Contraception: Your GoodRx Guide

Definition

Birth control, also known as contraception, is a term for preventing unplanned pregnancy. 

Although most people who menstruate are sexually active, not all of them are ready for pregnancy and parenthood. About 95% of women who are married or living with a partner are sexually active. Almost 9 in 10 single women are sexually experienced, and 7 in 10 of them are sexually active. 

Being able to prevent pregnancy is important for many reasons. Whatever your reason, you have the right to choose if, when, and how you become pregnant.  

Although preventing pregnancy is the obvious benefit of contraception, you might be interested in getting it for its other effects. Depending on which form you choose, birth control can help you have:

• Lighter and less painful periods

• Improved symptoms related to endometriosis or PMDD

• Better control over acne

• Less unwanted hormone-related hair growth 

There are lots of options when it comes to birth control — prescription, over-the-counter, and lifestyle. 

Keep in mind that most contraceptive methods don’t protect against sexually transmitted infections or diseases, such as chlamydia or HIV. Also, no contraceptive is 100% effective at preventing unplanned pregnancy. Only abstinence can prevent both.

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How it works

Several forms of birth control are available, and they work in different ways. (Here’s a good refresher on how pregnancy happens.) 

Barrier methods, such as condoms and diaphragms, physically block the sperm’s access to an egg. These options do not have hormones, and they must be used every time you have sex.

Sterilization also keeps the sperm from getting to an egg. This is a permanent (not reversible) surgical procedure that closes the fallopian tubes (so sperm can’t get to the eggs). You may have heard of it as “getting your tubes tied.” It’s over 99% effective.

However, most forms of birth control contain human-made versions of the sex hormones estrogen and progestin, or in some cases, progestin only. These methods are collectively known as hormonal contraception. They prevent pregnancy by:

• Stopping the ovaries from releasing eggs (called ovulation)

• Thickening the mucus in the cervix (the opening of the uterus or womb), which makes it harder for sperm to reach and fertilize an egg

• Making the lining of the uterus less hospitable to a fertilized egg 

According to the National Center for Health Statistics, approximately 65% of women aged 15 to 49 in the U.S. were using some type of birth control between 2015 and 2017. That’s almost 47 million people. Female sterilization is the most common choice (18.6%), followed by the oral contraceptive pill (12.6%).

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The pill

You’ve probably heard of birth control pills (“the pill”), since they’ve been around for decades. There are two main types of pills. Combination pills contain estrogen and progestin. “Mini pills” contain only progestin. An example is Opill (norgestrel), the first FDA-approved OTC birth control pill (more on this below). 

With perfect use, where you take the pill every day (and at the same time with a mini pill) and don’t miss a dose, the pill is 99% effective. With “typical” use, it typically prevents unplanned pregnancy in around 91 out of 100 people who use it. It's also prescribed to treat pain from periods, PCOS, and endometriosis. And it can even treat acne.

Monophasic pills are the most common combination pills, and they have the same amount of hormone in each pill. Phasic (biphasic or triphasic) pills have different levels of hormones from one week to the next, like your normal monthly cycle would. 

Multiple versions of the pill are available, and choosing one can feel overwhelming. Pills have different levels of hormones, so they have different benefits and risks. Your provider or pharmacist can help you choose which is best for you, based on your medical history, reason for taking the pill, and cost. At the end of the day, though, it’s common to go through a period of trial and error before finding a pill that works for them.

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Pill alternatives

The pill is a popular contraceptive option, but it’s not for everyone. Some other options require you to see a healthcare provider, such as implants, intrauterine devices (IUDs), and shots. There are others that you can apply and remove yourself, including vaginal rings, patches, and caps. 

Long-acting reversible contraceptives

Long-acting reversible contraceptives (LARCs) are the most effective (over 99%) non-pill, nonsurgical contraceptives. These include: 

• Contraceptive implant: This is a thin plastic rod containing etonogestrel (a progestin), which is placed into your arm.

• IUD: This is a T-shaped contraceptive device that’s placed in the uterus. Five of the available IUDs contain progestin, and the copper IUD is hormone-free.

LARCs require a visit to your healthcare provider for placement, and they provide protection against unplanned pregnancy for years. 

Contraceptive injection 

The injection is the next most effective form of birth control. The injection contains progestin, and it protects against pregnancy for several weeks. You will need to get the shot from your healthcare provider at first, but then you can continue the injections on your own. With typical use, it’s about 94% effective. 

Vaginal rings and contraceptive patches 

You can replace and remove these hormonal (estrogen and progestin) methods yourself. The ring stays in place (in your vagina) for several weeks. But the patch (on your skin) needs to be replaced weekly. They are about 91% effective.

Cervical caps and diaphragms 

These are the least effective non-pill, prescription birth control. These are nonhormonal barrier methods: They put a physical barrier between sperm and egg. 

You only use them when you need them (they’re placed right before you have sex) — which requires planning. They are less than 90% effective, and you need to use spermicide with caps and diaphragms for them to work.

Phexxi

This nonhormonal vaginal gel containing lactic acid, citric acid, and potassium bitartrate is the latest prescription contraceptive option. It works by keeping the pH in the vagina at a level that is inhospitable to sperm. It’s applied to your vagina before sex, and it’s about 86% effective.

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Over-the-counter options

You don’t need a prescription to get OTC birth control, so these options play an important role in making contraception accessible for many people. Let’s look at the main options. 

Condoms

Condoms are single-use physical barriers that keep sperm from entering the vagina. With the exception of lambskin condoms, they are the only contraceptive that also provides protection against sexually transmitted infections. 

Condoms are made for both male and female body parts, but condoms for the penis are more effective at preventing unplanned pregnancy than are female (or internal) condoms. This is likely due to how well they fit and stay in place during sex, as well as the learning curve. Keep in mind that male and female condoms should not be used at the same time — they’re designed to be used alone. And to be effective, you must use them every time you have sex. 

Spermicide

Spermicide is a chemical that slows sperm cells down and makes it harder for them to travel. It comes in different forms — gels, foams, and creams — that you insert into the vagina. 

Spermicide can be used alone or with other contraceptive methods. It’s about 72% effective on its own, and you must use it every time you have sex. But spermicide can cause allergic reactions and vaginal irritation. Because of this, it increases your risk of HIV and other sexually transmitted infections.

Opill pill

Opill (norgestrel) is a new addition to the options for OTC birth control. It’s a “mini pill,” so it contains only progestin. Like other mini pills, you need to take it at the same time — every day. With typical use, it’s about 91% effective.

Opill works by thickening the mucus in the cervix, so sperm has a harder time reaching and fertilizing an egg. It also helps prevent ovulation, though it doesn’t do this consistently. It has similar side effects as other birth control pills. 

Opill launched in early 2024, and is now available online and next to condoms and spermicide in your local pharmacy and drugstore. It costs between $15 and $20 a month, depending on the quantity you buy. There is also a cost assistance program to help uninsured consumers with low incomes.

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Lifestyle methods

• The lactational amenorrhea method (LAM): This can be thought of as using breastfeeding as birth control. Lactation means making human milk, and amenorrhea means not having a menstrual cycle. In the first 6 months after giving birth, provided you haven’t restarted your period and you’re nursing exclusively, there’s a 98% chance you won’t become pregnant. 

• Fertility awareness or natural family planning: This is using your body’s signs to determine when you’re most likely to get pregnant, and avoiding sex on those days. It’s also called “the rhythm method.” Every day, you take your temperature and check your cervical mucus, and plot your menstrual cycle on a calendar. This method is around 76% to 88% effective, depending on how well you use it. It’s best to work with a healthcare provider on this.

• “Pulling out”: Removing the penis from the vagina before ejaculation is another way to avoid pregnancy. However, it’s not very effective on its own — only 70% to 75%. 
  

Getting birth control

Ease of access and cost are both important parts of finding a birth control that works well for you. Let’s review your options.

If you have insurance and a trusted healthcare provider

If you’re not sure which birth control method is right for you, and you have access to a provider, it’s best to talk through your options. Remember to share any past and current medical problems, as well as your medications. It’s OK to ask lots of questions, and it’s important to weigh up all of the benefits and risks before choosing.  

You will need to see a healthcare provider if you’re interested in having your tubes tied (sterilization) or getting an IUD or implant.

If you have insurance but no time for an appointment

In some states, you can get the pill, the patch, or the ring from your local pharmacist without making an appointment with your healthcare provider. This is a good option if you need a refill but you just can’t find the time to make an appointment with your healthcare provider. Find out more about how to get birth control without a doctor’s prescription.

If you don’t have insurance

If access is an issue for you, don’t worry: You still have options. 

• Ask about generic versions of the pill, which can be more affordable out of pocket.

• Check out these GoodRx savings on birth control.

• Visit your local women’s health or family-planning clinic, which may be able to help.

• You can get condoms, spermicide, and Opill without a prescription.

Of course, you can still pursue sterilization, LARCs, or any option without health insurance. But the out-of-pocket costs could be considerable. 

According to the Affordable Care Act, plans in the Health Insurance Marketplace must cover birth control and counseling without copays or coinsurance when in-network.

If you don’t want to see a provider in person

If you don't have a regular provider, need a refill for your current birth control, or need emergency contraception, consider scheduling a consultation with an online doctor through a telehealth service like GoodRx Care. Once it becomes available in early 2024, you may also consider the OTC birth control pill Opill.

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