For some women, choosing the right method of birth control is a simple process, while for others, the decision might feel overwhelming. Either way, understanding the pluses and minuses of each option is key, and obstetrician-gynecologists from Yale Medicine Family Planning are experienced at helping women decide which kind of contraception makes the most sense for them.

Broadly speaking, birth control can be broken into three categories in terms of how well it prevents pregnancy. The most effective methods are male or female sterilization, intrauterine devices (IUDs, placed inside the uterus), and the arm implant. Medium protection comes from the hormonal pill, patch, ring, or injection. Methods like condoms, spermicide, withdrawal, and the rhythm method offer lower protection.

Effectiveness is typically the first “lens” doctors and patients work through when discussing contraception, but it is not the only one. Managing a health complaint, such as heavy periods, might be the leading concern for some women—and certain methods of birth control can help with that.

When you are discussing birth control, your health care provider will also talk with you about prevention of sexually transmitted infections (STIs), which condoms offer, convenience (IUDs and implants are “set it and forget it” for several years), side effects, and the cost and availability of each method.

It is important to remember that for some methods reliability depends on proper use. For example, oral contraceptive pills need to be taken daily (and at the same time of day). Yale Medicine family planning experts walk patients through the pros and cons of all the types, helping them choose what is best for their lifestyle and health.

Contraception, also known as birth control, is any activity, medicine, or device used to prevent pregnancy for people having heterosexual sex. Birth control works by preventing the fertilization of an egg by sperm (conception). Some methods do this with a barrier between the egg and sperm (condoms, tubal ligation, vasectomy), others by stopping egg release, also called ovulation (pills, patch, ring, injection, arm implant), and others change the cervix and uterus to prevent sperm from getting through to the egg (IUDs).

Available in a variety of forms, hormonal contraceptives prevent pregnancy by preventing ovulation and thickening cervical mucus to help block sperm.

Here is more information about birth control pills: 

• Combined oral contraceptives: Often called “the pill,” these oral contraceptives contain the hormones estrogen and progestin. Combined in this way, they prevent ovulation and make the cervical mucus thick and sticky, so it is more difficult for sperm to navigate. The pill must be taken at the same time each day to be effective.
• Progestin-only pill: Also known as the “mini-pill,” this version contains progestin only. It is taken daily and thickens the cervical mucus, which prevents sperm from reaching the egg. The mini-pill is often used by mothers who are breastfeeding because it doesn’t contain estrogen, which can interfere with lactation.

Other forms of hormonal contraception include the patch, implant, injection, and vaginal ring.

Intrauterine devices must be placed inside the uterus through the cervix by your health care provider. They are typically about an inch and a half long. Your doctor can remove an IUD at any time, and you can get pregnant as soon as it is taken out.

Intrauterine devices fall into two main categories:

• Hormonal IUDs: These devices (made of soft, flexible pieces of plastic shaped like a ‘T’) release progestin, which thickens the cervical mucus to prevent sperm from reaching an egg. Depending on the brand, one device can remain in place and offer protection for three to seven years.
• Copper IUDs: This type doesn’t contain hormones, is also flexible and ‘T’-shaped, but is coiled with a small amount of copper. The copper triggers a change in the cervix and uterus response that makes it difficult for the sperm to move. One device can offer protection for up to 12 years.

When it comes to deciding which IUD is best, it depends on what women want their periods to be like. Women with normal periods can safely use the hormonal IUD or the copper IUD, but if women have very heavy, crampy periods, they may be better off with the hormonal IUD. With the hormonal IUD, women generally find that their periods get lighter, shorter, and less crampy. Some of them might find that their periods stop. And it is completely safe to have a period stop when doctors know why.

Emergency contraception reduces the chance of pregnancy after you have unprotected sexual intercourse.

There are two main options: 

• Having your health care provider insert a copper IUD within five days of unprotected sex. The copper, which is released into the uterus and fallopian tubes, makes it hard for sperm to swim well enough to reach an egg.
• Taking a contraceptive pill (different from “the pill”) up to five days after unprotected sex. Several different types of emergency contraception pills are available in the U.S.; some are sold over the counter while others require a prescription.  

Most forms of birth control are generally considered safe, but women and couples should be aware of the various side effects and risks for each. For example, people with a latex allergy should avoid certain barrier methods (latex male condom), as they could cause a severe reaction. Oral contraceptives pose a small increased risk of developing blood clots, stroke, or heart attack, but these risks are lower than the risk of these complications in pregnancy.

IUDs are also safe and effective. Some women mistakenly believe getting an IUD means it must stay in place for several years, which is not the case. You can have it in for a month, and if you don't like it, it can be removed. You can also have it in for longer, such as two years, and then decide it's the right time to be pregnant, and it can come out. And it doesn't affect future fertility

The obstetrician-gynecologists at Yale Family Planning are experienced and skilled at helping women and couples understand and choose the method of birth control that’s right for them. In particular, they see women who have complex medical conditions that can mean some contraceptives are not safe for them. Considering medical issues, patient values and past experience, Yale Family Planning physicians specialize in complex contraceptive counseling.