At least for now.
Before President-elect Donald Trump takes office in January, women all over the country are rushing to get IUDs—and with good reason. The future of reproductive healthcare in this country is murky at best. Trump has consistently promised to repeal the Affordable Care Act, which has made reproductive healthcare free for millions of Americans, and has appointed to his team men like Sen. Jeff Sessions (R-AL), who wants to bar funding to Planned Parenthood, and Stephen Bannon, whose alt-right tabloid once compared Planned Parenthood to the Holocaust.
If you’re someone who is concerned about accidental pregnancy, wants to put off having children for some time (or forever), wants to protect against STIs, uses birth control for treatment of conditions like acne and endometriosis, or needs emergency contraception, here are all 18 FDA-approved birth control options, covered by Obamacare—along with supplementary information to help you make the best choice for your body and your future.
Editor’s Note: For the sake of readability, we’ll refer to condoms for penises as “male condoms” and condoms for vaginas as “female condoms,” but it should be noted that not everyone with a penis identifies as male and not everyone with a vagina identifies as female.
Also, birth control success rate numbers are based on the assumption that people don’t always use the method exactly as directed; for example, taking your pill at a slightly different time each day or applying a condom incorrectly would constitute imperfect use.
Barrier methods do exactly what they sound like they’ll do—bar sperm from reaching an egg, as well as protect against STIs in certain cases.
Male condoms are among the most common birth control methods in the United States, especially for teens and people in their 20s. In order to be effective, male condoms must be used during each sexual encounter—and even then, they have an 82 percent rate of effectiveness, meaning around 18 out of 100 people whose partners use condoms may get pregnant. Male condoms also protect against sexually transmitted infections; in fact, male and female condoms are the only birth control methods that prevent against pregnancy and STIs, though they’re not 100 percent effective for either.
Health risks associated with male condoms are minor and include irritation or allergic reactions. For people with a latex allergy, the FDA recommends polyurethane condoms, which are readily available at most drug stores for under $15. Condoms can also be found at Planned Parenthood or other community health centers for free, and there’s no age minimum for purchasing them at drug stores.
To learn how to put on a condom properly (which is crucial!), check out this handy resource from Planned Parenthood.
Female condoms are lubricated pouches inserted into the vagina and, like male condoms, are a one-time-use birth control method. Though female condoms are not used as frequently as male condoms, their rate of effectiveness is similar at around 21 pregnancies per 100 uses.
In some cases, they may cause irritation or burning sensations, but female condoms are good alternatives for people with latex allergies and are safe for both anal and vaginal sex. Other than irritation, female condoms pose no health risks, but people who use them may feel a decrease in sensation during sex. Like male condoms, they can be found for free at Planned Parenthood or community health centers or can be bought without a prescription at most drugstores for under $10.
Diaphragms are half-moon-shaped, flexible silicone disks that are inserted into the vagina to cover the cervix. To use a diaphragm properly, it must be combined with a jelly, cream, or gel spermicide to prevent the sperm from moving, making diaphragms a physical and chemical prevention method. Unlike male and female condoms, diaphragms can last about two years and just need to be washed with mild soap and water after each use for proper maintenance. Though diaphragms don’t prevent STIs, they are more effective than male or female condoms at preventing pregnancy, with an 88 percent success rate, and can be used in conjunction with male condoms for extra protection and to prevent against STIs.
Planned Parenthood notes that diaphragms are not appropriate for everyone, including people with a history of frequent UTIs, people who have recently given birth or had an abortion, or people who are sensitive to silicone or spermicide. According to the FDA, using diaphragms in conjunction with spermicide containing N9 may increase the risk of getting HIV from an infected partner.
Like condoms, diaphragms don’t contain any hormones, so they’re a good birth control option for people who prefer or can’t use hormonal birth control. A prescription is needed for diaphragms and they can cost between $0 and $75. It’s important to see a healthcare provider to find the correct fit, as diaphragms that are too big or too small won’t be as effective.
To learn about fit, application, and side effects, refer to this guide from Planned Parenthood.
There are many similarities between cervical caps and diaphragms—both must be used with spermicide, require a prescription, cost about the same, can be used for up to two years, won’t necessarily interrupt sex, and must be left in place for at least 6 hours after sex.
Cervical caps are about 5–7 percent less effective at preventing pregnancy than diaphragms because they don’t work as well for women who have given birth, but many people opt to use them because they’re smaller than diaphragms and fit some people more appropriately. Planned Parenthood doesn’t recommend cervical caps for people who have breaks or cuts in vaginal or cervical tissue, poor vaginal tone, or recently had surgery on their cervix. Like diaphragms, it is always best to use a cervical cap with a male condom to prevent STIs.
Birth control sponges are disk-shaped polyurethane devices that already contain spermicide. They have an 88 percent rate of effectiveness when it comes to pregnancy but do not protect against STIs, which is why you should always use them with a condom.
One major benefit of the sponge is that it can be left in the vagina for up to 24 hours and doesn’t require reapplication of spermicide after each use. Though, leaving a sponge in for too long (i.e., past 24 hours) can put you at risk for toxic shock syndrome. Otherwise, sponges pose no serious side effects. Unlike diaphragms or cervical caps, sponges can be purchased over-the-counter at drugstores or online for up to $15 for three sponges. Like all barrier methods, sponges don’t affect the wearer’s hormones.
Many people choose to use spermicide without physical barriers like sponges, cervical caps, or diaphragms. Whether you’re using spermicide in foam, gel, film, suppository, or cream form, it always works the same way: Spermicide goes into the vagina before sex to stop sperm from reaching the egg, preventing pregnancy but not STIs.
Spermicide is non-hormonal, over-the-counter, accessible, and costs under $10. Though its rate of effectiveness alone is about 72 percent, spermicide will be significantly more effective if used with other barrier methods.
Some people report that spermicides are leaky or messy, and Planned Parenthood warns that spermicide may not form a proper barrier over the cervix if not used exactly as directed. The FDA also highlights that some associated side effects may include allergic reactions and UTIs.
Short-Acting Hormonal Methods
Combination Oral Contraceptives (The Pill)
According to the Center for Disease Control (CDC), the pill has been one of the two most commonly used birth control methods since the 1980s (female sterilization is the other) and an estimated 16 percent of American women use it as their primary method of birth control. The most commonly used pill uses two hormones called estrogen and progestin to stop the ovaries from releasing eggs, while thickening cervical mucus to make it harder for the sperm to reach the egg. The pill is more effective than any other barrier method, with a 91 percent rate of success. That percentage goes up to 99 percent for people who use it exactly as instructed.
Progestin-Only Oral Contraceptive (The Mini Pill)
As the name suggests, progestin-only pills don’t contain estrogen, but they’re just as effective when it comes to avoiding pregnancy. According to Go Ask Alice!, many people use the progestin-only pill when they want to decrease the side effects of estrogen.
Unlike the combination pill, which should be used at the same time each day to be effective, the progestin-only pill must be used at the same time to maintain the correct level of hormones in a person’s body. Combination pills ensure that users will get their period during the fourth week, but progestin-only pills may also completely eliminate a person’s period or cause users to bleed on and off during the month.
If you’re worried about negative side effects associated with estrogen, make sure to talk to your healthcare provider about switching to or starting a progestin-only pill.
The birth control patch is much like the combination pill but, well, in a patch form. It contains estrogen and progestin and is placed on the abdomen, butt, upper arms, or upper back each week for a week at a time, followed by a patch-free week. Like the pill, the patch has a 91 percent success rate and has many of the same potential side effects and benefits. Since the patch needs to be reapplied only once a week, it’s a better option for people who can’t remember to take the pill each day; however, the Guttmacher Institute notes that people who use the patch are more likely to develop discomfort in their breasts or uncomfortable periods.
The patch costs between $0 and $80, based on insurance coverage, and can easily be obtained with a prescription.
The vaginal ring, also known by its brand name “NuvaRing,” is a small, flexible ring inserted into the vagina to stop pregnancy by releasing estrogen and progestin, while thickening cervical mucus to stop sperm. The ring stays in the vagina for three weeks after insertion, followed by a ring-free week, during which time most people get their period. It’s 91 percent effective, but like all short-acting hormonal methods, the vaginal ring doesn’t protect against STIs.
It’s a good option for people who would prefer not to remember to take a pill each day, but some side effects may include increased discharge or vaginal irritation. The vaginal ring can be obtained with a prescription for under $80.
Long-Acting Reversible Contraceptive (LARC)
LARC’s are birth control methods that last for several years but can be taken out anytime the user wants to get pregnant.
Copper IUD/IUS (intrauterine device or system)
A copper IUD is a T-shaped copper device that needs to be inserted by a healthcare provider and can last up to 10 years. Though it doesn’t stop monthly ovulation, the IUD prevents sperm from reaching the egg, prevents sperm from fertilizing an egg, and could prevent an egg from implanting in the uterus. Unlike short-acting hormonal methods or barrier methods, an IUD is inserted once and needs no additional care, and it’s one of the only mistake-proof methods of contraception. Out of every 100 women who have an IUD, less than one may get pregnant, which are some of the best birth control odds out there. Plus, if someone with an IUD does want to get pregnant, it can be taken out at any time, and depending on their age, shouldn’t have a hard time getting pregnant.
Some common side effects include irregular bleeding or abdominal pain, and some people who have copper IUDs report that their period completely stops. In rare cases, IUDs can cause infection or can be rejected by the body. According to Planned Parenthood, side effects usually go away within the first six months of insertion.
There are several benefits to the IUD, one being that it’s among the two most effective reversible contraceptive methods. Copper IUDs can also be used as emergency contraception for up to five days after having unprotected sex and since copper IUDs are hormone free, they are a great contraceptive option for people who can’t or prefer not to use hormonal methods. Despite their high success rate at preventing pregnancy, IUDs can’t prevent STIs, so they’re best paired with condoms.
Talk to a health care professional to learn about whether the copper IUD is a good fit for you, as well as potential up-front costs.
An IUD with progestin has a similar success rate, similar side effects, and can cost the same up-front as a copper IUD. Progestin IUDs can be left in the uterus for three to five years and may be a better option for people who don’t need a full 10-year contraceptive or for people who want to make their period cramps less painful, their flow lighter, or their period stop entirely. Since progestin is a hormone, this kind of IUD may not work well with people who have health conditions that prevent them from taking hormones or for people who experience adverse side effects from hormonal birth control.
To learn more about what happens during IUD insertion, check out this run-down from Planned Parenthood.
Like IUDs, the mistake-free implantable rod is 99 percent effective in preventing pregnancy and can last up to four years. It’s a thin piece of plastic containing progestin that is inserted on the inside of the upper arm and stops the ovaries from releasing eggs. It can be removed at any time.
The rod can also ease period cramps, and the ability to become pregnant after the rod is removed is high. Though there are some side effects, like irregular bleeding or increased spotting, these tend to go away after the rod has been in for three to six months. Less common side effects can include nausea, sore breasts, or a decrease in sex drive.
The rod can cost between $0 and $800 up front, based on insurance coverage, for four years of contraceptive protection.
This birth control method is administered every 12 weeks under the skin or in the muscle.
Birth Control Shot
A contraceptive injection, also known as the birth control shot, releases progestin into the body to thicken cervical mucous and prevent eggs from leaving ovaries. Shots are administered by health care providers and protect against pregnancy for up to 12 weeks, so many people may need or want regular administration of the shot for a long-term contraceptive. Prices are calculated per shot, plus any exam fees. Like with all birth control, it’s important to discuss costs with a health care professional before committing to the injections.
Side effects of the shot can include weight gain, abdominal discomfort, or loss of bone density, but many people prefer it because it’s non-hormonal, comes with discreet packaging, and can help prevent cancer of the lining of the uterus, according to Planned Parenthood.
Permanent sterlization contraceptive methods are one-time procedures meant to be permanent.
Trans-abdominal surgical sterilization
Trans-abdominal surgical sterilization is performed by sealing, tying, cutting, clamping, or removing part of the fallopian tubes to prevent the sperm from meeting and fertilizing the egg. Like many surgeries, people undergoing the procedure will need general anesthesia and some risks involve pain, bleeding, and post-op complications.
Unlike many other forms of birth control, sterilization does not change your hormones and should not affect hair, voice, sex drive, muscle tone, or breast size. Though most women can be sterilized safely, there are some serious risks that can develop after the procedure, including ectopic pregnancy, which needs immediate medical attention.
Planned Parenthood notes that sterilization may be best for people who never wish to have a child biologically, are unable to take other methods of contraception, don’t want to pass on hereditary illness or disability, or may be compromising their own health by a future pregnancy. Sterilization may not be a good option to solve problems you suspect may be temporary, since sterilization is nearly 100 percent effective.
To learn more about the different kinds of sterilization, surgery costs, and recovery times, refer to this guide from Planned Parenthood.
Transcervical Tubal Sterilization Implant
The transcervical tubal sterilization implant, also known as Essure, is a nickel coil inserted into the vagina without an incision. The device causes scar tissue to form around the coil over a period of three months, and eventually blocks sperm from reaching the egg.
Though the procedure itself is safer than trans-abdominal surgical sterilization, it’s worth noting that the FDA has ordered a postmarket surveillance study to obtain more data about Essure’s risks after reports of “persistent pain, perforation of the uterus and/or fallopian tubes, intra-abdominal or pelvic device migration, abnormal or irregular bleeding, and allergy or hypersensitivity reactions.”
You can read more about the FDA’s evaluation status of Essure here.
A vasectomy is a permanent contraceptive method that blocks the tubes that carry sperm from the testicles, meaning that seminal fluid will eventually contain no sperm. Some risks include bleeding, surgery, or infection, but the operation is nearly 100 percent effective and mostly painless; plus, most people recover quickly afterward.
Planned Parenthood notes that sterilization for people with fallopian tubes and uteruses is more costly and complicated, so one reason many people get vasectomies is to spare their partner(s) tubal sterilization. For those who want less permanent contraceptive solutions, methods like condoms, outercourse, withdrawal (the pull-out method), and abstinence are some other solutions to consider.
It should be noted that though vasectomies are approved by the FDA, they aren’t regularly covered by Obamacare. To learn more about potential risks associated with vasectomies, freezing sperm, and surgery costs, visit Planned Parenthood or check out this online resource.
Emergency contraceptives such as ella or Plan B are birth control options for people whose regular birth control failed. However, they should not be used as a regular form of birth control. According to this guide from the FDA, emergency contraception can prevent 55–85 percent of pregnancies, but in some cases certain forms may cause headaches, dizziness, or menstrual pain.
For people who would like a more long-term contraceptive solution, some IUDs can also act as emergency contraceptives and have the added benefit of protecting against accidental pregnancies in the future.
Check out this guide from Planned Parenthood for details about differences between emergency contraceptives.
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