Dr. Annie Answers: Birth Control Breakdown

This has been and still remains one of my all-time favorite conversations to have in my clinic. There are so many options for birth control these days, it can be a little overwhelming to know what is right for you. Even condensing it, it’s a long post, but hopefully you or someone you know and share it with will get some good background info to go get their safe-sex groove on. I’ll be sharing more detail on each category in future blog posts, don’t worry!

**This blog post, ofcourseofcourseofcourse does NOT take the place of a thoughtful conversation between you and your OWN doctor about what is the best choice for your particular health needs. I am not your doctor.**

I like to break the options down into bigger categories to keep it straight. With each I will give you the ‘failure rate’ for ‘typical use’ – aka if 100 normal women have a sex regularly for 1 year, this is how many will get knocked up (reference here). Here’s the big picture with color gradient for how frequently you have to do something to prevent pregnancy:

Screen Shot 2018-04-17 at 9.10.20 PM

Important side-bar #1: IF THIS POST IS RELEVANT TO YOU, YOU SHOULD BE TAKING A PRENATAL VITAMIN! Yes, I understand that you are looking at birth control because you don’t want to have a baby. Take one because IF you get pregnant despite these interventions, and there is a any spec of a chance in the universe you *might* keep the baby even to give it up for adoption, the vitamins need to ALREADY be on board. Like 3 months ago. Take one. Any of them. Don’t care if it’s a gummy.


The two most broad categories of contraceptive options are those with hormones versus those without hormones. I’ll start with the latter because there aren’t many (hey researches, hellllooooo??? can you get to work on this please??). There are a handful of reasons that people might need to use contraception without hormones (history of blood clots, certain cancers in the family, bad reactions in the past) or you might just want to avoid the exposure for personal reasons.

The Copper IUD aka PARAGARD®: Less than 1 in 100

Screen Shot 2018-04-17 at 1.03.26 PM

Did you notice how reliable this one is? Also, it’s good for up to 10 years with absolutely zero effort involved. AND, if plans change after 1 year and you want a baby? So easy to remove, no hormone wash-out period, so you can get pregnant right after. OK, ok, I know. Intrauterine devices have a lot of bad press. I will write a whole separate blog post with more details, suffice it to say complications and adverse reactions are RARE, only about 15% of women have theirs taken out in the first year for any reason.

Rhythm method or Natural Family Planning: 24 in 100 (about 1 in 4)

The reliability of this is INCREDIBLY variable. IF you have extremely regular cycles, AND you are meticulous about tracking AND you can avoid sex for 2 weeks at a time depending on the cycle, it can be close to other methods’ reliability. There are very few people who achieve this. In medicine we say, “what do you call people who use NFP? …. parents.”. That being said, if you wouldn’t be excited to be pregnant, not the best choice.

Barrier methods: 18 in 100 (about 1 in 5)

This includes condoms (also the only thing that prevents STDs) and diaphragms (yes, some women still use and love these). Not many people still do the sponge for a variety of reasons. There are new and better condom makers, vegan, non-toxic, etc… They still have a relatively high rate of failure due to tears, slipping, forgetting to put on at the right time… In my professional opinion, condoms should be used as STD preventers, NOT as contraception because 1 in 5 is HIGH failure rate, ya’ll! Fun guide to condoms in This Women’s Health Magazine Article.


There are a few advantages to hormonal methods – mostly involving period and, well, hormone regulation. Like I said above, there are some health conditions that influence the decision here, talk to your doctor. I also break this down into two larger categories: Combined estrogen/progesterone and progesterone-only.


The IUD squad: Mirena®, Liletta®, Kyleena®, Skyla®: Less than 1 in 100

No, these aren’t the top 4 up-and-coming baby names of 2019, these are the 4 varieties of Progesterone IUDs. The Mirena and Liletta are the classics – differing only in the insertion device we use. Good for 5 (under testing for up to 7) years. The Kyleena has slightly less progesterone and the Skyla has even less and is 0.1 inch smaller, but you only get 3 years here. Procedure is the same as copper IUD. The lower the progesterone, the more likely you are to have irregular bleeding.

Screen Shot 2018-04-17 at 6.32.11 PM

All of these usually decrease or eliminate your period bleeding. YAYYYYYYY!!!!! NO PERIODS!!!!!!

Important side bar #2: “But don’t I have to bleed? That seems unnatural…” N. O. No. Think about this: if your body had NO contraception and we were living the ‘natural’ life of our ancestors, you’d be pregnant or breastfeeding for most of your fertile years – aka, no periods. Your body is actually made to have fewer periods than most of us do. There is a slight decrease in the rates of endometrial and ovarian cancer with suppressing cycles, and NO negative health impacts.

Nexplanon (formerly known as Implanon): Less than 1 in 1000

No, that’s not a typo, failure rate here is 0.05%. That is 10 times more reliable than a tubal ligation. This is a tiny, flexible medical plastic device that goes under the skin of your arm and releases a steady, tiny amount of progesterone for up to 3 years. To get it in, we numb up your arm and then use the handy-dandy (nearly) foolproof inserter to put it in and release it.

Screen Shot 2018-04-17 at 8.25.53 PM Implanon isn’t used anymore because the inserter was NOT foolproof and some implants were put too deeply, and it wasn’t visible on x-ray so was really hard to get back out. They fixed both issues for Nexplanon.

Depo Provera: 6 in 100

This is an injection of progesterone you get every 3 months. It’s cheap, it is likely to wipe out your periods BUT has a high rate of side effects and you have to remember to go in every 3 months, so not my highest recommendation. However, some people like it. We usually recommend it as a short-term solution while you’re deciding on something else – ie: to buy you 3 months to convince your husband to stop being a weenie and go get a vasectomy.

Progesterone-only mini pill: 10 in 100 or more

I generally only recommend this one when you are breastfeeding (NOT pumping, but direct breast feeding) full time in the first 6 months of your baby’s life. It is otherwise very unreliable and if you miss taking your dose by even 2 hours, you can get pregnant.

Combined Estrogen Progesterone

Important side bar #3: If you’re somewhere in life that it is hard to get birth control – ie without insurance, without a primary care doctor or without any doctors in the area you live in, there’s an app for that!! Check out This NPR Article about it (yay for progress!!!).

Pills: 9 in 100 (if you remember)

Pills are the old standard of birth control. Easy to get, easy to start, easy to stop. Side benefits may include skipping your periods if you choose, better skin, hormone regulation. However… you have to remember them. every. day. I barely manage to brush my teeth every day. If you are that unicorn person with no problems with this, awesome. If you’re more like me? Think about another option.

The morning after pill – aka Plan B One Step – is something that everyone without a longer-term option (ie IUD or Implant) should know how to get or keep on hand. It does NOT cause abortions, contrary to the fake news out there, but CAN prevent an egg from being fertilized or implanting if you get to it asap (ideally within 3 days, but up to 5) of an “oops”. You can buy at any pharmacy in most states or on Amazon: Plan B One Step

Patch: 9 in 100

The patch is 7 times easier to remember than the pill and you get some decreased side effect due to the transdermal absorption which skips the gut/liver processing. Works great for a niche audience who doesn’t mind the patch being there.

Nuvaring: 9 in 100

Screen Shot 2018-04-17 at 8.41.00 PM

The Nuvaring is a flexible ring that you put in your vagina (a la OB applicator-less tampons) and leave for 3 weeks.  So, 21 times easier than the pill. Again, lower side effects and hormone dose than the pills because you absorb directly into the bloodstream instead of through the gut/liver. You can leave it in during sex (some people find it stimulating in a good way) or remove for up to 3 hours, rinse and replace. This one is a great option for when you need something easier than the pill but aren’t ready to commit to an IUD or implant!

Things that are not birth control:

  • Pulling out. Not even ‘pull out and pray’.
  • Spermacide alone (1 in 3 failure rate)
  • Having sex during your period
  • The first time you’ve ever had sex
  • A quickie
  • Having sex in weird positions


Wow, that was A LOT OF INFORMATION!!!! I’m sure you have questions… ask me, ask your provider. Don’t ask people who don’t do women’s health as their profession, just, please, trust me on this one. Now, go get your safe-sex on, HEY-YO!!!

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Real As A M*ther

Four girls became best friends in high school and have stayed together through a whole lot of life. We are now a doctor, a lawyer, a financial advisor and a badass doula slash massage therapist and homesteader and want to share what we've learned as wives, moms, women and in our careers with the world... and entertain you along the way!

2 thoughts on “Dr. Annie Answers: Birth Control Breakdown

  1. My favorite is, “Things that are not birth control.” 😉 To the point, accurate, and hilarious. 🙂 Thanks, Annie!


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