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Fertility control has been one of the many challenges that women of reproductive age have had to contend with throughout history. And although we are far from having found the definitive solution, the last number of decades have introduced us to massive breakthroughs and innovations in contraceptive methods.

The exponential advances in the fields of contraception, gynecology, and obstetrics over the last thirty years, in particular, not only have freed women of the burden of unplanned pregnancy but have also facilitated easier and healthier family planning for couples.

Today, women have an assortment of birth control options with varying degrees of effectiveness, risks, side effects, and convenience. Choosing the right option requires a good understanding of each method of contraception as well as a good assessment of an individual’s needs and lifestyle choices.

What Are the Deciding Factors?

When considering a birth control method, you should first factor in its effectiveness in preventing pregnancy, and the safety of its use. The effectiveness of a contraceptive method is typically measured and shown by the percentage of individuals who fail at contraception within a year of using that method. For example, male condoms are 84% effective which means that 16 out of 100 women who solely rely on male condoms (if used properly) as a birth control method will get pregnant in a year.

Other factors include your partner’s level of involvement, your commitment and adherence to the regimen, the method’s reversibility, and its costs over a prolonged period of time. Medical considerations play a role too as certain underlying conditions might make some birth control methods unsafe. This is why it is always recommended that you consult an OB-GYN if you have access to one.

The Most Common Birth Control Methods

Below, we have listed the most widely used contraceptive methods ranked from the most effective to the least effective.

Subdermal Implants

A subdermal implant is a long-acting reversible contraceptive. It is a very small plastic rod embedded with progesterone that is inserted underneath the skin, under the non-dominant arm. It works by steadily releasing the hormone into your system which thickens cervical mucus to prevent sperm from reaching the egg and atrophies the endometrial lining to make it less hospitable for implantation. It also inhibits the LH (Luteinizing Hormone) rise which prevents ovulation. 

The failure rate of the subdermal contraceptive implant is the lowest of any birth control method (0.05%) and its effect lasts up to three years.

IUDs

An intrauterine device or IUD is another long-acting reversible form of contraception that is FDA approved to be effective for up to ten years. As its name might suggest, it is a small device that is inserted into a woman’s uterus. IUDs come in two progesterone-containing and hormone-free variants and each type have a different mechanism of contraception. Progesterone IUDs work similarly to the other hormone-based contraceptives.

Hormone-free or copper-containing IUDs work by releasing copper salts that create inflammatory reactions in the fallopian tube and uterus which neutralize the egg and sperm. With an effectiveness of over 99%, intrauterine devices are among the most effective contraceptive options available today.

Combined Hormonal Methods: Pills, Patches, and Rings

Combined contraceptive pills, patches, and vaginal rings contain both estrogen and progesterone. Their mechanism of action is comprised of two components. Estrogen suppresses the FSH—i.e., the follicle-Stimulating hormone which stimulates the growth of ovarian follicles—to inhibit follicular development and prevent the growth of the eggs. And progesterone, as we previously discussed, suppresses the mid-cycle LH surge and prevents ovulation as well as thickens the cervical mucus.

The way pills, patches, and rings differ is their method of hormone delivery. Pills are (obviously) taken orally every day and their hormone content enters the bloodstream through the stomach; Patches can be worn on a weekly basis anywhere on the body except for the breasts and the hormones they release are absorbed through the skin, and the ring is placed inside the vagina for 21 days and the hormones are absorbed through the vaginal walls.

Progesterone-Only Pills (Minipill)

The minipill is a contraceptive for those who prefer oral progesterone-only birth control. It is not as effective as the combined contraceptive pill but typically works for those who are postpartum and breastfeeding.

Contraceptive Injection

This is a progesterone-only contraceptive that is delivered via intramuscular injection every three months and its mechanism of action is similar to the other progesterone-based contraceptives discussed above.

Barrier Methods

The barrier methods may be among the least effective ones when it comes to pregnancy prevention, but they are the best methods for the prevention of sexually transmitted infections. As such, the use of a barrier method as a safe sex practice alongside other forms of birth control is always encouraged. As a primary method of contraception, condoms are user-dependent and that’s why they are very low on the list. However, condoms have a high efficacy (98%) when used correctly every time.