Comparison of birth control methods

Different types of birth control methods have large differences in effectiveness, actions required of users, and side effects.

Ease of use

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, 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, 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.

The lactational amenorrhea method (LAM) requires breast feeding at least every four to six hours.

Oral contraceptives and periodic abstinence methods 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 several years without any user action after implatation.

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.

User dependence

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 few months. 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. Barrier methods, coitus interruptus, and spermicides must be used at every act of intercourse. They do not provide any protection from pregnancy if they are not used. Periodic abstinence methods require daily tracking of the menstrual cycle. They also do not provide any protection from pregnancy if incorrectly used. The actual failure rates for these methods are much higher than the perfect-use failure rates.

Side effects

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, periodic abstinence, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. 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.

After IUD insertion, menstrual periods are often heavier, more painful, or both - especially for the first few months after they are inserted.

Because of their systemic nature, hormonal methods have the largest number of possible side effects.

Effectiveness calculation

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:

• mistakes on the part of those providing instructions on how to use the method
• mistakes on the part of the method's users
• conscious user non-compliance with method.
• insurance providers sometimes impede access to medications (e.g. require prescription refills on monthly basis)

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 by mistake not take the pill one day, or simply not bother to 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.

Effectiveness of various methods

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 combined for higher effectiveness rates. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users.

If a method is known 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.

Comparison table

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		0.05	0.05	Progestogen	Subdermal implant	3 years
Jadelle (lower-dose)		0.05	0.05	Progestogen	Subdermal implant	5 years
Vasectomy	"male sterilization"	0.15	0.1	Sterilization	Surgical procedure	Once
Combined injectable	Lunelle, Cyclofem	0.2	0.2	Estrogen + progestogen	Injection	Monthly
Essure	"female sterilization"	0.2	0.2	Sterilization	Surgical procedure	Once
IntraUterine System	Mirena	0.2	0.2	Intrauterine & progestogen	Intrauterine	5 years
Tubal ligation	"female sterilization"	0.5	0.5	Sterilization	Surgical procedure	Once
Copper intrauterine device	Paragard, Copper T	0.8	0.6	Intrauterine & copper	Intrauterine	5 to 12+ years
LAM for 6 months only; not applicable if menstruation resumesTemplate:Fn	"ecological breastfeeding"	2	0.5	Behavioral	Breastfeeding	Every few hours
Depo Provera	"the shot"	3	0.3	Progestogen	Injection	3 months
Creighton Model		3	0.5	Behavioral	Observation and charting	"Throughout day" or "daily" Template:Fn
Lea's Shield and spermicide used by nulliparousTemplate:Fn Template:Fn		5	no data	Barrier + spermicide	Vaginal insertion	Every act of intercourse
FemCap and spermicide	cervical cap	7.6 (estimated)	no data	Barrier & spermicide	Vaginal insertion	Every act of intercourse
Combined oral contraceptive pill	"the Pill"	8	0.3	Estrogen & progestogen	Oral medication	Daily
Contraceptive patch	Ortho Evra, "the patch"	8	0.3	Estrogen & progestogen	Transdermal patch	Weekly
NuvaRing	"the ring"	8	0.3	Estrogen & progestogen	Vaginal insertion	In place 3 weeks / 1 week break
Progestogen only pill	"POP", "minipill"	8	0.3	Progestogen	Oral medication	Daily
Ormeloxifene	"Saheli", "Centron"	9	1.63	SERM	Oral medication	Weekly
Male latex condom	Condom	15	2	Barrier	Placed on erect penis	Every act of intercourse
Lea's Shield and spermicide used by parousTemplate:Fn Template:Fn		15	no data	Barrier + spermicide	Vaginal insertion	Every act of intercourse
Diaphragm and spermicide		16	6	Barrier & spermicide	Vaginal insertion	Every act of intercourse
Prentif cervical cap and spermicide used by nulliparousTemplate:Fn		16	9	Barrier + spermicide	Vaginal insertion	Every act of intercourse
Today contraceptive sponge used by nulliparousTemplate:Fn	"the sponge"	16	9	Barrier & spermicide	Vaginal insertion	Every act of intercourse
Female condom		21	5	Barrier	Vaginal insertion	Every act of intercourse
Symptoms-based fertility awarenessTemplate:Fn Template:Fn	basal body temperature, cervical mucus	25	3	Behavioral	Observation and charting	"Throughout day" or "daily" Template:Fn
Standard Days Method		25	5	Behavioral	Calendar-based	Daily
Knaus-Ogino method	"the rhythm method"	25	9	Behavioral	Calendar-based	Daily
Coitus interruptus	"withdrawal method"	27	4	Behavioral	Withdrawal	Every act of intercourse
Spermicidal gel, foam, suppository, or film		29	18	Spermicide	Vaginal insertion	Every act of intercourse
Today contraceptive sponge used by parousTemplate:Fn	"the sponge"	32	20	Barrier & spermicide	Vaginal insertion	Every act of intercourse
Prentif cervical cap and spermicide used by parousTemplate:Fn		32	26	Barrier + spermicide	Vaginal insertion	Every act of intercourse
None (unprotected intercourse)		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

Template:Fnb The word nulliparous refers to those who have not given birth.
Template:Fnb The word parous refers to those who have given birth.
Template:Fnb The pregnancy rate applies until the user reaches six months postpartum, or until menstruation resumes, whichever comes first. If menstruation occurs earlier than six months postpartum, the method is no longer effective. For users for whom menstruation does not occur within the six months: after six months postpartum, the method becomes less effective.
Template:Fnb In the effectiveness study of Lea's Shield, 84% of participants were parous. The unadjusted pregnancy rate in the six-month study was 8.7% among spermicide users and 12.9% among non-spermicide users. No pregnancies occurred among nulliparous users of the Lea's Shield. Assuming the effectiveness ratio of nulliparous to parous users is the same for the Lea's Shield as for the Prentif cervical cap and the Today contraceptive sponge, the unadjusted six-month pregnancy rate would be 2.2% for spermicide users and 2.9% for those who used the device without spermicide.
Template:Fnb No formal studies meet the standards of Contraceptive Technology for determining typical effectiveness. The typical effectiveness listed here is from the CDC's National Survey of Family Growth, which grouped symptoms-based methods together with calendar-based methods. See Fertility awareness#Effectiveness.
Template:Fnb The term "fertility awareness" is sometimes used interchangeably with the term "natural family planning" (NFP), though NFP usually refers to use of periodic abstinence in accordance with Catholic beliefs.
Template:FnbUsers may observe one or more of the three primary fertility signs. Basal body temperature (BBT) and cervical position are checked once per day. Cervical mucus is checked before each urination, and vaginal sensation is observed throughout the day. The observed sign or signs are recorded once per day.

References for effectiveness rates

• Combined injectable contraceptive: "FDA Approves Combined Monthly Injectable Contraceptive". The Contraception Report. Contraception Online. June 2001. Retrieved 2008-04-13.
• Jadelle: Sivin I, Campodonico I, Kiriwat O; et al. (1998). "The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study". Hum. Reprod. 13 (12): 3371–8. doi:10.1093/humrep/13.12.3371. PMID 9886517. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
• Essure: "Essure System - P020014". United States Food and Drug Administration Center for Devices and Radiological Health. {{cite web}}: Cite has empty unknown parameters: |month=, |dateformat=, and |coauthors= (help)
• FemCap: "Clinician Protocol". FemCap manufacturer. {{cite web}}: Cite has empty unknown parameters: |month=, |dateformat=, and |coauthors= (help)
• Lea's Shield: Mauck C, Glover LH, Miller E; et al. (1996). "Lea's Shield: a study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide". Contraception. 53 (6): 329–35. doi:10.1016/0010-7824(96)00081-9. PMID 8773419. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
• Prentif cervical cap and Knaus-Ogino method:Trussell, James (2004). "Contraceptive Efficacy". In Hatcher, Robert A.; et al. (eds.). Contraceptive Technology (18th rev. ed.). New York: Ardent Media. pp. 773–845. ISBN 0-9664902-6-6. {{cite book}}: Explicit use of et al. in: |editor= (help)

All other methods: Trussell, James (2007). "Contraceptive Efficacy". In Hatcher, Robert A.; et al. (eds.). Contraceptive Technology (19th rev. ed.). New York: Ardent Media. ISBN 0-9664902-0-7. {{cite book}}: Explicit use of et al. in: |editor= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)