There are more ways to prevent pregnancy than ever before, ranging from daily pills to devices that work for a decade with no maintenance. The right method depends on how long you want protection, how much effort you’re willing to put in, and whether you also need protection against sexually transmitted infections. Here’s what each option actually does, how well it works, and what the tradeoffs look like.
How Effectiveness Numbers Work
Every contraceptive method has two effectiveness ratings: perfect use and typical use. Perfect use means the method was used exactly as directed, every single time. Typical use reflects what happens in real life, where people miss pills, use condoms inconsistently, or forget appointments. The gap between those two numbers tells you how forgiving a method is. A method with nearly identical perfect and typical use rates (like an implant) is essentially mistake-proof. A method with a big gap (like condoms) works well in theory but demands consistent effort.
Without any contraception at all, about 85 out of 100 couples will experience a pregnancy within a year. Every method described below improves on that significantly, but the range is wide.
Long-Acting Reversible Methods
If you want the highest effectiveness with the least daily effort, long-acting reversible contraception is the gold standard. These methods are placed once and then work continuously for years. They include the contraceptive implant (a small rod inserted under the skin of the upper arm) and intrauterine devices (IUDs), which sit inside the uterus.
The implant is the single most effective reversible method available. It releases a small, steady amount of hormone that prevents ovulation and thickens cervical mucus so sperm can’t reach an egg. With a first-year failure rate of just 0.05% in both typical and perfect use, there’s essentially no way to use it wrong. It lasts up to three years.
Hormonal IUDs work primarily by thickening cervical mucus to the point that sperm cannot pass through. The most studied version has a typical-use failure rate of 0.2% and lasts up to seven years depending on the specific device. The copper IUD takes a different approach: instead of hormones, it releases copper ions that are toxic to sperm, impairing their movement and viability. It’s FDA-approved for up to 10 continuous years of use and has a typical-use failure rate of 0.8%. All of these devices can be removed at any time if you want to become pregnant, and fertility returns quickly.
The Shot
The contraceptive injection is given once every 13 weeks (about three months). It works by suppressing ovulation and has a perfect-use failure rate of 0.2%. In typical use, though, that rate climbs to 6%, mostly because people don’t always get their next shot on time. One important consideration: after stopping the shot, it can take 10 months or longer before ovulation resumes. If you think you might want to get pregnant in the near future, this may not be the best fit.
Pills, Patches, and Rings
Combined hormonal methods contain two types of hormones that work together to stop ovulation. They also thicken cervical mucus and thin the uterine lining, creating multiple layers of protection. The pill is taken daily, the patch is replaced weekly, and the vaginal ring is swapped monthly. All three have the same effectiveness profile: 0.3% failure with perfect use, but 9% in typical use. That gap exists because these methods require you to remember a routine, and real life gets in the way.
Since July 2023, a progestin-only pill called Opill has been available without a prescription in the United States. You can buy it at drug stores, grocery stores, convenience stores, and online with no age restrictions. It’s a good option if you want a pill but face barriers to getting a prescription, though progestin-only pills require more precise daily timing than combined pills.
Barrier Methods
Condoms, diaphragms, and sponges physically block sperm from reaching the egg. They’re less effective than hormonal or long-acting methods, but condoms have one major advantage nothing else on this list offers: protection against STIs, including HIV. Latex and polyurethane condoms provide the best STI protection. Natural membrane (lambskin) condoms do not block viruses.
External (male) condoms have a typical-use failure rate of 18% and a perfect-use rate of 2%. Internal (female) condoms sit at 21% typical use and 5% perfect use. That’s a significant gap, which means proper technique matters. One practical tip: only use water-based or silicone lubricants with latex condoms. Oil-based products like baby oil, lotion, petroleum jelly, and coconut oil weaken latex and increase the risk of breakage.
The diaphragm is a dome-shaped silicone or latex cup that covers the cervix and must be used with spermicide. It has a 12% typical-use failure rate. Some versions require a fitting by a healthcare provider, while a one-size option fits most people. If your weight changes by 10 pounds or more, or you give birth or have abdominal surgery, you’ll need a new fitting because the shape of your cervix and vagina can change.
Fertility Awareness and Withdrawal
Fertility awareness-based methods involve tracking your body’s signals to identify the days you’re most likely to conceive, then avoiding sex or using a barrier method during that window. The signs people track include menstrual cycle length, basal body temperature, urinary hormone levels, and changes in cervical fluid. These can be used alone or in combination.
Effectiveness varies enormously depending on which approach you use and how precisely you follow it. The symptothermal method, which combines temperature tracking with cervical fluid observation, has a perfect-use failure rate of just 0.4%, which rivals hormonal methods. But across all fertility awareness methods collectively, the typical-use failure rate is 24%, meaning about 1 in 4 couples using these methods will experience a pregnancy within a year. The gap between best-case and real-world performance is the largest of any category.
Withdrawal (pulling out before ejaculation) has a typical-use failure rate of 22% and a perfect-use rate of 4%. It’s better than nothing, but it relies entirely on timing and self-control in the moment.
Breastfeeding as Contraception
Exclusive breastfeeding can suppress ovulation, but only under three strict conditions that must all be met simultaneously: your period has not returned, you are fully or nearly fully breastfeeding with no more than 4 hours between daytime feeds and 6 hours at night, and your baby is less than 6 months old. If any one of those criteria stops being true, the protection drops and you need a backup method.
Permanent Options
Sterilization is intended to be permanent. For women, tubal ligation involves blocking or cutting the fallopian tubes. It has a first-year failure rate of about 0.5%, though long-term failure rates of 2% to 3% have been reported. Vasectomy, the male equivalent, is a simpler office-based procedure that cuts or seals the tubes carrying sperm. Its failure rate is about 0.15% in the first year, and the pregnancy rate continues to drop over time, falling from roughly 3 per 1,000 couples in the first several months to about 1.5 per 1,000 after three years.
Emergency Contraception
If a method fails or you had unprotected sex, emergency contraception can still prevent pregnancy, but timing matters. Two types of emergency contraceptive pills are available. The most common contains levonorgestrel (the active ingredient in Plan B and its generics) and is available over the counter. The other option, ulipristal acetate (sold as ella), requires a prescription. Both should be taken as soon as possible within 5 days of unprotected sex. Within the first 3 days, they’re similarly effective. Between days 3 and 5, ulipristal acetate works noticeably better.
The most effective emergency contraceptive isn’t a pill at all. A copper IUD placed within 5 days of unprotected sex prevents pregnancy more reliably than any pill, and then continues working as your regular contraception for up to a decade. If the timing of ovulation can be estimated, placement may even be possible beyond the 5-day window, as long as it happens within 5 days of ovulation.
Comparing Your Options at a Glance
- Implant: 0.05% failure rate, lasts 3 years, no daily effort
- Hormonal IUD: 0.2% failure rate, lasts 3 to 7 years
- Copper IUD: 0.8% failure rate, lasts 10 years, hormone-free
- Shot: 6% typical failure rate, given every 3 months
- Pill, patch, or ring: 9% typical failure rate, requires consistent routine
- Male condom: 18% typical failure rate, only method that protects against STIs
- Diaphragm: 12% typical failure rate, used with spermicide
- Fertility awareness: 24% typical failure rate, requires daily tracking
- Sterilization: under 1% failure rate, intended to be permanent
The most effective methods are the ones that don’t depend on you remembering to do something every day or every time you have sex. But effectiveness isn’t the only factor. Some people prefer hormone-free options. Some need STI protection. Some want something they can start and stop easily. The best method is whichever one you’ll actually use consistently.