Comparison of Common Contraceptive Methods
Type | Pregnancy Rate in First Year of Use With Perfect Use | Pregnancy Rate in First Year of Use With Typical Use | Percentage of Women Continuing Use at 1 Year | Requirements for Use | Selected Disadvantages |
|---|---|---|---|---|---|
Hormonal | |||||
Oral contraceptives (OCs) | 0.3% | 9% | 67% | Pill taken daily Progestin-only pills: Taken at the same time every day | Bloating, breast tenderness, nausea, headache Combined estrogen-progestin OCs: Increased risk of venous thromboembolism Progestin-only OCs: Irregular bleeding |
Transdermal patch (estrogen, progestin) | 0.3% | 9% | 67% | Weekly application and removal | Similar to OCs Local irritation |
Vaginal ring (estrogen, progestin) | 0.3% | 9% | 67% | Monthly application (inserted vaginally) and removal | Similar to OCs |
0.2% | 6% | 56% | Injection every 3 months | Amenorrhea, irregular bleeding, weight gain, headache, mood changes | |
0.05% | 0.05% | 84% | Implant every 3 years (some evidence supports ovulation suppression to 5 years) | Amenorrhea, irregular bleeding, headache, weight gain | |
intrauterine devices (IUDs) | 0.4% (3-year IUD: 13.5 mg), 0.2% (5-year IUD: 19.5 mg), or 0.2–0.6% (8-year IUD: 52 mg) | Same as perfect use | 78–80% | Insertion every 3, 5, or 8 years (depending on type) | Spontaneous expulsion, uterine perforation (rare) Irregular bleeding, amenorrhea |
Pericoital | |||||
Condom, external (male)* | 2% | 18% | 43% | Used with every episode of sexual intercourse | Allergic reaction |
Condom, internal (female)* | 5% | 21% | 41% | Used with every episode of sexual intercourse | Allergic reaction |
Diaphragm with spermicide | 6% | 12% | 57% | Used with every episode of sexual intercourse May be inserted up to 2 hours before intercourse Should be left in place ≥ 6 hours (and ≤ 24 hours) after intercourse | Occasionally vaginal irritation Increased incidence of urinary tract infections (UTIs) |
Cervical cap with spermicide | 10–13% | 18% (higher among parous women) | N/A | Used with every episode of sexual intercourse May be inserted 15 minutes to 40 hours before intercourse Should be left in the vagina for ≥ 6 hours (and ≤ 48 hours) after intercourse | Possibly vaginal irritation or ulceration if left in place for > 48 hours |
7% | 14% | — | Used within 1 hour before each episode of sexual intercourse | Vulvovaginal burning, itching, urinary tract and yeast infection | |
(containing sustained-release spermicide) | 9% for nulliparous women 20% for parous women | 12% for nulliparous women 24% for parous women | 36% | Used with every episode of sexual intercourse May be inserted ≤ 24 hours before intercourse Must remain in place for ≥ 6 hours after intercourse (should remain in a total of ≤ 30 hours after insertion) | Allergic reaction, vaginal dryness or irritation |
Spermicide alone | 18% | 28% | — | Must be placed in the vagina at least 10 to 30 minutes and no more than 1 hour before each episode of sexual intercourse Because efficacy is limited, often used with other barrier methods | Vaginal burning, irritation, rash, increase in urinary tract infections |
Other | |||||
IUD) | 0.6% | Same as perfect use | 78–80% | Insertion every 10 years | Spontaneous expulsion, uterine perforation (rare) Increased menstrual blood loss, pelvic pain |
Fertility awareness–based methods (periodic abstinence) | 4% or higher, depending on method | 24% | 47% | Training, effort, and multiple steps required for the more effective methods | No likely systemic or significant local adverse effects |
Withdrawal method | 4% | 22% | 46% | Used with each episode of sexual intercourse | Requires cooperative partner |
Permanent contraception (sterilization) | |||||
0.5% | Same as perfect use | 100% | Requires a procedure (typically done in an operating room) | Usually permanent | |
0.15% | Same as perfect use | 100% | Requires a procedure (done in an office) and a local anesthetic | Usually permanent | |
* Condoms, primarily latex and synthetic condoms, protect both partners against sexually transmitted infections. | |||||
N/A = not applicable. | |||||
Data based on Shoupe D: The Contraception Handbook: Evidence Based Practice Recommendations and Rationales, ed. 3. New York, Humana Press, 2020. doi:10.1007/978-3-030-46391-5 | |||||