Implant (Nexplanon)

Category: LARC | Type: Hormonal

Typical-use failure rate: 0.1% | Perfect-use: 0.05%

Duration: 3-5 years

Releases etonogestrel to suppress ovulation, thicken cervical mucus, and thin endometrium.

Pros: Most effective reversible method; Set-and-forget for 3-5 years; Quick return to fertility after removal; Safe for breastfeeding

Cons: Irregular bleeding (most common side effect); Requires trained provider for insertion/removal; May cause headaches, mood changes; Does not protect against STIs

Cost (US): $0-$1,300 (free with most insurance)

Reversibility: Immediate upon removal

Hormonal IUD

Category: LARC | Type: Hormonal

Typical-use failure rate: 0.2% | Perfect-use: 0.2%

Duration: 3-8 years

Releases levonorgestrel locally to thicken cervical mucus, thin endometrium, and partially suppress ovulation.

Pros: Extremely effective; Lighter periods (many stop entirely); Lower hormone dose than pill; Can treat heavy menstrual bleeding

Cons: Insertion can be painful; Risk of expulsion (2-10%); Irregular spotting first 3-6 months; Rare perforation risk (0.1%)

Cost (US): $0-$1,300

Reversibility: Immediate upon removal

Copper IUD (Paragard)

Category: LARC | Type: Non-hormonal

Typical-use failure rate: 0.8% | Perfect-use: 0.6%

Duration: Up to 10 years

Copper ions create inflammatory reaction toxic to sperm, preventing fertilization. Also alters endometrial lining.

Pros: Hormone-free; Longest-lasting reversible method; Can be used as emergency contraception (within 5 days); Immediate effectiveness

Cons: Heavier, longer, more painful periods; Cramping during insertion; Risk of expulsion; Rare: copper sensitivity

Cost (US): $0-$1,300

Reversibility: Immediate upon removal

Combined Oral Contraceptive (The Pill)

Category: Short-acting | Type: Hormonal

Typical-use failure rate: 7% | Perfect-use: 0.3%

Duration: Daily

Estrogen + progestin suppress ovulation, thicken cervical mucus, thin endometrium.

Pros: Regulates periods; Reduces acne, PMS; Decreases ovarian/endometrial cancer risk; Decades of safety data

Cons: Must take daily at same time; Nausea, breast tenderness, spotting initially; Slight increase in blood clot risk; Drug interactions (rifampin, some anticonvulsants)

Cost (US): $0-$50/month

Reversibility: 1-3 months typical

Progestin-Only Pill (Mini-Pill)

Category: Short-acting | Type: Hormonal

Typical-use failure rate: 7% | Perfect-use: 0.3%

Duration: Daily

Progestin thickens cervical mucus and may suppress ovulation (norethindrone ~50%, drospirenone ~98%).

Pros: Safe for smokers over 35; Safe while breastfeeding; No estrogen side effects; Slynd (drospirenone) has 24-hr missed pill window

Cons: Must take within same 3-hour window daily (except Slynd); Irregular bleeding common; Less effective than combined pill for some formulations

Cost (US): $0-$50/month

Reversibility: Immediate

Contraceptive Patch (Xulane/Twirla)

Category: Short-acting | Type: Hormonal

Typical-use failure rate: 7% | Perfect-use: 0.3%

Duration: Weekly

Transdermal delivery of estrogen + progestin. Same mechanism as combined pill.

Pros: Only change weekly; Visible reminder (you can see it); Same benefits as pill

Cons: May be less effective in women >198 lbs; Skin irritation at site; Visible on skin; Higher estrogen exposure than pill

Cost (US): $0-$150/month

Reversibility: 1-3 months

Vaginal Ring (NuvaRing/Annovera)

Category: Short-acting | Type: Hormonal

Typical-use failure rate: 7% | Perfect-use: 0.3%

Duration: Monthly (NuvaRing) / Yearly (Annovera)

Vaginal delivery of estrogen + progestin. Same suppression of ovulation as pill.

Pros: Monthly insertion (NuvaRing); Annovera lasts full year (reusable); Lower systemic hormone levels; Can be removed for up to 3 hours

Cons: Vaginal discharge; Ring may slip out; Partner may feel during sex; Requires comfort with vaginal insertion

Cost (US): NuvaRing: $0-$200/month; Annovera: $0-$2,200/year

Reversibility: 1-3 months

Injectable (Depo-Provera)

Category: Short-acting | Type: Hormonal

Typical-use failure rate: 4% | Perfect-use: 0.2%

Duration: Every 3 months

Medroxyprogesterone acetate suppresses ovulation and thickens cervical mucus.

Pros: Only 4 injections per year; Very private; May reduce endometriosis pain; May reduce sickle cell crises

Cons: Weight gain (average 5.4 lbs in year 1); Bone density loss (reversible); Delayed return to fertility (up to 10 months); Irregular bleeding, then amenorrhea

Cost (US): $0-$150 per injection

Reversibility: 6-10 months after last injection

Male (External) Condom

Category: Barrier | Type: Non-hormonal

Typical-use failure rate: 13% | Perfect-use: 2%

Duration: Per use

Physical barrier preventing sperm from entering vagina/rectum. Also blocks STI transmission.

Pros: Only method that prevents both pregnancy AND STIs; No prescription needed; No hormonal side effects; Inexpensive and widely available

Cons: Must be used every time; Can break or slip (especially if wrong size); Reduces sensation for some; Latex allergy (alternatives: polyurethane, polyisoprene)

Cost (US): $0.50-$2 each (often free at clinics)

Reversibility: N/A

Female (Internal) Condom

Category: Barrier | Type: Non-hormonal

Typical-use failure rate: 21% | Perfect-use: 5%

Duration: Per use

Nitrile pouch inserted into vagina before sex, creating barrier.

Pros: Female-controlled; Can be inserted up to 8 hours before sex; Protects against STIs; Safe with oil-based lubricants (nitrile)

Cons: Higher failure rate than male condom; Can be noisy; May shift during use; Less available, more expensive

Cost (US): $2-$4 each

Reversibility: N/A

Diaphragm (Caya)

Category: Barrier | Type: Non-hormonal

Typical-use failure rate: 17% | Perfect-use: 6%

Duration: Per use

Silicone dome covers cervix, used with spermicide to block and kill sperm.

Pros: Reusable for 1-2 years; Hormone-free; Can be inserted up to 2 hours before sex; Caya is one-size-fits-most

Cons: Must use with spermicide; Must leave in 6+ hours after sex; Increases UTI risk; Requires fitting (traditional) or sizing (Caya)

Cost (US): $0-$75 (plus spermicide)

Reversibility: N/A

Spermicide / Phexxi

Category: Barrier | Type: Non-hormonal

Typical-use failure rate: 21% | Perfect-use: 16%

Duration: Per use

Nonoxynol-9 kills sperm on contact. Phexxi lowers vaginal pH to immobilize sperm.

Pros: No prescription for N-9 spermicide; Phexxi is hormone-free, on-demand; Can supplement other methods

Cons: High failure rate alone; N-9 can irritate tissue and increase STI risk; Must apply before each act; Phexxi may cause burning/itching

Cost (US): Spermicide: $8-$15; Phexxi: $0-$285/box

Reversibility: N/A

Withdrawal (Pull-Out)

Category: Natural | Type: Non-hormonal

Typical-use failure rate: 20% | Perfect-use: 4%

Duration: Per use

Withdrawal of penis before ejaculation to prevent sperm from entering vagina.

Pros: No cost; No devices needed; No hormones; Always available

Cons: Requires significant self-control; Pre-ejaculate may contain sperm (debated); High typical-use failure rate; No STI protection

Cost (US): Free

Reversibility: N/A

Fertility Awareness Methods

Category: Natural | Type: Non-hormonal

Typical-use failure rate: 23% | Perfect-use: 5%

Duration: Daily tracking

Tracking basal body temperature, cervical mucus, and/or calendar to identify fertile window and avoid unprotected sex during that time.

Pros: No hormones or devices; Helps understand your cycle; Can also be used to achieve pregnancy; Accepted by all religions

Cons: Requires daily tracking and discipline; Irregular cycles make it harder; Must abstain or use barrier during fertile window; 6+ menstrual cycles to learn method

Cost (US): Free-$200 (thermometer + app)

Reversibility: N/A

Vasectomy

Category: Permanent | Type: Surgical

Typical-use failure rate: 0.15% | Perfect-use: 0.1%

Duration: Permanent

Vas deferens cut or blocked, preventing sperm from reaching semen. Sperm are reabsorbed by the body.

Pros: Most effective permanent method; Outpatient procedure (15-30 min); No effect on hormones, sex drive, or erections; One-time cost

Cons: Should be considered permanent; Not effective immediately (need semen analysis at 8-16 weeks); Temporary swelling/pain; Reversal possible but expensive and not guaranteed

Cost (US): $0-$1,000

Reversibility: Reversal possible (40-90% success) but expensive ($5,000-$15,000)

Tubal Ligation / Salpingectomy

Category: Permanent | Type: Surgical

Typical-use failure rate: 0.5% | Perfect-use: 0.5%

Duration: Permanent

Fallopian tubes cut, tied, or removed (salpingectomy), preventing egg from reaching uterus.

Pros: Permanent and effective; Bilateral salpingectomy may reduce ovarian cancer risk by 40-60%; No hormonal side effects; Immediate effectiveness

Cons: Requires surgery (usually laparoscopic); General anesthesia; Should be considered permanent; Higher upfront cost than vasectomy

Cost (US): $0-$6,000

Reversibility: Very difficult reversal (success varies widely)

Emergency Contraception (Pills)

Category: Emergency | Type: Hormonal

Typical-use failure rate: null% | Perfect-use: null%

Duration: Single use (within 72-120 hours)

Plan B (levonorgestrel): delays ovulation. ella (ulipristal): blocks progesterone receptors to delay/prevent ovulation.

Pros: Available without prescription (Plan B); ella effective for 5 full days; Safe for most women; Does not affect existing pregnancy

Cons: Not for regular use; Plan B less effective in heavier women; ella requires prescription; Nausea, headache, irregular bleeding

Cost (US): Plan B: $25-$50 OTC; ella: $50-$90 with Rx

Reversibility: N/A

NES/T Gel (Male)

Daily gel applied to shoulders. Nestorone + testosterone suppresses sperm production. 86% achieved suppression at 12 weeks.

Status: Phase 2 complete

YCT-529 (Male)

Blocks vitamin A receptor (RAR-alpha) in testes. Prevents sperm maturation without affecting hormones. No adverse effects in safety trial.

Status: Phase 2a

ADAM Hydrogel (Male)

Gel injected into vas deferens acts as temporary vasectomy. Participants reached azoospermia at 24 months.

Status: Human safety trial

Vasalgel (Male)

100% success rate blocking sperm for up to 10 years. Potentially reversible with solvent injection.

Status: North American trial complete