What is the recommended birth control method for a generally healthy individual?

Recommended Birth Control Method

For a generally healthy individual, long-acting reversible contraceptives (LARCs)—specifically the etonogestrel implant (Nexplanon) or levonorgestrel IUD (Mirena)—are the recommended first-line birth control methods due to their superior effectiveness in preventing pregnancy and excellent continuation rates. 1

Why LARCs Are Superior

Effectiveness is the critical factor in contraceptive selection, particularly for minimizing unintended pregnancy risk. 1 LARCs dramatically outperform other reversible methods:

• Nexplanon (etonogestrel implant): 0.05% typical use failure rate (99.95% effective), with continuation rates exceeding 80% at one year 2
• Mirena (levonorgestrel IUD): 0.2% typical use failure rate (99.8% effective), with continuation rates exceeding 80% at one year 2
• Copper IUD (Paragard): 0.6-0.8% typical use failure rate 2

These methods are highly effective because they do not depend on regular user compliance, eliminating the primary cause of contraceptive failure. 1

Comparison with User-Dependent Methods

Methods requiring consistent user action have substantially higher failure rates:

• Combined oral contraceptives, patches, vaginal rings: 9% typical use failure rate (only 91% effective) due to missed pills, late applications, or incorrect use 2
• Depo-Provera injections: 6% typical use failure rate due to missed appointments 2
• Condoms: 18-21% typical use failure rate 2
• Fertility awareness-based methods: 24% typical use failure rate 2
• Spermicides: 28% typical use failure rate 2

Specific LARC Selection

Choose Nexplanon when:

• The patient cannot use estrogen-containing methods 2
• The patient has contraindications to IUDs 2
• The patient prefers a non-uterine method 2

Choose Mirena when:

• The patient desires reduced menstrual bleeding as an additional benefit 2
• The patient has no contraindications to IUD placement 1

Choose Copper IUD when:

• The patient wants highly effective non-hormonal contraception 1
• The patient has contraindications to hormonal methods 1

Critical Counseling Points

All patients must be counseled about STD protection regardless of contraceptive choice. 1 Hormonal contraceptives and IUDs do not protect against HIV or other sexually transmitted diseases. 1 Consistent and correct use of male latex condoms reduces the risk for HIV infection and other STDs, including chlamydial infection, gonorrhea, and trichomoniasis. 1

Accessibility Considerations

LARCs are appropriate for most women, including adolescents and nulliparous women. 1 Remove unnecessary medical barriers to access:

• Most women can start most contraceptive methods at any time 1
• Few examinations or tests are needed before starting a contraceptive method 1
• Pelvic examination is not required before initiating hormonal contraceptives 1
• Same-day provision should be offered whenever possible 1

Common Pitfall to Avoid

Do not recommend fertility awareness-based methods or other low-efficacy options as first-line contraception for women seeking maximum pregnancy prevention. 2 While these methods may be appropriate for women who cannot or will not use other methods, they have unacceptably high failure rates (24-28%) for most healthy individuals seeking reliable contraception. 1, 2

When LARCs Are Not Chosen

If a patient declines LARC methods after counseling, the next most effective options in descending order are:

1. Depo-Provera injections (6% failure rate) 2
2. Combined hormonal contraceptives (pills, patch, ring: 9% failure rate) 2
3. Barrier methods only if higher-efficacy methods are refused 2

Emphasize that oral contraceptives require daily adherence at approximately the same time each day to maintain effectiveness, particularly progestin-only pills where peak levels are reached 2 hours after administration and return to baseline by 24 hours. 1