Birth Control Options Compared: Effectiveness, Side Effects and How to Choose
Written by Cherlie Joseph, MSN, FNP-BC · Medically reviewed by Naurah Gaspard, DNP, FNP-C, FNP-BC · Updated November 2026
The most effective reversible birth control options are the implant and IUDs, with fewer than 1 in 100 users getting pregnant each year. The shot, pill, patch and ring are also very effective when used on time (about 4 to 7 in 100 with typical use). The best method is the one that fits your health, your schedule and your goals.
In this guide
Birth control effectiveness at a glance
The numbers below are the CDC's estimates of how many people out of 100 get pregnant in the first year of typical use, meaning real life, including late or missed doses.
| Method | Pregnancies per 100 per year | How often you think about it |
|---|---|---|
| Implant (Nexplanon) | 0.1 | Several years (check your device) |
| Hormonal IUD | 0.1 to 0.4 | 3 to 8 years depending on brand |
| Copper IUD (Paragard) | 0.8 | Up to 10 years |
| Shot (Depo-Provera) | 4 | Every 3 months |
| Pill, patch or ring | 7 | Daily, weekly or monthly |
| External (male) condom | 13 | Every time |
| Withdrawal | 20 | Every time |
Condoms are the only method on this list that also lowers the risk of STIs, so many people pair them with another method.
Long-acting options: IUDs and the implant
Hormonal IUDs (Mirena, Liletta, Kyleena, Skyla) release a small amount of levonorgestrel into the uterus. Periods often get lighter, and some people stop bleeding altogether, which can be a plus for heavy or painful periods. Irregular spotting is common in the first few months.
The copper IUD has no hormones. It can make periods heavier and crampier, especially in the first year. It can also be used as emergency contraception within 5 days of unprotected sex.
The implant is a small rod placed under the skin of the upper arm. Unpredictable bleeding is the most common reason people have it removed.
All of these need an in-person visit to place and remove, and fertility returns quickly after removal.
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Start a visit →Short-acting hormonal options: pill, patch, ring and shot
Combined pills, the patch and the ring contain estrogen and a progestin. They can make periods lighter and more predictable and may help acne and PMS. Because estrogen raises the risk of blood clots, they are generally not recommended if you smoke and are 35 or older, have migraine with aura, have had a blood clot, or have certain heart or blood pressure conditions. Some patch labels carry extra cautions for people with a BMI of 30 or higher.
Progestin-only pills are an option when estrogen isn't safe. Opill (norgestrel) has been sold over the counter since 2024 with no age limit or prescription. It must be taken at the same time every day. Drospirenone (Slynd) is a prescription progestin-only pill with a wider timing window.
The shot (Depo-Provera) is given every 3 months. It can cause irregular bleeding and weight gain in some people, and fertility can take several months to return after stopping. It also carries a warning about bone density loss with long-term use.
How to choose the right method for you
A few questions narrow things down quickly:
- How important is never thinking about it? If remembering a daily pill is hard, an IUD, implant, ring or shot may suit you better.
- Can you safely take estrogen? Smoking at 35+, migraine with aura, past blood clots and uncontrolled high blood pressure point toward progestin-only or non-hormonal methods.
- What do you want your periods to do? Lighter or fewer periods favor hormonal IUDs and continuous pill use; avoiding hormones favors the copper IUD.
- When do you want to be pregnant? If within a year or so, a method with a fast return to fertility may be a better fit than the shot.
- Are you taking other medicines? Some seizure drugs, rifampin and certain HIV drugs make pills, patches and the implant less effective. Tirzepatide (Mounjaro, Zepbound) can lower birth control pill levels, so the label advises a backup or non-oral method for 4 weeks after starting and after each dose increase.
The CDC's medical eligibility criteria (US MEC) guide which methods are safe for each health condition. Your provider uses these to match options to your history.
Get in-person care or call 911 if you have:
- Sudden chest pain, shortness of breath or coughing up blood
- Pain, swelling and warmth in one leg
- A sudden severe headache, vision loss, or weakness or numbness on one side
- Severe lower belly pain with a positive pregnancy test (possible ectopic pregnancy)
Frequently asked questions
What is the most effective birth control?
The implant and IUDs are the most effective reversible methods, with fewer than 1 in 100 users getting pregnant each year. Sterilization is also highly effective but is meant to be permanent.
Can I get birth control without seeing a doctor in person?
Yes. Opill is sold over the counter, and pills, patches and rings can be prescribed after an online visit that reviews your health history and blood pressure. IUDs, implants and the shot require an in-person visit.
Does birth control cause weight gain?
Studies have not shown that the pill, patch, ring or IUDs cause meaningful weight gain for most people. The shot is the method most linked to weight gain in some users.
Sources
- CDC: Contraception
- CDC: U.S. Medical Eligibility Criteria for Contraceptive Use, 2024
- FDA: Birth Control Chart
Keep reading
- Missed a birth control pill? What to do
- Emergency contraception: Plan B vs ella vs IUD
- STD testing online in Florida
- Browse all conditions and treatments A to Z
Want help choosing or refilling birth control?
$79 visit, no appointment needed. Adults 18+ in FL, NM, OR and WA.
Start a visit →
Cherlie Joseph, MSN, FNP-BC
Board-certified family nurse practitioner licensed in Florida, caring for adults online at OurTopClinic. Meet our providers.
This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.
