Most Effective Birth Control Options
Long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and implants are the most effective birth control options with failure rates less than 1% per year. 1, 2, 3
Effectiveness Hierarchy of Contraceptive Methods
Tier 1: Most Effective (>99% effective)
- Intrauterine Devices (IUDs)
- Copper T380A IUD: 0.6-0.8% failure rate
- Levonorgestrel IUD: 0.1-0.2% failure rate
- Subdermal Implants: 0.05% failure rate
- Female Sterilization: 0.5% failure rate
- Male Sterilization: 0.1-0.15% failure rate
Tier 2: Very Effective (91-99% effective)
- Injectable contraceptives (DMPA): 0.3-6% failure rate
- Combined hormonal contraceptives (pills, patch, ring): 0.1-9% failure rate with typical use
- Progestin-only pills: 0.5-5% failure rate
Tier 3: Moderately Effective (72-95% effective)
- Male condoms: 3-14% failure rate
- Female condoms: 5-21% failure rate
- Diaphragm with spermicide: 6-20% failure rate
- Withdrawal: 4-19% failure rate
Tier 4: Less Effective (75-88% effective)
- Fertility awareness methods: 1-25% failure rate
- Spermicides alone: 6-26% failure rate
Key Considerations for Method Selection
Long-Acting Reversible Contraceptives (LARCs)
- IUDs and implants are recommended as first-line options due to:
- Highest effectiveness (>99%)
- No daily adherence required
- Rapid return to fertility after removal
- Long duration of action (3-10 years depending on type)
- Minimal drug interactions 1
Combined Hormonal Contraceptives
- Effectiveness is 91-95% with typical use 1
- Contraindicated in women with:
- History of thromboembolic disorders
- Uncontrolled hypertension
- Migraine with aura
- Breast cancer
- Liver disease 1
- Increases risk of venous thromboembolism from 2 per 10,000 woman-years to 7-10 per 10,000 woman-years 4
Progestin-Only Methods
- Good option for women with contraindications to estrogen
- Typical failure rate is 0.5-5% for pills 2
- Injectable DMPA has 0.3-6% failure rate 3
Managing Common Side Effects
Bleeding Irregularities
- For IUD users with spotting or bleeding:
- NSAIDs for 5-7 days may help 5
- For implant users with heavy bleeding:
- NSAIDs for 5-7 days
- Hormonal treatment (low dose COCs) for 10-20 days
- Antifibrinolytic agents for 5 days 5
Extended Cycle Regimens
- Can reduce frequency of withdrawal bleeding to 4 times per year 6
- Beneficial for conditions like:
- Anemia
- Severe dysmenorrhea
- Endometriosis
- Migraines without aura 1
Special Populations
Women Taking Enzyme-Inducing Medications
- IUDs are recommended as first-line options for women taking medications like oxcarbazepine
- Combined hormonal methods and progestin-only pills may have reduced effectiveness due to drug interactions 1
Women with Higher BMI
- All contraceptive methods remain effective options
- For emergency contraception, ulipristal acetate may be preferred 1
Emergency Contraception Options
- Should be taken as soon as possible within 5 days of unprotected intercourse
- Levonorgestrel prevents 75-80% of expected pregnancies
- Ulipristal acetate prevents approximately 85% of expected pregnancies and is effective up to 120 hours 1
Remember that while effectiveness is a critical factor in choosing contraception, other considerations such as side effects, non-contraceptive benefits, and personal preferences are also important in selecting the most appropriate method for an individual.