This comparison chart describes the various birth control methods, detailing the advantages and disadvantages in hopes to aid the decision of choosing a method. Birth control preference differs among individuals as everyone’s body and lifestyle is different. The following methods of birth control are in order from most effective to least effective. Within this chart, the effectiveness of these methods is based on the failure rate, which represents the likelihood of pregnancy. The failure rate statistics below are from the Center for Disease Control and Prevention report published in 2019.

To reduce the risk of sexually transmitted infection (STI) transmission, all birth control methods can be combined with a male or female condom. However, a male and female condom should not be used together as this increases risk of ripping or tearing due to friction.

Birth Control Method	Advantages (+)	Disadvantages (-)
Abstinence Failure rate: 0% STI Protection: Dependent on which behaviors a person chooses to engage in. Oral, anal and vaginal sex all carry risks for STI transmission. Hormones: None	Advantages (+) -No cost -No side effects -Most effective method of STI prevention -Can still receive sexual pleasure through masturbation, either solo or mutual with partner(s) -Can focus on alternative activities with partner(s)	Disadvantages (-) -May require discipline and self-control -May be unprepared for protection against pregnancy if user decides to forego abstinence -Pregnancy can still occur from non-coital activities, any activity that allows semen to come into contact with the vaginal opening carries a risk of pregnancy
IUD (Hormonal) Popular Brands: Mirena, Skyla Failure rate: 0.1-0.4% STI Protection: None Hormones: Progestin	Advantages (+) -Mirena lasts up to five years, Skyla lasts up to three years -Can be removed at any time by a healthcare professional -Most inexpensive long-term method of contraception -Ability to become pregnant returns quickly upon removal -Allows sexual spontaneity and does not require daily attention -May reduce cramps and lighten or completely eliminate menstrual period (on average, menstrual flow is reduced by 90%) -Can be used while breastfeeding -Can help prevent endometrial cancer -Gives the user more control over their own pregnancy prevention	Disadvantages (-) – Must be inserted by a healthcare professional – Requires monthly thread checks -Relatively high upfront cost (but no long-term costs) -Insertion of IUD may be painful -May experience cramping or backaches for a few days following insertion -Can cause irregular periods for the first 3-6 months -Slight chance that IUD may slip out of the uterus (usually within the first few months following insertion) -Can increase the risk of ectopic pregnancy
IUD (Nonhormonal) Popular Brands: ParaGuard Failure rate: 0.8% STI Protection: None Hormones: None	Advantages (+) -Lasts up to ten years -Can be removed at any time by a healthcare professional -Most inexpensive long-term method of contraception -Ability to become pregnant returns quickly upon removal -Allows sexual spontaneity and does not require daily attention -Can be used while breastfeeding -Can help prevent endometrial cancer -Very effective form of emergency contraception if inserted within five days after unprotected sex -Gives the user more control over their own pregnancy prevention	Disadvantages (-) – Must be inserted by a healthcare professional -Requires monthly thread checks -Relatively high upfront cost (but no long-term costs) -Insertion of IUD may be painful -May experience cramping or backaches for a few days following insertion -Slight chance that the IUD may slip out of the uterus (usually within the first few months following insertion) -Can increase the risk of ectopic pregnancy -May increase menstrual cramps or bleeding during the first 6 months following insertion -Can cause a 50 to 75% increase in menstrual flow, increasing the user’s risk for anemia
The Implant Popular Brands: Implanon, Nexplanon Failure Rate: 0.01% STI Protection: None Hormones: Progestin	Advantages (+) -Provides protection from pregnancy for up to three years -Allows sexual spontaneity by remaining in place, does not require daily attention -Easily reversible (can return to fertility within three months of removing the implant) -Safer than the pill method for those who are older than 35, smoke, have high blood pressure, are overweight, or have a history of blood clots -Does not have the estrogenic side effects of combination pills (including nausea and vomiting, abdominal pain, back pain and decreased vaginal lubrication) -Most users experience shorter and lighter menstrual periods within the first year of use -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -Requires visit to healthcare professional for insertion and removal -Relatively high upfront cost -Implant may leave a bump on the skin that can be felt or visible -Irregular bleeding is common during the first 6-12 months of use (some experience longer and heavier periods or increased spotting between periods) -Additional side effects include breast tenderness, irregular bleeding, discoloring of the skin over the implant, pain or infection at the insertion side, a change in sexual desire, mood swings, weight gain, acne, and headaches1 -May not be reliable for individuals that weigh over 200 pounds
The Shot Popular Brands: Depo-Provera Failure Rate: 4% STI Protection: None Hormones: Progestin	Advantages (+) -Single injection lasts up to 12 weeks -Protection begins immediately following first injection -Can be used while breastfeeding -Over 50% of users’ menstrual periods will stop after a year of use -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -Requires repeated medical visits (every 12 weeks) -Many experience irregular menstrual cycles during the first year of use -Possible side effects include loss of bone density, irregular bleeding, bleeding between periods, headaches, weight gain, nervousness, dizziness, and abdominal discomfort1 -FDA discourages use exceeding two years due to possible loss of bone density -Negative side effects may remain for three months after the last injection, until the hormones wear off -Not immediately reversible (can take 6-10 months to return to full fertility following the last shot)
Sterilization Includes: Vasectomy (males) or Tubal Ligation (females) Vasectomy Failure Rate: 0.15% Tubal Ligation Failure Rate: 0.5% STI Protection: None Hormones: None	Advantages (+) Vasectomy: -Highly effective and permanent  -No effects on sexual desire or performance -Ease of surgery (surgery performed under general anesthesia and takes around 30 minutes; patient can usually return home within one hour)  -Sexual activity can resume about a week after surgery -Has no noticeable effect on the volume of ejaculate  -Reversible in most cases Tubal Ligation: -Immediately effective following surgery -Highly effective and permanent -No effects on sexual desire or performance -Ease of surgery (surgery is performed under general anesthesia and only takes about 30 minutes; patient can usually return home within a few hours)  -Can be performed on patients within 24 hours after childbirth -Associated with a decrease in the risk of ovarian and endometrial cancer -Reversible in most cases	Disadvantages (-) Vasectomy: -Not immediately effective (residual sperm may remain in the vas deferens for three months after the surgery) -Reversal procedures can be expensive and high risk -Long-term vasectomy complications can include chronic testicular aches that intensify with ejaculation -Vasovasostomy surgery (vasectomy reversal) only has a 50% chance of success Tubal Ligation: -Surgery is riskier and more expensive than a vasectomy -Longer recovery period than vasectomy -Reversal procedures can be expensive and high risk -If tubal ligation fails, there is an increased risk for ectopic pregnancy -Pregnancy following tubal ligation reversal surgery has a 40-80% success rate, dependent on factors including age, amount of scar tissue and type of ligation procedure performed -Many individuals experience difficulty in getting approved for the surgery Both: -High initial cost -Since sterilization is a surgical procedure, there is risk of infection at the site of incision -Must be performed under anesthetics -Reversal procedures can be expensive and high risk
The Combination Pill Popular Brands: Seasonale, Seasonique, Jolessa, Loestrin, Lybrel, Quasense, Yaz Failure Rate: 7% STI Protection: None Hormones: Estrogen and progestin	Advantages (+) -Does not interfere with sexual spontaneity -Has no effect on penile or vaginal sensation -Easily reversible (can return to fertility within three months of stopping the pill) -Can reduce menstrual cramps and bleeding -If used for ten years, it reduces the risk of ovarian and endometrial cancer by 80% -Can also reduce the risk or prevalence of iron-deficiency anemia, endometriosis, ovarian cysts, acne and hirsutism (excessive facial and body hair) -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -Requires daily attention and responsibility, as it must be taken daily at the same time -Possible side effects include nausea and vomiting, breast tenderness, irregular bleeding, abdominal pain, back pain, decreased vaginal lubrication, weight gain, and headaches1 -Can increase risk of blood clots -Should not be used during breastfeeding (hormones can reach the baby through the milk) -May experience irregular or absent periods for the first two months after discontinuation
The Progestin-Only Pill (the mini-pill) Popular Brands: Cerazette, Ovrette, Ortho-Micronor, Errin, Camilla, Jolivette Failure Rate: 7% STI Protection: None Hormones: Progestin	Advantages (+) -Does not interfere with sexual spontaneity -Has no effect on penile or vaginal sensation -Easily reversible (can return to fertility within three months of stopping the pill) -It is safer than the combination pill for those who are older than 35, smoke, have high blood pressure, have a history of blood clots, or are overweight -Does not have the estrogenic side effects of combination pills -Can experience shorter and lighter menstrual periods within the first year of use -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -Effects last only 24 hours, so the user must be very careful not to miss a dose or take it at the incorrect time – Possible side effects include nausea and vomiting, breast tenderness, irregular bleeding, abdominal pain, back pain, decreased vaginal lubrication, weight gain, and headaches1 -Can cause menstrual cycle irregularity during the first three months
The Patch Popular Brands: Ortho Evra Failure Rate: 7% STI Protection: None Hormones: Estrogen and progestin	Advantages (+) -Easy to use and replace-Small and easily hidden -External visibility can serve as a visual reminder  -Can be used continuously to eliminate monthly menstrual periods -Does not interfere with sexual spontaneity -Has no effect on penile or vaginal sensation -May experience shorter and lighter periods -Can reduce the risk or prevalence of iron-deficiency anemia, endometriosis, ovarian cysts, acne and hirsutism (excessive facial and body hair) -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -Must be replaced weekly -Can cause skin irritations -Externally visible (but can be hidden with clothing) -Can become loose or fall off -Users with the patch are exposed to about 60% more estrogen compared to combination pills (increased exposure can put users at a greater risk of blood clots and heart attack, users should not be over the age of 35 who smoke or who weigh more than 200 pounds) -Possible side effects include nausea and vomiting, breast tenderness, irregular bleeding, abdominal pain, back pain, skin irritation, headaches, decreased vaginal lubrication, and weight gain1 -Should not be used during breastfeeding (hormones can reach the baby through the milk)
Vaginal Ring Popular Brands: NuvaRing Failure Rate: 7% STI Protection: None Hormones: Estrogen and progestin	Advantages (+) -Can remain in place for up to three weeks (low maintenance)  -Hormones are absorbed directly from the vagina -Ring releases a lower dosage of estrogen into the bloodstream compared to the combination pill or the patch -Can put users at lower risk of blood clots, vaginal spotting, and cancer -Can be used continuously to eliminate monthly menstrual periods -Does not interfere with sexual spontaneity -Has no effect on penile or vaginal sensation -Easily reversible (can return to fertility within three months of stopping the ring) -Can reduce menstrual cramps and bleeding -Can reduce the risk or prevalence of iron-deficiency anemia, endometriosis, ovarian cysts, acne and hirsutism (excessive facial and body hair) -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -The ring may slip out (if so, it should be rinsed in lukewarm or cool water and placed back into the vagina within three hours) -Possible side effects include abnormal vaginal discharge, discomfort in the vagina, mild vaginal irritation, breast tenderness, nausea and vomiting, headaches, mood swings, decreased vaginal lubrication, and weight gain1 -Can cause long-term increase in vaginal discharge, irritation, or infection -Should not be used during breastfeeding (hormones can reach the baby through the milk)
Emergency Contraceptive Pills (ECPs) (also known as “the morning-after pill”) Popular Brands: Plan B One-Step, i-pill, My Way, Next Choice One Dose, Levonorgestrel Tablets, Ella Failure Rate: 5-12%3 STI Protection: None Hormones: Estrogen and progestin	Advantages (+) -Can reduce risk of pregnancy if used within the first three to five days following unprotected intercourse (is more effective the sooner it is used) -If pregnancy has already occurred, the pill(s) will not harm or affect the existing fetus	Disadvantages (-) -Should not be used as a permanent or reliable method of birth control -Can cause nausea, vomiting and irregular bleeding (if vomiting occurs within two hours of taking the pill, the pill will not be effective) -Can cause a heavier or lighter period, as well as make it earlier or later than usual -Frequent use can cause irregularity in the menstrual cycle -Can be relatively expensive or difficult to access (some countries and states have minimum age requirements and require proof of identification)
Male Condom Popular Brands: Crown, Durek, Lifestyles, Trojan Failure Rate: 13% STI Protection: Yes*Lambskin condoms are porous and therefore do not protect against STIs Hormones: None	Advantages (+) -Offers significant protection against STIs -Allows the male to share responsibility in pregnancy prevention and STI protection -Widely available (sold at most local drugstores, online, and at family planning clinics) -Relatively inexpensive -No prescription required for purchase -Lightweight and disposable -Variety of colors, textures, and flavors -Polyurethane, polyisoprene, and lambskin condoms can be used if one is allergic to latex (lambskin condoms are porous and therefore do not protect against STIs) -Immediately effective upon insertion -Immediately reversible upon removal -Reliable when properly used -Can be used in combination with any method, except the female condom (friction between two condoms can cause ripping or tearing) -Can be used with water-based lubricants to reduce friction and increase sensation	Disadvantages (-) -Can decrease sexual spontaneity -Can decrease penile and vaginal sensitivity -Cannot be put on the penis until the male has an erection -Requires male to maintain an erection as long as the condom is in use  -Must withdraw promptly and carefully after ejaculation -May rip during use, especially if expired or put on incorrectly -Cannot be used with oil-based lubricants (petroleum jelly, baby oil, Vaseline or vegetable oil) as this will greatly increase the chance of condom ripping or tearing
Contraceptive Sponge Popular Brands: Today Sponge Failure Rate: 14% (27% for those who have given birth) STI Protection: None Hormones: None	Advantages (+) -Small, lightweight, relatively inexpensive -Available at most local drugstores and family planning clinics -Does not require a prescription or fitting -Can be inserted hours before sex -Effective for 24 hours without requiring removal or reinsertion -Can be used during breastfeeding	Disadvantages (-) -May be difficult to insert or remove -Requires spermicide to be applied to sponge, which can cause vaginal irritation or numbing -Can increase the risk of toxic shock syndrome (TSS) if used during a menstrual period -Less effective for users who have given birth
Diaphragm with Spermicide Popular Brands: Koro-flex, Koromex, Ortho-Diaphragm Failure Rate: 17% STI Protection: None Hormones: None	Advantages (+) -Can be inserted up to six hours prior to intercourse (but spermicide must be reapplied within two hours before intercourse) -Can remain in place for repeated acts of coitus -Does not affect penile or vaginal sensation during coitus -Reusable and relatively inexpensive -Can last up to two years -Can be used while breastfeeding -Does not affect hormonal balance -Immediately effective upon insertion  -Immediately reversible upon removal -Long-term use is associated with a lowered risk of cervical cancer because it offers some protection against HPV -Gives the user more control over their own pregnancy prevention	Disadvantages (-) -Requires initial fitting with healthcare professional -May be difficult to insert or remove  -Requires throughout every act of intercourse -Spermicide must be reapplied before each sexual act or if two hours have passed since insertion -The spermicide may cause irritation, which could increase the risk of STI transmission -Can possibly get dislodged during intercourse -Can increase the possibility of urinary tract infection (UTI) -May increase the risk of TSS if left in the vagina for over 24 hours
Cervical Cap with Spermicide Popular Brands: FemCap Failure Rate: 17% STI Protection: None Hormones: None	Advantages (+) -Smaller version of the diaphragm which requires less application of spermicide -Can be inserted two hours prior to intercourse -Can remain in place for repeated acts of coitus -Does not affect penile or vaginal sensation during coitus -Reusable and relatively inexpensive -Can last up to two years -Can be used while breastfeeding -Does not affect hormonal balance -Immediately effective upon insertion  -Immediately reversible upon removal	Disadvantages (-) -Requires initial fitting with a healthcare professional – Required throughout every act of intercourse -May be difficult to insert or remove –Spermicide must be reapplied before each sexual act or if two hours have passed since insertion -The spermicide may cause irritation, which could increase the risk of STI transmission -Can possibly get dislodged during intercourse -Can increase the possibility of UTI -May increase the risk of TSS if left in the vagina for over 24 hours -Can be more difficult to insert than the diaphragm (can also be more easily dislodged from the vagina) -Less effective for those who have given birth
Female Condom Popular Brands: Care, Dominique, Femy, Myfemy, Protectiv, Reality Failure Rate: 21% STI Protection: Yes Hormones: None	Advantages (+) -Offers significant protection against STIs -Can be used for vaginal and anal intercourse -Can be used with oil-based and water-based lubricants -Remains in place whether or not the partner has an erection -Can be inserted up to eight hours ahead of time -The ring may stimulate the clitoris during vaginal intercourse -Can be used in combination with any other method of birth control except the male condom	Disadvantages (-) -May cause vaginal, penile, or anal irritation -Can slip into the vagina or anus during intercourse -Can decrease penile and vaginal sensitivity -Can generate distracting noises during intercourse
Vaginal Spermicide Failure Rate: 21% STI Protection: None Hormones: None	Advantages (+) -Low cost -Readily available without a prescription -Can provide lubrication in addition to pregnancy prevention -Immediately reversible	Disadvantages (-) -Can create an unwanted mess -The taste may make oral sex less enjoyable -Can cause genital irritation (irritation is more common if used more than once a day) -Genital irritation can increase the likelihood of STI transmission
Fertility Awareness Includes: Standard Days, Calendar Rhythm, Cervical Mucus and Basal Body Temperature Methods Failure Rate: 23% STI Protection: None Hormones: None	Advantages (+) -Little cost (only requires the purchase of a digital thermometer and calendar) -Immediately reversible -No hormonal side effects -Viable method for individuals who dislike or are unable to consume artificial hormones	Disadvantages (-) -Considerably less reliable than other methods due to user error and cycle irregularity -Requires user to keep track of their menstrual cycle for at least three months prior to using the method -Requires a minimum of six days abstention from vaginal intercourse during each cycle -Should not be used with those who have irregular periods or who are not completely dedicated to tracking their fertility cycle -Should not be used immediately following the use of hormonal contraception (hormonal contraception will affect the user’s cycle, dependent on the specific method)
Withdrawal (also known as “pulling out”) Failure Rate: 27% STI Protection: None Hormones: None	Advantages (+) -No cost  -Requires no prior planning, allowing for sexual spontaneity) -Can be combined with another contraceptive method for extra protection -Allows males to share responsibility in pregnancy prevention -No hormonal side effects	Disadvantages (-) -Requires a high amount of self-control, risk, and trust between partners -High amount of human error and risk-taking -Should not be used for men who ejaculate prematurely or have difficulty recognizing when they are about to ejaculate -Sperm can be present in pre-ejaculatory fluid, or “pre-cum,” which can still cause pregnancy

References

1. Commissioner, Office of the. “FDA Birth Control Chart.” U.S. Food and Drug Administration, FDA, 11 Feb. 2020.
2. “Contraception.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 Nov. 2019.
3. “Emergency Contraception: Effectiveness of Emergency Contraceptives.” Princeton University, The Trustees of Princeton University, 22 Feb. 2019.

Last Updated 5 March 2020.