control for up to 10 years.
• Birth control is fully reversible upon the device’s removal.
• They’re a hormone-free contraception option.
• They don’t require daily attention.

Horowitz also notes the follow possible drawbacks of copper IUDs:

• Potentially heavier periods
• The requirement of a pelvic examination and procedure for insertion
• Potential spotting between periods and cramps
• A lack of protection against STIs

Individuals may experience anxiety about IUD insertion procedures, and it’s important for health care providers to address those concerns, say Dr. Evans and Horowitz.

“The reality of an IUD insertion is that it requires a speculum, and it can be uncomfortable,” says Dr. Evans. To enhance comfort during an IUD insertion, a provider may advise individuals to take a non-steroidal anti-inflammatory drug (NSAID) or an over-the-counter pain reliever prior to the procedure. Additionally, placing a heating pack on an individual’s abdomen during the insertion, having a support person in the room and/or applying a topical ​​anesthesia, such as lidocaine at the time of service may help, she adds.

Fertility Awareness-Based Birth Control Methods

Many people seek non-hormonal pregnancy prevention, says Dr. Evans. She often recommends fertility tracking, also referred to as natural birth control, in such cases. Natural birth control methods involve avoiding unprotected intercourse during one’s peak fertility days, which can be determined by monitoring basal body temperature, the texture of cervical mucus and the physical positioning of the cervix.

Fertility tracking methods may be a good choice for those avoiding hormonal contraceptives because of personal preferences or health reasons. However, natural contraception has a higher failure rate than other means of preventing pregnancy. Fertility tracking can be difficult to learn how to do accurately, laborious and inhibited by inconsistent tracking, irregular menstrual cycles, perimenopause or conditions like PCOS.

The introduction of specific technologies and tools designed to monitor fertility and ovulation, such as apps and smart watches or rings, can enhance the effectiveness of natural birth control, according to Dr. Evans. Regardless, it’s particularly valuable for gaining a clearer understanding of one’s cycle, she notes

Both Dr. Evans and Horowitz frequently direct individuals to Bedsider.org, a birth control support network for in-depth information on all things birth control, as well as a provider directory.

A knowledgeable health care provider can also offer essential and personalized birth control advice. Horowitz suggests seeking specialists in women’s health and trauma-informed care, asking friends and family members for trusted recommendations, and scheduling a preliminary consultation to gauge the provider’s approach.

“At the end of the day, it’s the individual’s choice, and I’m here to provide medically relevant information and help them navigate what makes the most sense for them in their own personal situation,” says Dr. Evans. If someone feels dismissed or like their questions aren’t being adequately addressed, it’s okay to look for another provider, says Horowitz.