Published Aug 22, 2023

How birth control works and what birth control is best for you

Dr. Sudip Bose
Medically reviewed by
Dr. Sudip Bose
Detail of the feet of a couple lying in bed
Published Aug 22, 2023

There is a lot to consider when choosing the right birth control. The bottom line? The best one for you is the one you will use correctly and consistently.

When thinking about trying a new contraceptive method, it can be helpful to ask questions like:

  • Will I remember to take a pill every day at the same time? Or do I need something that is more “set-and-forget”?
  • Do I want to also protect against sexually transmitted infections (STIs)?
  • How much am I willing to pay out of pocket?
  • Do I want help with other health issues, like acne, painful periods or polycystic ovary disease (PCOS)?
  • Do I want to get pregnant one day? If so, how soon?

With tons of birth control medicines available today, there is something to suit practically everyone. And if you’d like to get a birth control prescription online, a convenient $15 consultation with Dr. B is just a click away!

When and where was birth control invented?

The earliest known forms of birth control date over 4,000 years ago to ancient Egypt, when physicians recommended putting a mixture of honey and crocodile dung or acacia leaves into the vagina. (Surprisingly, the low pH of these substances may have helped immobilize sperm!) Meanwhile, the ancient Greeks and Romans relied on amulets and condoms made from animal bladders.

The 1839 breakthrough discovery of vulcanized rubber made (reusable) condoms and other early devices easier to produce. And in the 1920s, condoms made from latex appeared on the market.

Access to contraception transformed in 1960 when the FDA approved the first birth control pill. Married people could get the pill in 1965, and unmarried people in 1972.

How birth control works

Prescription birth control treatments prevent pregnancy in different ways. Some contain hormones that change the body to make pregnancy less likely. Other types create a barrier that stops sperm from entering the uterus and reaching an egg.

When used correctly, birth control can:

  • Stop sperm from reaching the egg
  • Prevent an egg from being released each month
  • Thin the lining of the uterus so an egg is less likely to implant
  • Thicken cervical mucus, making it harder for sperm to enter

Only barrier methods—like male and female condoms—protect against sexually transmitted infections. To protect against STIs and maximize pregnancy prevention, combine hormonal medications like the pill, patch, ring or implant with barrier methods like condoms.

Types of birth control

The two main types—non-hormonal and hormonal. Each comes with its own benefits and downsides.

Non-hormonal birth control physically prevents sperm from meeting the egg. Some of the below are available over-the-counter (like condoms). Others require a visit to the doctor.

Types of non-hormonal methods include:

  • Male and female condoms
  • Diaphragms and cervical caps
  • Sponges
  • Vaginal gels and spermicides
  • The copper intrauterine device (Paraguard)
  • Male and female sterilization (vasectomy or tubal ligation)

Hormonal contraception uses hormones to prevent the body from releasing an egg each month. (Without an egg, you can’t get pregnant.) Some hormones also thin the uterus lining so a fertilized egg won’t implant. Some make the mucus over the cervix thick and sticky, which keeps sperm from swimming through.

Hormonal birth control includes:

  • The pill
  • The patch (Xulane and Twirla)
  • Vaginal rings (NuvaRing and Annovera)
  • Shots (Depo-Provera)
  • Implants (Nexplanon)
  • Hormonal IUDs (Mirena, Skyla, Liletta, Kyleena)

Different types of birth control pills include combination pills (which contain estrogen and progestin), the minipill and low-dose pills. Some have other benefits, like making periods lighter and less painful. And the implant and IUDs can be left in place for years, making pregnancy prevention easier.

How effective is birth control?

Birth control is very effective when used perfectly. But in real life? Effectiveness can depend on which type you use and how well you use it.

Condoms are 98% effective at preventing pregnancy when used perfectly. In real life, 18 out of 100 people become pregnant if they only rely on condoms.

Similarly, when used perfectly, the pill is 99% effective at preventing pregnancy. But as it can be hard to remember to take the pill at the same time every day, 9 people out of 100 get pregnant every year while using the pill.

This window is why the most effective form of birth control is the one you don’t have to think about. The most reliable forms include:

  • The implant (Nexplanon)
  • IUDs (like Paraguard and Mirena)
  • Male and female sterilization (vasectomy and tubal ligation)

These methods of birth control are highly effective because human error is unlikely after they’re correctly in place. But these forms are not right for everyone. Some people don’t want to alter their hormones. Others may want to get pregnant soon.

Birth Control Effectiveness

Adapted from Contraception

MethodEffectiveness with typical use, %Effectiveness with perfect use, %
Implant99.9599.95
Male sterilization (vasectomy)99.8599.9
Female sterilization (tubal ligation or “tying your tubes”)99.599.5
Copper IUD99.299.4
Pill9199.7
Patch9199.7
Ring9199.7
Diaphragm8894
Male condom8298
Withdrawal7896
Fertility awareness7695 - 99.6
No method1515

Is birth control safe?

Birth control is generally safe for most people. Depending on your health history, some forms may not be appropriate. For example, women over 35 who smoke should not take combination birth control pills.

Some people who are breastfeeding or have a history of certain cancers might consider hormone-free or progestin-only birth control. If you want to try prescription birth control but are unsure of your risk, ask your healthcare provider. They can help you choose a method appropriate for your specific situation.

Side effects of birth control

The most common side effects of hormonal methods (like the pill or implant) are headache, nausea, sore breasts and changes in your period or spotting. Most side effects are mild and get better after 2-3 months.

Serious side effects are uncommon and depend on the kind of birth control you’re using. And sometimes, it takes a few tries to find the right contraceptive option for you. If your side effects don’t get better in a few months or are really bothering you, talk to your healthcare provider. They can help you learn more about specific risks and benefits.

Banner advertising Dr. B's services for birth control

Online options for birth control

When it comes to getting the pill or ring online, you have options! Start a $15 consultation for birth control online—with insurance or without insurance.

A licensed provider will help you find the most appropriate and affordable option for you. If you have health insurance, you may even be able to get your birth control online for free! Start a consultation today.

Sources:

Comparetto, C., et al. (2014). The history of contraception: From ancient Egyptians to the "morning after."

Cooper, D. B., et al. (2022). Oral contraceptive pills. StatPearls.

Cuomo, A. (2010). Birth control. Encyclopedia of motherhood.

Horvath, S., et al. (2018). Contraception. Endotext.

Jackson, J. (2018). How Puerto Rican women made birth control possible-at the expense of their health. BESE.com.

Khan, F., et al. (2013). The story of the condom. Indian Journal of Urology.

Lans C, et al. (2018). Herbal fertility treatments used in North America from colonial times to 1900, and their potential for improving the success rate of assisted reproductive technology. Reproductive Biomedicine & Society Online.

Our Bodies, Ourselves Today. A brief history of birth control.

Planned Parenthood. Depo-Provera: birth control shot: birth control injection.

Planned Parenthood. Birth control implants: NEXPLANON information.

Planned Parenthood. Birth control patch: Ortho Evra: transdermal patch.

Planned Parenthood. IUD birth control: Info about Mirena & Paragard IUDs.

Planned Parenthood. Nuvaring: Birth control vaginal ring: Estrogen Ring.

Public Broadcasting Service. The Boston Pill Trials.

Public Broadcasting Service. Eugenics and birth control.

Sitruk-Ware, R., et al. (2013). Contraception technology: past, present and future. Contraception.

Women’s Health Policy. (2020). Intrauterine devices (IUDs): Access for women in the U.S.

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