A generation ago, implants and injections were in their infancy, intrauterine devices (IUDs) were often recommended only for women who’d already had children, and women on oral contraception often complained of mood swings and weight gain.
Today, thanks to design changes and recent declarations by physician’s groups that they are safe for all ages, IUDs are swiftly gaining popularity, with 14% of college women now using them. Other forms of long-acting reversible contraception (LARC) are also slowly gaining traction, with 9% using implants and 3% using shots.
“With these, you just set it and forget it,” says Joanne Brown, a nurse practitioner with University of Kentucky Health Service.
Oral contraception, still the most popular choice besides condoms, has also undergone improvements, with lower hormone levels leading to reduced side effects.
The ideal method for you depends on your personal and family medical history, how soon you want to get pregnant, your budget, and more. Here’s a snapshot of available options:
IUDs
During a brief office visit, a health care professional inserts a device into the uterus, where it remains. Some prevent pregnancy by emitting the hormone progestin, which thickens mucus in the cervix, making it hard for sperm to enter, and thins the uterine lining, so an egg won’t implant. Others are hormone-free and made of copper, which impairs sperm movement.
The upside: They’re up to 99% effective, last from 3 to 10 years, there’s no need to remember a daily pill, and for those concerned about taking hormones, the copper option is a good one, says Brown. Those with progestin can also decrease menstrual cramp pain.
Things to consider: Contrary to popular belief, IUDs do not cause pelvic inflammatory disease. But they can worsen the impact of a sexually transmitted infection if you already have one when it’s inserted, so get tested beforehand, says Brown.
Copper IUDs may cause heavier bleeding and cramping, so those who already have tough periods may want to consider another option.
Progestin-containing IUDs can come with side effects, including missed periods or spotting between periods. Insertion can hurt, and in rare cases complications occur. At about $1,000 out of pocket, it can be expensive for those without insurance coverage or those who (for privacy reasons) don’t want to use their parent’s plan.
Implants
A health care professional inserts a matchstick-sized rod under the skin of the upper arm, which emits progestin and stops ovulation.
The upside: It’s up to 98% effective, lasts up to 3 years, and may ease period cramps and stop periods altogether. The insertion isn’t as uncomfortable as for an IUD, and design improvements have made it easier to remove than it used to be.
Things to consider: Irregular bleeding or unpredictable spotting is common. Other reported side effects include digestive problems, headaches, breast pain, weight gain, and acne.
Injections
A health care professional gives a progesterone-like shot every 3 months in the arm or buttocks to prevent pregnancy. (You can also give yourself the shot.)
The upside: No need to remember to do anything daily and no risk of using it the wrong way.
Things to consider: Injectable contraception has been linked to loss of bone density, so be sure you are getting enough calcium. Studies also show it may lead to weight gain, with 1 in 4 users gaining 5% or more of their starting weight within the first 6 months of use. (For a 140-pound woman, that’s 7 pounds.) Headaches may occur with injectable contraception, so this option is not recommended if you're susceptible to migraine.
Oral Contraception
The pill uses progestin and estrogen, or progestin alone, to prevent pregnancy, mostly by preventing ovulation. Literally dozens of varieties exist, with newer options formulated to enable lighter periods, quarterly periods, or no period. With far less estrogen than earlier versions or none at all, pills today come with fewer side effects like mood swings and weight gain.
The upside: For those with insurance, it’s often free. For those without, it can be obtained for less than $10 at some community health centers and under some pharmacy discounts. At 97% effective when used perfectly, it’s reliable and it can regulate periods, ease cramps, and quell acne.
Things to consider: “The biggest risk with any combined hormonal type of birth control pill, and it probably has to do with estrogen, is the risk of developing a blood clot or deep vein thrombosis,” says Brown. Those who have high blood pressure or migraines with vision changes are not advised to take it. And you have to take it at the same time every day for it to be totally effective.
What about weight gain? “That is mostly an urban legend,” says Brown, although early versions of the pill did increase appetite and lead to mild increases in weight.
Other forms: The hormonal patch and vaginal ring work in a similar fashion as the pill, and with similar effectiveness. The upside: You only have to remember to replace the patch weekly and the ring monthly. The downside: The patch has higher levels of hormones, so there is some concern side effects may be greater, says Brown.
Condoms
You place the condom over the penis (male condoms) or inside the vagina (female condoms). It forms a barrier, blocking sperm and fluids.
The upside: It’s hormone-free, you don’t need a prescription, it’s cheap, and it protects against STDs, including HIV, says Brown. For that last reason, it’s ideal to use with other forms of birth control.
Things to consider: When used perfectly, condoms are 98% effective, but they are often used incorrectly. Men often wait too long to put it on, fail to leave a reservoir at the tip, don’t use a lubricant (so it breaks) or wait too long to take it off, so it comes off inside, says Brown. Used incorrectly, they are about 85% effective at preventing pregnancy.
Other Options
These include sperm-killing cream (spermicides), which can be inserted inside the vagina prior to intercourse via a sponge or film (about 71% effective); a diaphragm, inserted inside the vagina to keep sperm from getting in (92% to 96% effective when used perfectly); or emergency contraception pills, which can be taken within 5 days after unprotected sex to prevent a pregnancy from occurring. Emergency contraception is ideal for occasions when a pill is missed or a condom breaks. Insertion of a copper IUD can also be used as a form of emergency contraception if it is done within 5 days of unprotected sex.
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