Different types of birth control methods have large differences in effectiveness, actions required of users, and side effects.
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Different methods require different actions of users. Barrier methods, spermicides, and coitus interruptus must be used at every act of intercourse. The male condom may not be applied until the man achieves an erection. Barriers such as diaphragms, caps, the contraceptive sponge, and female condoms may be placed several hours before intercourse begins (note that when using the female condom the penis must be guided into place when initiating intercourse). The female condom should be removed before arising.[1] The other female barrier methods must be left in place for several hours after sex. Spermicides, depending on the form, may be applied several minutes to an hour before intercourse begins.
Fertility awareness-based methods require that users recognize fertility signs and abstain from intercourse or use other methods during their fertile time.
The lactational amenorrhea method (LAM) requires breast feeding at least every four to six hours.
Oral contraceptives require some action every day. Other hormonal methods require less frequent action - weekly for the patch, twice a month for vaginal ring, monthly for combined injectable contraceptive, and every twelve weeks for the injection Depo-Provera.
Implants, such as Implanon, provide effective birth control for three years without any user action between insertion and removal of the implant. Insertion and removal of the Implant involves a minor surgical procedure.
Intrauterine methods require clinic visits for removal and replacement (if desired) only once every few years (5-10, depending on the device).
Sterilization is a one-time, permanent procedure - after the success of surgery is verified, no action is usually required of users.
Different methods require different levels of diligence by users. Methods that require a clinic visit less than once per year are said to be non-user dependent. Intrauterine methods, implants and sterilization fall into this category. For methods that are not user dependent, the actual and perfect-use failure rates are very similar.
Many hormonal methods of birth control, and LAM require a moderate level of thoughtfulness. For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every 12 weeks. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly (rarely going longer than 4–6 hours between breastfeeds, a late pill or injection, or forgetting to replace a patch or ring on time). The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.
Higher levels of user commitment are required for other methods.[2] Barrier methods, coitus interruptus, and spermicides must be used at every act of intercourse. Fertility awareness-based methods may require daily tracking of the menstrual cycle. The actual failure rates for these methods may be much higher than the perfect-use failure rates.[3]
Different forms of birth control have different potential side effects. Not all, or even most, users will experience side effects from a method.
The less effective the method, the greater the risk of the side-effects associated with pregnancy.
Minimal or no other side effects are possible with coitus interruptus, fertility awareness-based, and LAM. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.
Barrier methods have a risk of allergic reaction. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.
Sterilization procedures are generally considered to have low risk of side effects, though some persons and organizations disagree.[4][5]
After IUD insertion, menstrual periods may be heavier, more painful, or both - especially for the first few months after they are inserted. However, some IUDs are designed to cause periods to become lighter or to cease completely.
Because of their systemic nature, hormonal methods have the largest number of possible side effects.[6]
Failure rates may be calculated by either the Pearl index or a life table method. A "perfect-use" rate is where any rules of the method are rigorously followed, and (if applicable) the method is used at every act of intercourse.
Actual failure rates are higher than perfect-use rates for a variety of reasons:
For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or for some reason not take the pill one or several days, or not go to the pharmacy on time to renew the prescription, or the pharmacy might be unwilling to provide enough pills to cover an extended absence.
The table below color codes the typical-use and perfect-use failure rates, where the failure rate is measured as the expected number of pregnancies per year per 100 women using the method:
| Blue | under 1% | lower risk |
| Green | up to 5% | |
| Yellow | up to 10% | |
| Orange | up to 20% | |
| Red | over 20% | higher risk |
| Grey | no data | no data available |
In the User action required column, items that are non-user dependent (require action once per year or less) also have a blue background.
Some methods may be used simultaneously for higher effectiveness rates. However, mathematically combining the rates to estimate the effectiveness of combined methods can be inaccurate, as the effectiveness of each method is not necessarily independent, except in the perfect case.[8]
If a method is known or suspected to have been ineffective, such as a condom breaking, emergency contraception may be taken up to 120 hours after sexual intercourse. Emergency contraception should be taken shortly before or as soon after intercourse as possible, as its efficacy decreases with increasing delay.
This table lists the chance of pregnancy during the first year of use.
| Birth control method | Brand/common name | Typical-use failure rate (%) | Perfect-use failure rate (%) | Type | Implementation | User action required |
|---|---|---|---|---|---|---|
| Implanon[ref 1] | "the implant" | 0.05 | 0.05 | Progestogen | Subdermal implant | 3 years |
| Jadelle[ref 2] (lower-dose) | "the implant" | 0.05 | 0.05 | Progestogen | Subdermal implant | 5 years |
| Vasectomy[ref 1] | "male sterilization" | 0.15 | 0.1 | Sterilization | Surgical procedure | Once |
| Combined injectable[ref 3] | Lunelle, Cyclofem | 0.2 | 0.2 | Estrogen + progestogen | Injection | Monthly |
| Essure[ref 4] | "female sterilization" | 0.2 | 0.2 | Sterilization | Surgical procedure | Once |
| IUD with progestogen[ref 1] | Mirena | 0.2 | 0.2 | Intrauterine & progestogen | Intrauterine | 5 years |
| Tubal ligation[ref 1] | "female sterilization" | 0.5 | 0.5 | Sterilization | Surgical procedure | Once |
| IUD with copper[ref 1] | Paragard, Copper T | 0.8 | 0.6 | Intrauterine & copper | Intrauterine | 5 to 12+ years |
| LAM for 6 months only; not applicable if menstruation resumes[ref 1][note 1] | "ecological breastfeeding" | 2 | 0.5 | Behavioral | Breastfeeding | Every few hours |
| Depo Provera[ref 1] | "the shot" | 3 | 0.3 | Progestogen | Injection | 12 weeks |
| Lea's Shield and spermicide used by nulliparous[ref 5][note 2][note 3] | 5 | no data | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| FemCap and spermicide[ref 6] | cervical cap | 7.6 (estimated) | no data | Barrier & spermicide | Vaginal insertion | Every act of intercourse |
| Combined oral contraceptive pill[ref 1] | "the Pill" | 8 | 0.3 | Estrogen & progestogen | Oral medication | Daily |
| Contraceptive patch[ref 1] | Ortho Evra, "the patch" | 8 | 0.3 | Estrogen & progestogen | Transdermal patch | Weekly |
| NuvaRing[ref 1] | "the ring" | 8 | 0.3 | Estrogen & progestogen | Vaginal insertion | In place 3 weeks / 1 week break |
| Progestogen only pill[ref 1] | "POP", "minipill" | 8 | 0.3 | Progestogen | Oral medication | Daily |
| Ormeloxifene[ref 7] | "Saheli", "Centron" | 9 | 2 | SERM | Oral medication | Weekly |
| Male latex condom[ref 1] | Condom | 15 | 2 | Barrier | Placed on erect penis | Every act of intercourse |
| Lea's Shield and spermicide used by parous[ref 5][note 2][note 4] | 15 | no data | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| Diaphragm and spermicide[ref 1] | 16 | 6 | Barrier & spermicide | Vaginal insertion | Every act of intercourse | |
| Prentif cervical cap and spermicide used by nulliparous[ref 8][note 3] | 16 | 9 | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| Today contraceptive sponge used by nulliparous[ref 1][note 3] | "the sponge" | 16 | 9 | Barrier & spermicide | Vaginal insertion | Every act of intercourse |
| Female condom[ref 1] | 21 | 5 | Barrier | Vaginal insertion | Every act of intercourse | |
| Symptoms-based fertility awareness[ref 1][note 5][note 6] | basal body temperature, cervical mucus | 25 | 3 | Behavioral | Observation and charting | "Throughout day" or "daily"[note 7] |
| Standard Days Method, CycleBeads & iCycleBeads[ref 1] | 12 | 5 | Behavioral | Calendar-based | Daily | |
| Knaus-Ogino method[ref 8] | "the rhythm method" | 25 | 9 | Behavioral | Calendar-based | Daily |
| Coitus interruptus[ref 1] | "withdrawal method", "pulling out" | 27 | 4 | Behavioral | Withdrawal | Every act of intercourse |
| Spermicidal gel, foam, suppository, or film[ref 1] | 29 | 18 | Spermicide | Vaginal insertion | Every act of intercourse | |
| Today contraceptive sponge used by parous[ref 1][note 4] | "the sponge" | 32 | 20 | Barrier & spermicide | Vaginal insertion | Every act of intercourse |
| Prentif cervical cap and spermicide used by parous[ref 8][note 4] | 32 | 26 | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| None (unprotected intercourse)[ref 1] | 85 | 85 | n/a | n/a | n/a | |
| Birth control method | Brand/common name | Typical-use failure rate (%) | Perfect-use failure rate (%) | Type | Delivery | User action required |
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