How to Prevent Pregnancy With the Right Contraceptive Choices

Several factors, including overall health and age, come into play when deciding which method of birth control is best for you to prevent pregnancy. Other factors that determine the best type of birth control are the number of partners and frequency of sexual intercourse, family history, and if you want to have children in the future.

This article discusses the different types of birth control, how they work, and how effective they are at preventing pregnancy.

Young couple relaxing on their balcony, embracing
Westend61 / Getty Images

The Pill

The pill is the first contraceptive that most think of when considering birth control. Today, the pill is available as combined oral contraceptives (COC), which contain both estrogen and progestin. It is also available in progestin-only pills (POP) that reportedly with use, 9 in 100 people who take it get pregnant during the first year.

Combined Oral Contraceptives

COCs work by preventing ovulation and may make periods more regular. They may also protect against pelvic inflammatory disease and ovarian and endometrial cancers.

These pills are considered safe for most. However, those over 35 who smoke or who have a family history of heart disease should not use combination oral contraceptives. This is because of an increased risk of cardiovascular diseases.

People assigned female at birth with a medical history of blood clots or breast or endometrial cancers also should not use combined oral contraceptives. Possible side effects include nausea, headache, breast or chest tenderness, weight gain, irregular bleeding, and depression. These side effects may lessen after a few months.

Progestin-Only Pills

POPs prevent pregnancy by preventing the sperm from reaching the egg by thickening the cervical mucus and thinning out the uterine lining to keep fertilized eggs from implanting. Because these pills contain no estrogen, there isn’t a risk of blood clots like the combined oral contraceptives.

This type of birth control pill is a good option for people who cannot take estrogen. The progestin-only pill may cause menstrual changes, weight gain, and breast or chest tenderness.

In July 2023, the Food and Drug Administration (FDA) approved Opill (norgestrel), a progestin-only oral contraceptive, to be sold over-the-counter (OTC). Opill is the first and only birth control pill available without a prescription. Before starting a birth control method, it’s a good idea to speak with your healthcare provider, even if your method of choice doesn’t require a prescription.

Recap

Birth control pills are available in a combined pill with estrogen and progestin or as a pill with just progestin. A doctor may suggest one or the other depending on your medical history.

Injectable Progestins

Pregnancy can be prevented for up to three months by injection of Depo-Provera. Depo-Provera prevents pregnancy by:

  • Preventing ovulation
  • Changing the cervical mucus to prevent sperm from reaching an egg
  • Changing the uterine lining so a fertilized egg can’t implant

This method is extremely effective since all that’s required is a shot every three months at a healthcare provider’s office. The benefits and side effects of Depo-Provera are similar to those of progestin-only pills.

The failure rate for these injections is typically about 4%.

Recap

For injectable progestins, a doctor will give you a shot once every three months. The failure rate is low at about 4%.

Intrauterine Devices (IUD)

An IUD is a T-shaped device inserted into the uterus by a healthcare professional. The form of birth control is most suitable for those with only one sexual partner since it does not protect them from sexually transmitted infections (STIs).

The IUD had serious safety problems in the past. In the 1970s, an IUD called the Dalkon Shield caused pelvic infections, infertility, and some deaths. It was later found that a multifilament string, with a number of strands, increased the risk of infections in the uterus.

Back then, the Food and Drug Administration (FDA) didn’t do extensive testing because the device was not considered a drug. When Congress passed the 1976 Medical Devices Amendment, it led to increased regulations of IUDs in the 1970s and 1980s.

Today, IUD complications are rare, with 1% causing pelvic inflammatory disease in the first 20 days of insertion.

IUDs have one of the lowest failure rates of any contraceptive method. Less than one in 100 people will get pregnant when using an IUD.

Recap

In the 1970s, an IUD called the Dalkon Shield caused serious health problems for many people. Since then, the FDA has increased regulations of the IUD. It has one of the lowest failure rates of contraceptives.

The Sponge

The sponge works by releasing spermicidal gel over the vaginal mucus. It also forms a barrier to kill or immobilize sperm before they can reach the cervix and enter the uterus. Out of 100 people who have given birth, 27 may get pregnant using the sponge for birth control. For those who haven’t given birth, the number is closer to 14 in 100.

The sponge can be inserted several hours before intercourse and can be left in place up to 6 hours after sex. It does not need to be replaced if sexual intercourse is repeated. Those who are allergic to nonoxynol-9 or who have had toxic shock syndrome should not use the sponge.

The sponge may not work as well for those who have been pregnant. That’s because giving birth stretches out the vagina and cervix, so the sponge may not fit the same way.

Recap

The sponge helps prevent pregnancy by releasing spermicidal gel and acting as a barrier to sperm. The failure rate is higher for those who have been pregnant before.

Diaphragm

The diaphragm is available by prescription and is sized by a healthcare professional to ensure a proper fit.

It works by covering the cervix with a dome-shaped rubber disk with a flexible rim to prevent sperm from entering the uterus. A spermicide is applied to the diaphragm before insertion to kill sperm. The diaphragm may be left in place for six hours. For repeated sexual intercourse or intercourse after six hours, spermicide should be inserted into the vagina while the diaphragm is still in place.

Diaphragms should never be left in for more than 24 hours due to the risk of toxic shock syndrome (TSS). About 17 out of 100 people may get pregnant when using a diaphragm for birth control.

Recap

The diaphragm keeps sperm from entering the uterus. It can be left in place for six hours.

Cervical Cap

The cervical cap is similar to the diaphragm. It is a soft rubber cup with a rounded rim and is sized by a healthcare professional to fit tightly around the cervix. Like the diaphragm, spermicide is required with the cervical cap. It protects against pregnancy for 48 hours and for multiple acts of sexual intercourse during this time. Prolonged use (over 48 hours) may increase the risk of TSS and can produce a foul odor or discharge.

About 17% of people may get pregnant when using the cervical cap for birth control.

Recap

The cervical cap is fitted by a medical professional so it fits tightly around the cervix. It should be removed within 48 hours.

Vaginal Spermicides

Vaginal spermicides are available over the counter in the form of cream, jelly, foam, film, vaginal suppositories, or tablets. These products contain a sperm-killing chemical. There is a debate about the effectiveness of using vaginal spermicides alone. They have a failure rate of approximately 15% per year if used alone and 25% per year if they are used incorrectly.

People who choose this method of contraceptive should be sure to follow the package directions exactly, as each product is different. Allow the spermicide to remain in the vagina for six to eight hours following intercourse. Do not douche or rinse the vagina during this time.

Recap

Spermicides have a sperm-killing chemical. They may have a failure rate of up to 25% a year.

Natural Family Planning

Being aware of your fertility is another way of reducing your chances of getting pregnant. Natural family planning is the only method accepted by some religions. It requires extreme attention and a highly motivated couple for it to be successful.

It works by avoiding sexual intercourse on the days when you are most likely to ovulate. These methods estimate fertility based on changes in the cervical mucus or changes in body temperature.

Rates of pregnancy from natural family planning can range from 2% to 23%.

Recap

Natural family planning works by avoiding sex on the days you’re ovulating. You can estimate ovulation by changes in cervical mucus and temperature.

Withdrawal

The effectiveness of withdrawal depends upon a partner’s ability to withdraw their penis from the vagina before ejaculation. This method does not guarantee that pre-ejaculatory sperm has not been released into the vagina. It also does not provide protection against HIV or STIs.

The perfect-use failure rate for withdrawal is 4%.

Lactational Amenorrhoea Method (LAM)

People who are breastfeeding or chestfeeding exclusively may be protected against pregnancy. This protection can last for up to six months after birth if one’s period has not returned. This method is highly effective when used correctly. The pregnancy rate is 0.5% to 1.5% for people using only LAM for birth control.

LAM works by preventing an egg from being released from your ovary. Once your baby starts food other than breast milk or when your period returns, choose an additional birth control method.

Recap

The withdrawal method has a high failure rate and doesn’t protect against STIs. Breastfeeding or chestfeeding exclusively can help prevent pregnancy for up to six months after birth if your period hasn’t returned.

Surgical Sterilization

When you are sure that your pregnancy days are over for good, sterilization may be an option. Either partner may choose surgical sterilization—tubal ligation for people assigned female at birth or vasectomy for people assigned male at birth.

During a tubal ligation, the fallopian tubes are cut or blocked, which prevents the sperm and egg from meeting. In a vasectomy, the tubes that carry sperm from the testicles to the urethra are cut and sealed. This keeps the sperm from getting into the semen. With either a vasectomy or tubal ligation, the chance of getting pregnant is less than one in 100.

It’s important that you do not consider this a temporary contraception that can be reversed if you change your mind. Sterilization reversal is a major surgery that is often unsuccessful.

Recap

Sterilization can include tubal ligation and vasectomies. Both should be considered permanent birth control since the procedures to reverse them don’t always work.

Emergency Contraception

Emergency contraception works by preventing pregnancy within a few hours or days of unprotected sex. Methods used for emergency contraception include combined oral contraceptives, progestin-only pills, and insertion of an IUD.

When Unplanned Pregnancy Occurs

When birth control methods are practiced faithfully, most methods of contraception are highly effective against unplanned pregnancy. However, sometimes other factors come into play and contraception does fail.

If you find yourself faced with an unplanned pregnancy, you’ll need to make a decision about how to proceed. Will you choose abortion, adoption, or parenting? It’s a decision that no one can make for you and one that you will have to live with for the rest of your life. Choose what feels right for you, and don’t let yourself be influenced by others’ feelings.

An Important Message About Condoms

Latex or polyurethane condoms should always be used, in addition to other birth control, especially by people who are not in committed long-term monogamous relationships. When used correctly, they reduce the risk of STIs and HIV.

Lambskin condoms can help prevent pregnancy, but they don’t protect against all STIs.

Don’t use oil-based lubricants (petroleum jelly, lotions, or baby oil) with latex or lambskin condoms. They can weaken the material and cause the condom to break. People today have the choice of using the traditional external condom or using the internal condom. The Reality condom is approved by the FDA and is shaped similarly to the external condom. Condoms, whether external or internal, are intended for one-time use and should never be reused.

If the cost of condoms is an issue for you, visit a local family planning clinic. Many family planning clinics will happily give you as many condoms as you need.

With external condoms, about 13% of people may get pregnant. With internal condoms, that number is about 21 in 100.

Recap

Latex or polyurethane condoms help prevent pregnancy along with STIs and HIV. Both external and internal condoms should only be used once and never reused.

Myths About Contraception

Maybe you have heard that you cannot get pregnant on your period. Or someone said you can’t get pregnant if you don’t have an orgasm or your partner pulls out before ejaculation. This is not true.

Perhaps someone told you that douching will wash away the sperm before pregnancy can occur. This isn’t true either. Douching does not work to prevent pregnancy. In fact, it can lead to pelvic inflammatory disease and increase your risk of other STIs and infections.

Don’t be fooled—the only 100% effective method of preventing pregnancy is abstinence.

Summary

There are many different forms of birth control. Different kinds may work best for you depending on factors like your age, health, and your relationship with your partner.

Some methods of birth control can be more effective than others. However, avoiding sex is the only way to completely prevent pregnancy.

A Word From Verywell

It can be overwhelming to try to choose which method of birth control you should use. If you have trouble deciding, or have any concerns, check with a doctor. They can help answer your questions so you can make an informed decision that feels right to you.

28 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Child Health and Human Development. What are the different types of contraception?.

  2. American College of Obstetricians and Gynecologists. Progestin-only hormonal birth control: pill and injection.

  3. National Cancer Institute. Oral contraceptives and cancer risk.

  4. National Library of Medicine: DailyMed. Cryselle—norgestrel and ethinyl estradiol kit [drug label].

  5. Jin J. JAMA patient page. Oral contraceptives. JAMA. 2014;311(3):321. doi:10.1001/jama.2013.283505

  6. LaVasseur C, Neukam S, Kartika T, Samuelson Bannow B, Shatzel J, DeLoughery TG. Hormonal therapies and venous thrombosis: considerations for prevention and management. Res Pract Thromb Haemost. 2022;6(6):e12763. doi:10.1002/rth2.12763

  7. National Library of Medicine: MedlinePlus. Birth control pills.

  8. Cole K, Saad A. The coming-of-age of subcutaneous injectable contraception. Glob Health Sci Pract. 2018;6(1):1-5. doi:10.9745/GHSP-D-18-00050

  9. KFF. DMPA contraceptive injection: use and coverage.

  10. American College of Obstetricians and Gynecologists. Long-acting reversible contraception (LARC): intrauterine device (IUD) and implant.

  11. Arizona State University Embryo Project Encyclopedia. The Dalkon Shield.

  12. Pisac A, Wilson N. FDA device oversight from 1906 to the present. AMA J Ethics. 2021;23(9):E712-E720. doi:10.1001/amajethics.2021.712

  13. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, Long-Acting Reversible Contraceptive Expert Work Group. Committee Opinion No 672: Clinical challenges of long-acting reversible contraceptive methods. Obstet Gynecol. 2016;128(3):e69-e77. doi:10.1097/AOG.0000000000001644

  14. Centers for Disease Control and Prevention. Contraception.

  15. American College of Obstetricians and Gynecologists. Barrier methods of birth control: spermicide, condom, sponge, diaphragm, and cervical cap.

  16. Department of Health and Human Services Office on Women's Health. Birth control methods.

  17. National Library of Medicine: MedlinePlus. Vaginal sponge and spermicides.

  18. Fehring RJ, Rodriguez D. Spiritual care of couples practicing natural family planning. Linacre Q. 2013;80(3):225-238. doi. 10.1179/0024363913Z.00000000023

  19. Jones RK, Lindberg LD, Higgins JA. Pull and pray or extra protection? Contraceptive strategies involving withdrawal among US adult women. Contraception. 2014;90(4):416-421. doi:10.1016/j.contraception.2014.04.016

  20. Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Health Neonatol Perinatol. 2017;3:1. doi:10.1186/s40748-016-0040-y

  21. National Library of Medicine: MedlinePlus. Sterilization surgery - making a decision.

  22. American Academy of Family Physicians. Tubal sterilization (tubal ligation).

  23. World Health Organization. Emergency contraception.

  24. Centers for Disease Control and Prevention. Condom effectiveness.

  25. Centers for Disease Control and Prevention. Male (external) condom use.

  26. Centers for Disease Control and Prevention. Female (internal) condom use.

  27. Nationwide Children’s Hospital. Birth control myths.

  28. Nemours Foundation. Does douching prevent pregnancy?.

Additional Reading

By Tracee Cornforth
Tracee Cornforth is a freelance writer who covers menstruation, menstrual disorders, and other women's health issues.