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

Progestin injection

0.2%

6%

56%

Injection every 3 months

Amenorrhea, irregular bleeding, weight gain, headache, mood changes

Subdermal progestin implant

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

Contraceptive pH regulator gel

7%

14%

—

Used within 1 hour before each episode of sexual intercourse

Vulvovaginal burning, itching, urinary tract and yeast infection

Contraceptive sponge

(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)

Tubal sterilization

0.5%

Same as perfect use

100%

Requires a procedure (typically done in an operating room)

Usually permanent

Vasectomy

0.15%

Same as perfect use

100%

Requires a procedure (done in an office) and a local anesthetic

Usually permanent