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As a woman, you’re probably looking for birth control or will be at some point in your life. Which means that you have found (or will find) yourself asking, “What is the most effective birth control?“ We’ve heard all about “The Pill,“ of course. It brags some of the best protection rates and is incredibly popular. But are there other valid options?
Your OB-GYN or general practitioner may or may not tell you about all options. In fact, your doctor may not have all of the facts about birth control. Our world has simply too much information for everyone to know everything now, but my disappointment in doctors is that they specialize in an area and they ignore really important parts of medicine, like the natural signs of our bodies. Anyway, this post is not about doctors; it’s about birth control.
When I was first looking at birth control options, I was given all of the hormonal birth control options, and a comment was thrown in at the end of the conversation that went something like, “And there are barrier methods like condoms, but they don’t work great.“
While I knew all of these options and had even done a bit of research before going to my appointment, I still wanted to know more (it’s in my nature, I just want all the knowledge). So I asked more about what the hormonal options (most of those listed above) do. She responded with something along the lines of, “Well, it changes some hormones in your body that makes it so you shouldn’t ovulate. If you have break through ovulation, the fluid is thicker so it’s less likely for sperm to make it far enough to fertilize anything. And even if that happens, the balance of hormones in your body changes so the egg probably won’t be able to implant.“
That didn’t really inspire confidence. I wasn’t really sure still because my questions weren’t answered as well as I wanted, and she just gave me a prescription for a standard birth control pill. I took it for a month and a half before I decided I hated how I felt and needed to go another route. But I walked away from that whole situation wondering if that was a good representation of how women always feel at their appointments. I left with a mission to educate myself on birth control, even if my medical practitioner wasn’t keen on helping me do that.
My dad is a doctor and has always encouraged me to know what I’m putting in my body and why. So after my appointment I went home and researched birth control. A whole ton. I would like to note that never once in my exam did my doctor mention natural methods of birth control, even though some of them have success rates similar to the pill.
What I Found: Birth Control 101
Our crazy world has come up with so many methods of birth control. Many of these work against our bodies rather than with our bodies. Often they are split into two main categories: hormonal and non-hormonal.
I’d like to go through different options here to help educate you in a way your doctor may not have time to do. As I said, my dad is a doctor, so I know there are doctors who want to spend more time with you personally, getting to know you and your personal conditions and concerns. But in the United States, at least, the healthcare system often fails to allow them to give you the best treatment.
Hormonal Birth Control
Most birth control that is long-lasting is going to be hormonal. I’ll go through each option in this category individually, but first you should know how a hormonal method of birth control affects your body, and that these do not protect against STDs/STIs. As the following items are common across hormonal forms of birth control, let’s start with the commonalities.
If you take a pill, get shots, or have an implant/ring/IUD, it’s controlling your hormones. Hormonal birth control is designed to keep your hormones at artificial levels to prevent ovulation. If you don’t ovulate (release an egg), you can’t get pregnant. In order to do this, your body also halts the natural hormones it creates.
When you’re on hormonal birth control, you don’t actually menstruate (unless you have a break through ovulation). “What? That’s crazy!“ Nope. Sure, you still bleed but it technically isn’t menstrual blood.
Women who use hormonal birth control may find it hard to conceive for months after they stop the treatments. Some studies say this is undeniable fact, while others say it’s a complete a myth. But knowing what we know (that your body has forgotten how to produce the correct hormones and needs time to figure it out), it’s probably best to assume that different bodies react in different ways, just as they react differently after giving birth or any other large hormonal change. Some women are immediately fertile after getting birth while others aren’t for months. Bodies are just individual.
You may be prescribed a birth control pill or another form of hormonal birth control as a solution to some problem in your body. For example, PCOS is commonly “treated” using the pill. However, rather than actually treating the problem, you’re treating symptoms. As soon as you stop taking this treatment, the underlying problem still remains. Honestly, that may be the only option for your specific problem. Just make sure you talk to very qualified professionals – I would suggest specialists – in order to figure out if this really is a solution or just a way to stall.
Now that you have background about how these work in general, here are some specifics about the different types of hormonal birth control.
- The Pill (both versions): 91% typical use, 99.7% perfect use. Well, well. This is probably the most glorified option of birth control. It’s the one that you hear about the most, and it has that nickname The Pill, with a capital P. This form of birth control must be taken every single day at the same time. By “at the same time,“ I mean as close to the same exact time as possible every day. It regulates your hormone levels
- Morning After Pill (Plan B): 89% typical use, 95% perfect use (avoid extended use). The morning after pill, the most common of which is Plan B, is essentially the same thing as a normal birth control pill, just in a very compressed package. Its job is to change your hormones so that your body can’t be a host to a fertilized egg. It must be taken within 24 hours to be effective (although there is varying effectiveness up to 72 hours later). Women are actually only fertile 3-6 days each month, which means that women who use this repeatedly mess up their cycles and hormones for absolutely no reason. You need to be aware of your body to do so, though, and the best way to do that is to get involved in charting your cycles. This is discussed more in the FAM section under non-hormonal birth control, as well as in my post about FAM specifically.
- Patch: 91% typical use, 99.7% perfect use. On the first day of your cycle (or the Sunday afterward, whichever is easier to remember), you place a patch on an approved area of your body. Seven days later, you change it. Continue this pattern throughout your “cycle” (your body is no longer cycling, this just simulates a cycle).
- Levonorgestrel (Mirena) IUD: 99.9% typical use, 99.9% perfect use. IUDs are also pretty common. Some are hormonal while some are not. Mirena does use hormones. Rather than taking a pill every day at the same time, a device inside your uterus slowly releases hormones to prevent ovulation, fertilization, and implantation. With any sort of IUD, there is a minimal chance that it can rip or penetrate your uterus wall.
- Implant: 99.95% typical use, 99.95% perfect use. Hormonal implants are about the size of a matchstick. One is placed in your arm and will last up to 4 years. Many women experience spotting for the first 6-12 months of the implant’s life. There are also significantly more horror stories about the implant than other hormonal birth controls.
- Shot (Depo-Provera): 97% typical use, 99.95% perfect use. The birth control shot is administered by your doctor, and its effects last about three months. After three months, you return for another shot.
- Vaginal Ring (Nuvaring): 92% typical use, 99.7% perfect use. A vaginal ring is placed inside your vagina. It slowly releases hormones (similar to the Mirena), and it falls out once it’s been used to its fullest extent. You then place another one in (usually after a week wait bleed). When it becomes displaced, its effectiveness decreases.
Non-Hormonal Birth Control
In my mind, non-hormonal birth control is the way to go. It does not disrupt the natural workings of your body and it also doesn’t do harm to your body.
- Fertility Awareness Methods (FAM). The CDC officially reports this method of birth control having about a measly 24% success rate, but they also assume you’re using the Standard Days Method or Two Days Method, which are regarded by professionals to be inaccurate and not real birth control. Some other locations will increase that number to 75%, which is still not accurate. Either way, these methods are most effective when both parties involved are invested and on board with using them. Below, I’ve included a chart from the FACTS website showing the most effective methods, boasting rates as high as the pill, potentially completely free (or you could pay for something to help you with recording your symptoms), and charting your overall health. I have also written a much more in-depth post about this method here, and I would suggest a book called Taking Charge of Your Fertility to learn the science that proves these methods. Because hormonal birth control alters your natural body cycles, these FAM methods can’t be used in conjunction with types of hormonal birth control.
- Sponges: 92% typical use, 99.7% perfect use. These are female use. They’re a little more spontaneous than some other forms of non-hormonal birth control because they can be in place for up to 24 hours before use. The sponge is placed inside the vagina to cover the cervix to collect the sperm so that it doesn’t make it to an egg.
- Spermicide: 71% typical use, 82% perfect use. Spermicide is typically used in conjunction with other forms of non-hormonal birth control to increase effectiveness rather than on their own. It’s placed inside the vagina right before use.
- Copper IUD: 99.2% typical use, 99.4% perfect use. Copper IUDs, like other IUDs, must be placed by a physician, but they can last up to 12 years. The copper IUD slowly releases trace amounts of copper into your uterus to prevent sperm from fertilizing an egg. They are relatively effective and can be used in conjunction with other non-hormonal forms of birth control. Women who use copper IUDs often find that they have heavier periods or abnormal bleeding in addition to increased cramping for the first six months of having the IUD (occasionally lasting longer).
- Male Condom: 85% typical use, 98% perfect use. The only non-permanent male form of birth control (which is extremely unfair since men are always fertile and women are only fertile 4-6 days per cycle), male condoms one of the most common forms of non-hormonal birth control. They’re considered easy to use (because most teenagers learn how to use them in high school “sex ed” classes), but they’re most effective when used in conjunction with other forms of birth control, such as sponges or spermicide. Male condoms are placed between erection and penetration, so some people think they’re a pain because of the extra step they necessitate.
- Female Condom: 79% typical use, 95% perfect use. Female condoms are not as effective as male condoms, but they are another option. They are placed inside the vagina and can be entered a little while before use. They are less effective than male condoms and most users consider them more difficult to place than male condoms.
- Withdrawal (Pull Out) Method: 73% typical use, 96% perfect use. The withdrawal method is when a man withdraws before climaxing. This theoretically keeps sperm away from egg by not releasing sperm to meet an egg. The reason this method of birth control is less effective in general is that you have to be self-disciplined and follow this method every time. It’s most effective when, similar to spermicide, it is used with one of the other barrier forms of birth control.
Top Five Fight it Out
So what is the most effective form of birth control? The birth control with the highest “typical use” rates of success are
- implant (99.95%) – hormonal.
- Mirena (99.9%) – hormonal.
- copper IUD (99.2%) – irregular bleeding, increased cramps.
- sympto-thermal method (98.4%) – completely natural and potentially free.
- Depo-Provera shot (97%) – hormonal.
According to these statistics, the most effective forms of birth control tend to be hormonal. Hormonal birth control, as described above, masks symptoms of health concerns and alters body chemistry to make the body think it’s pregnant for an extended period of time. Many women on these types of birth control were put on them initially for reasons other than birth control (acne, controlling bleeding, etc.). Some women have been taking them for so long that except for near pregnancies, they may not know what it’s like to not take hormonal birth control. These methods also don’t align with those who believe life begins at conception for the most part.
Between a copper IUD and the sympto-thermal method of FAM, the copper IUD still has side effects that aren’t, well, fun. The sympto-thermal method takes some education (self education through books, or classes which are not free but they are a one-time cost). It also takes commitment from at least the woman, but it works best when both partners are on board, knowledgeable, and committed to the process. This method also has the additional benefit of increased awareness of one’s body’s processes and regular functions, which allows women to spot potential problems in fertility or other health subjects.
Who’s the Winner?
All in all, I believe that FAM sympto-thermal method is the most effective with the highest rewards in different aspects of life, as well as that it doesn’t alter your body. It can be all-natural or be supplemented by other non-hormonal methods. To read up more about sympto-thermal method, check out this book or my blog post dedicated to it. There are also wonderful resources including Facebook groups, apps with communities, and local groups. The world is there, just waiting for you to join.
What do you think is the most effective method of birth control? Does something other than the statistic of typical/perfect use factor into the decision for you?