IUD, condom, oral contraceptives, and pregnancy test

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We have more birth control options than ever before (thanks, science!)—an awesome thing when it comes to preventing unwanted pregnancy and sexually transmitted infections (STIs). Given the stakes, it’s something everyone could use a primer on.

But with so many effective options readily available, where do you start? We’ll get into what each method does and how to use it; but first, a word on effectiveness.

Perfect use vs. typical use

Most of the stats you see on how well a birth control method works refer to “perfect use” or “theoretical use.” That means that in clinical trials with lab-controlled participants, that’s how effective the birth control method would be at preventing pregnancy.

But that’s not necessarily how it works in real life, says Dr. Colleen Krajewski, or Dr. K., assistant professor at the University of Pittsburgh in Pennsylvania and medical advisor to Bedsider.org, an online birth control support network operated by the National Campaign to Prevent Teen and Unplanned Pregnancy. “There’s no [sense in] discussing perfect use in clinical practice,” she says. “Typical use” stats are the ones to pay attention to—these are how effective experts estimate a given birth control method is IRL.

Part of a birth control method’s effectiveness is in your control. For example, learning the proper way to use a condom—and then making sure to follow the right steps every single time.

But sometimes it’s out of your control. “There are a lot of reasons that birth control methods can fail,” says Dr. K. Learn what can impact the pill’s effectiveness.

The bottom line? Pay attention to stats about actual effectiveness and make sure to take the proper precautions accordingly.

male condoms

Made of multiple materials, including latex or polyurethane, condoms cover the penis to block sperm from entering the vagina and help prevent the spread of STIs through skin-to-skin contact.

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Condoms are 82 percent effective at preventing pregnancy with typical use. They’re also effective for preventing STIs.

Almost anywhere. At the drugstore, health clinics, your student health center, even online.

The average price is approximately $3.50 per condom, but your student health center or local family planning clinic may offer them for free.

Because it protects against STIs as well as pregnancy, “you can pretty much add a condom to anything—except another condom,” says Dr. K, as the increased friction can increase the risk of tears. Note: If you opt for lambskin condoms due to a latex allergy, keep in mind that they aren’t as effective at preventing STIs.

“Buy a jumbo pack of condoms at Costco and make a rule to use one every time, no matter what. Easy.” —Third-year graduate student, University of California, Los Angeles

Female condoms

The inverse of male condoms—rather than blocking sperm and STIs by covering the outside of the penis, female condoms are inserted into the vagina.

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Female condoms are about 79 percent effective with typical use.

These are a lot harder to find in stores than the male versions. Check drugstores, online sites, or your nearest Planned Parenthood. In some states, these now require a prescription.

Around $2 each.

Female condoms can be used just like male condoms. If you’re a heterosexual woman, they can offer more autonomy—in other words, you won’t have to rely on the guy to pack protection and be using protection properly.

Sponge

Shaped like a spongy little button with a string attached, the sponge physically blocks the cervix and also kills sperm. You can have sex multiple times while it’s in (up to 30 hours), unlike condoms, which have to be new every time.

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76–88 percent effective with typical use.

While not as common as condoms, you can find birth control sponges in some drugstores or online.

$4–$6.

Like the female condom, the sponge gives women more autonomy over their birth control. However, it doesn’t protect against STIs and isn’t the most effective for preventing pregnancy.

The pill

The birth control pill prevents pregnancy by adding a daily dose of hormones into your system that prevent the ovaries from releasing eggs.

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91 percent effective at preventing pregnancy with typical use. It doesn’t protect against STIs.

Typically, the pill is prescribed by your health care provider. You can also get prescriptions from Planned Parenthood or other public clinics.

Under the current health care law, insurers are required to cover prescription birth control—in other words, you shouldn’t have to pay anything. (Make sure to double-check with your provider.) Without insurance, it could cost anywhere from $10–$113 per month.

If cost is a barrier, explore low-cost prescription options and pharmacy savings clubs via large retailers such as Target, Walgreens, and Walmart. There are many birth control pill options available; your prescriber may be able to adjust the prescription to a lower-cost, but similar, combination.

Because it works by impacting your body’s hormone cycles, the pill needs to be taken at the same time every day for it to work. Oral contraceptive pills may provide other benefits, such as improving acne or easing painful periods.

“I take the pill at the same time every day, with two alarms on my phone that go off as reminders.” —Second-year graduate student, University of Delaware

Emergency contraception pill

The emergency contraception (EC) pill, aka the “morning-after” pill, is like a super-concentrated version of the pill that blocks a pregnancy before it can start. “It’s an over-the-counter medication that’s very safe—it’s not a bad idea to keep it in your medicine cabinet just in case,” says Dr. K.

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95 percent effective 3­­–5 days after sex with typical use. It doesn’t protect against STIs.

Get it at your student health center, local drugstore or health clinic, or online without a prescription.

If your doctor prescribes it, it should be covered by insurance. Without insurance, it will run you $35–$70.

When a condom breaks or other birth control method fails. Remember, it doesn’t protect against STIs.

“My partner and I use condoms as perfectly as possible and are prepared to use emergency contraception in the event of failure.” —Second-year student, Portland State University, Oregon

Intrauterine Device (IUD)

The IUD is a tiny T-shaped device inserted into the uterus by a health care provider. It prevents pregnancy by disabling sperms’ ability to swim. There are two main types of IUDs: copper (no hormones) and progesterone (a hormone that keeps your ovaries from releasing eggs, like the pill, and helps block sperm from getting into the uterus). With the latter, you may experience lighter or even no periods.

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99 percent effective against pregnancy with typical use. The IUD doesn’t protect against STIs.

You need a health care provider to get an IUD. If you don’t have a regular gynecological care provider (or aren’t comfortable going to them), check your local health clinics, like Planned Parenthood.

Free with insurance. If you’re uninsured, Liletta is the most affordable version at $50.

Since the IUD doesn’t pump hormones into your body (progesterone stays in the uterus), it’s a good option if you’ve experienced bad side effects from the pill. “I’d [recommend] it for anybody that wants to prioritize pregnancy prevention,” says Dr. K. Depending on which kind you get, the IUD will prevent pregnancy for 3–12 years.

“I have an IUD and have regular checkups with my doctor to ensure it’s still properly placed.” —Second-year student, Hawkeye Community College, Iowa

Implant

About the size of a matchstick, the implant is inserted under the skin in your upper arm and prevents pregnancy by releasing progesterone into your body.

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99 percent effective with typical use. The implant doesn’t protect against STIs.

Like the IUD, the implant must be inserted by a health care provider.

Under the Affordable Care Act (ACA), the implant should be fully covered by insurance. If you don’t have insurance, it can be a bit pricey—close to $500.

If you like the idea of the IUD, but the insertion process freaks you out, the implant is a great, super-effective alternative.

The ring

The ring is a flexible little circle you insert into your vagina—sort of like slipping in a tampon—which gives off hormones that prevent the ovaries from releasing eggs and thickens cervical mucus to help prevent sperm from entering the uterus.

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91 percent effective with typical use. It also doesn’t protect against STIs.

You need a prescription. Talk to your provider.

It’s typically covered by insurance, but out of pocket, the ring can range from $30–$75 per month.

The ring is a great middle ground between the IUD and the pill.

“I don’t have a schedule that’s structured enough to take a pill at the same time every day, so the ring was by far the easiest method of birth control for me. I’d set an alarm in my phone calendar and change it out once a month.” —First-year graduate student, Empire State College, New York

Depo-Provera (the shot)

Like the pill and the ring, the shot prevents pregnancy via progesterone, which keeps your ovaries from releasing eggs. Once you get the shot, you’re protected for three months.

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94 percent effective with typical use. The shot doesn’t prevent STIs.

After an initial exam, a health care provider can administer the shot. Ask your provider or see your local health clinic.

Without insurance (which will cover the cost under the ACA), each shot can cost up to $150.

If you struggle to remember to take your birth control, or don’t want to have to think about your birth control every day, the shot is a great alternative. One caveat: It does have potential side effects associated with weight gain. “If you’re someone who struggles with your weight and with your appetite, the shot is probably not for you,” says Dr. K.

“Before I was married, I took a pill every day at the same time until I switched to the shot, which was administered every three months. It required less thinking.” —Second-year student, Wake Technical Community College, North Carolina

"Not right now" or abstinence

You don’t engage in any type of sexual activity 100 percent of the time.

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There’s only one way that’s 100 percent effective at preventing both pregnancy and STIs—when practiced 100 percent of the time, abstinence is 100 percent effective.

If anything other than having a zero percent chance of an unwanted pregnancy or STI worries you, it’s an option to consider. At the end of the day, do what’s right for you.

Free!

1. Identify your priorities

  • Each method has pluses and minuses.
  • There isn’t one best method in the world for everyone.
  • Know what your priorities are and what you’d be willing to compromise on. For example:
    • Is pregnancy prevention your number-one priority?
    • Do you care about regulating your period?

2. Be ready, whatever your relationship status

  • Even if you’re not in a long-term relationship, it can still make sense to think about long-term birth control.
  • Being protected and safe, and taking control of your body, is empowering.
  • The IUD and implant are great long-term birth control options for many people.
  • Keeping emergency contraception on hand at all times can save you a whole lot of stress and inconvenience later.

3. Make conversation, not assumptions

  • Conversations with your partner, not assumptions, are key to healthy sexual and nonsexual relationships.
  • For example, if your partner observes a particular religion, you still need to talk about birth control, sexuality, boundaries, and other topics. Everyone is different.

4. Make sure you get the facts

  • There’s a lot of misleading info out there so make sure you’re only getting your info from reliable sources.
  • Great websites with reliable info include Bedsider.org and VeryWell.com.

Thanks to Bedsider.org and the National Campaign to Prevent Teen and Unplanned Pregnancy for providing key information, text/image elements, and Dr. K.

Find your local health center and other places to get birth control (including online options)

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Article sources

Bedsider.org provided images and elements of the text.

Colleen Krajewski, MD, MPH, assistant professor at the Magee-Womens Hospital of UPMC, Pennsylvania; medical advisor to Bedsider.org.

Joleen Nevers, MA Ed, CHES, AASECT Certified Secondary Education, sexuality educator, health education coordinator, University of Connecticut, Storrs.

Davis Smith, MD, director of health services, Westminster School, Simsbury, Connecticut.

Pierre-Paul Tellier, MD, director of student health services, McGill University, Montreal, Quebec.

Bedsider.org. (n.d.). The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved from https://bedsider.org/

Centers for Disease Control and Prevention. (2013). Reproductive health. Retrieved from https://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm

Guttmacher Institute. (2015, August 1). An overview of minor’s consent law. Retrieved from https://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdfhttps://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf

Planned Parenthood. (n.d.). IUD. Retrieved from https://www.plannedparenthood.org/health-info/birth-control/iud