5 Most Effective Birth Control Options (Besides the Pill)
Longer-Term & Less Hassle Birth Control Options
The good news is: there are other effective non-pill options out there to ward off the stork before you’re ready. Because it’s crucial to talk to your doctor about what birth control options are right for you, we’ve compiled an overview of popular birth control methods as a primer to empower you to bring up the topic at your next visit and have opinions formed about what you might like to try.
Sounds like something out of a sci-fi flick, but skin implants are actually a highly effective form of preventing an unwanted pregnancy. If you’re looking for a low-responsibility birth control option and can tolerate hormones, the implants might be your best bet. They were even recently named the most effective type of reversible contraceptive by the American College of Gynecologists due to their safety and efficacy—skin implants are more than 99 percent effective (meaning that less than one out of 100 sexually active women will become pregnant using them).
Skin implants (brand names Implanon or Nexplanon) are inserted into your arm just beneath the skin and release the hormone progestin. The implant is often recommended for women who can’t take estrogen, such as women who are breastfeeding (estrogen can interfere with breast milk).
Progestin helps prevent pregnancy by “preventing ovulation and thickening cervical mucous,” explains nurse midwife Melicia Escobar. So they prevent eggs from being released and, by thickening cervical mucous, also make it difficult for sperm to reach the egg (if it hypothetically were released).
The low-maintenance implant will work for three years to prevent pregnancy, and no one can tell if you have one. You may also experience fewer, lighter periods. Simple, discreet and it works: awesome. You’ll also be fertile again after the implant is removed, if you decide you do want to get pregnant.
The most common complaint about the implant is that it can cause irregular menstrual bleeding, particularly during the first six months to a year. Some also experience increased acne, mood swings, depression, changes in sex drive and appetite, pain or discoloration at the site of the implant, and mild insulin resistance—which is why it’s key to see your doctor regularly and not just when you need a refill.
Read here for more on implant birth control.
If you’re looking for an even longer-term form of birth control that’s also extremely low maintenance and highly effective, consider an IUD (intrauterine device). IUDs are small, T-shaped devices that help keep sperm from reaching your cervix. They are placed into the uterine cavity in just a few minutes in your doctor’s office and come in hormonal (progesterone) and non-hormonal (copper) options. Both hormonal and non-hormonal IUDs are more than 99 percent effective at preventing pregnancy.
IUDs are “a highly effective form of birth control, comparable in efficacy to getting your tubes tide, but it isn’t permanent,” explains obstetrician and gynecologist Mandi Beman, MD. “I think of an IUD as semi-permanent birth control. The progesterone-containing IUD can be left in place for five years and the copper-containing IUD for 10 years.” And when you want to become pregnant, you just need the IUD removed to be fertile again.
The fact that you have the option of getting a non-hormonal IUD (the brand name is Paragard) is huge for anyone who suffers from side effects associated with hormonal birth control. Many women turn to the copper IUD after having negative experiences with the birth control pill’s side effects. The copper IUD may result in heavier periods, though (nothing’s perfect).
If you opt for the progesterone containing IUD (brand name: Mirena), you may get lighter periods, but you may also experience side effects similar to birth control pills (headaches, acne, breast tenderness, spotting) due to the hormone. However, Dr. Berman says that they are less likely to occur with IUDs and often lessen or go away completely over time. You may also experience cramps and backaches as a side effect of using an IUD (either type).
No one can tell if you have an IUD, but sometimes partners will say that they can feel a string. This can be adjusted by your doctor if it’s an issue.
If you’re thinking an IUD may be the best option for you, consider this: “The best candidate for an IUD is a woman who is at low risk for an STD, wants a low-maintenance birth control, and does not desire pregnancy in the near future,” Dr. Berman explains.
The ring (brand name: NuvaRing) is a small, bendable ring that you insert (yourself) into your vagina once a month. While in place, the ring release low doses of progestin and estrogen, which help prevent your ovaries from releasing eggs and thicken your cervical mucous to help prevent sperm from being able to travel to the (hypothetical) egg. After wearing the ring for three weeks, you remove it yourself, and keep it out for one week of menstruation. After that, you insert a new ring and the cycle continues.
Since the ring is not implanted by your doctor and left in you for years, the way that the birth control implant and IUDs are, it is less effective at preventing pregnancy. People don’t generally use the ring perfectly (if they did, it would be 99% effective); with typical use, the ring has a 91 percent effective rate.
If you’re worried about giving the NuvaRing a try due to concerns it might interfere in sex, relax. “Even if your partner does feel the ring, it won’t in any way interfere with using it or make him/her uncomfortable,” explains certified sexuality counselor and nurse midwife Evelyn Resh. “It is very soft and pliable and generally adheres to the vaginal wall.”
Family nurse practitioner Bob Smithing adds, “If the ring does bother you or your partner, you can remove it during sex. It can stay out for no more than three hours and still be effective.” Just don’t forget to put it back though!
The most common side effects of the ring may include spotting between periods, breast tenderness and nausea (though these side effects are likely to go away after three months). You may also experience a change in your sex drive and vaginal irritation or increased discharge.
On the flip side, you could also experience shorter, lighter periods, reduced PMS and cramps, and you may find that the ring helps clear up acne.
Contraceptive injections (brand name Depo-Provera) are a shot of progestin that helps prevent you from ovulating and increases the thickness of cervical mucus, like some of the other forms of birth control mentioned. The shot lasts for three months, so you need to receive one from your doctor four times per year (so you don’t have to worry about it as often as you would the pill or the ring).
The shot is commonly prescribed to women older than 35, women who can’t take estrogen or those who have health problems such as anemia, seizures or endometriosis.
The shot has a 94 percent effective rate with typical use (with perfect use, it’s a 99 percent effective rate). It may also result in decreased painful period cramps, shorter and lighter periods, as well as a decreased risk of pelvic inflammatory disease. And of course, there is no way for anyone to tell that you are using the shot.
The most common side effects are irregular bleeding (particularly in the first six to twelve months) and a change in appetite/weight gain. Some women gain around five pounds in the first year—but others gain nothing. Fewer people experience side effects like depression, change in sex drive, hair loss, nausea, headaches and sore breasts. (If you are experiencing negative side effects after having two shots in a row, talk to your doctor about switching methods).
Note that though the shot works for three months, it can take up to 12 months for fertility to return in some women after their last shot. So if you think you may want to get pregnant in the shorter term (but just not immediately), this may not be the best option for you.
The patch (brand name Ortho Evra) looks like a square, nude colored adhesive bandage and works by releasing estrogen and progestin through the skin. You need to apply the patch once a week for three weeks, then you leave it off for the fourth week, when you’ll get your period.
If used perfectly, the patch would be 99 percent effective, but with typical use, the patch is 91 percent effective.
Side effects are typical of other estrogen and progestin birth control methods, but may also include an increase in blood clots (commonly associated with estrogen), as Ortho Evra results in a higher level of estrogen in your body than other estrogen-containing birth controls. Some also experience skin irritation where the patch is applied.
But on the flip side, the patch may also give you more regular, lighter periods, may help clear acne, and can reduce cramps and PMS. It’s also less invasive than the other non-daily birth control methods listed in this article (no rings to insert where the sun don’t shine, no shots, no implanted rods or IUDs), while having the benefit of not needing to think about it every day (just once a week).
Emergency contraception (EC), commonly dubbed, “The Morning After Pill,” is designed to be used after unprotected sex to prevent pregnancy, and is not recommended as a regular birth control method.
“The morning after pill is a progesterone-only pill that works primarily by preventing the release of an egg/ovulation,” explains Resh. She explains that the pill works to prevent pregnancy after unprotected sex by disrupting the uterine lining and making it impossible for a fertilized egg to attach.
The pill is 86 percent effective at preventing pregnancy if it is taken with 72 hours of unprotected sex or a condom-snafu. “The sooner it is taken after unprotected intercourse, the better it works and the more likely you will not be able to ovulate,” says Resh.
Plan B, Next Choice, and Levonorgestrel are common brands of EC that you can get without a prescription from your pharmacist if you’re 17 or older. Another brand, Ella, is available by prescription only, but unlike the other EC pills, Ella is shown to be effective for five days after unprotected sex without declining in effectiveness over those five days.
Because EC pills contain high doses of hormones, you should consider the side effects before making one a crutch. “It is essentially concentrated doses of hormones,” explains sex coach and sexuality educator Amy Levine. “It generally causes temporary side effects like nausea, dizziness and vomiting.”
Birth Control & STDs
Even if you’re on the birth control pill or one of the other contraceptive options discussed here, it goes without saying that you need to use a condom if you’re having sex with someone who is not a regular, monogamous partner, or if you and your partner have not been tested for STDs.
“It’s important to keep in mind that [any method of contraception] besides a condom, does not offer any protection from STDs,” stresses Levine. “Unless you’re in a monogamous relationship and you and your partner are STD-free, it’s a good idea to also use a condom to reduce STD risk.”
Read more on tips to properly use and put on condoms to ensure they don’t break.
References: Mayo Clinic (2012) NuvaRing (Vaginal Ring). Retrieved from mayoclinic.com/health/nuvaring; Mayo Clinic (2013) Depo-Provera (Contraceptive Injection). Retrieved from http://www.mayoclinic.com/health/depo-provera; Mayo Clinic (2013) Ortho Evra (Contraceptive Patch). Retrieved from http://www.mayoclinic.com/health/ortho-evra; Bedsider.org
More On ChickRx: