You would think that by now we would have perfected a way so that a woman wouldn’t get pregnant when she didn’t want to. Recent advances in contraception have given us methods for shorter or no periods. A new sterilization method called Essure seems more effective than the regular tubal sterilization. And there’s also new evidence that condoms really work and that women using condoms 100% of the time are one-third less likely to test positive for human papillomavirus (HPV).

We have so many more options than we did 50 years ago yet half of all pregnancies each year are unintended—oops! Forty percent of these end in an induced abortion.

So with so many options available, why are contraceptives seemingly failing women and their partners?

Experts believe it may be because women aren’t always choosing the best method for them. For example, medically speaking, if you smoke and are older than 35, you can’t use a contraceptive with estrogen because it will increase your chances of having a blood clot.

Your preferred method also needs to match your lifestyle—can you consistently remember to take your pill at the same time each day or put your diaphragm in before having sex? Will your partner use condoms 100% of the time if requested? Will you ever get lazy and just tell him it’s OK to skip it just this one time?

Your life stage also affects your best contraceptive choice, and you may change from method to method as your needs and age change. In your teens and 20s, contraception is often about controlling menstrual cramps, whereas controlling irregular bleeding is more important during the menopausal years.

You can also use contraception to decrease the severity of premenstrual syndrome (PMS), manage acne and regulate your cycles. In addition to these factors, you have to also consider each method’s efficacy, safety, noncontraceptive benefits and other personal needs.

Start with these charts and make a list of the top benefits you wish to receive from using contraception. Share that list of top choices with your healthcare provider to find the best methods for you.

Hormonal contraceptives work by preventing release of an egg from your uterus and making the cervical mucus unfriendly to sperm. *None of these methods should be used by women who are pregnant or have a history of blood clots, liver disease or breast cancer.

Type	How to use	Effectiveness (perfect use)	Best for women who	Skip this if *	Also consider
Oral contraceptives (the pill)	Take 1 pill every day as directed; some varieties allow you to have shorter or less frequent periods	99%	Can remember to take a pill every day; decreases cramps, acne	Older than 35 and a smoker; history of blood clots	Cost $45-$50/month; many generics available
The patch	Apply to skin and change weekly; a period every 28 days	99%	Can’t remember to take a pill every day	Older than 35 and a smoker; history of blood clots; skin sensitivity	Twice the incidence of blood clots as the pill; cost $45-$50/month; no generic
Vaginal ring	Insert monthly and leave in for 3 weeks; a period every 28 days	99%	Feel comfortable inserting something in vagina	Older than 35 and a smoker; history of blood clots	Cost $45-$50/month; no generic; lowest estrogen
Contraceptive injection	Get injection every 3 months; irregular or no bleeding	99%	Can’t take estrogen; are on seizure medication	You have low bone mass; don’t like irregular bleeding initially and no menses later	Decreases bone mass (which you will regain after stopping); possible weight gain; slower return to fertility; given by healthcare provider
Progesterone-releasing intrauterine device (IUD)	Inserted into uterus; can remain for up to 5 years; irregular bleeding initially; no menses in many women by 1 year	99%	Want long-term contraception or to control perimenopausal bleeding	You have aleeding disorder or history of ectopic pregnancy or pelvic inflammatory disease	Cost $800
5–year implant (Implanon)	Implanted in upper arm by healthcare provider; may have regular bleeding or spotting	99.5%	Want long-term control and high effectiveness; can’t take estrogen	You have unexplained vaginal bleeding	Cost $800-$1,500

These contraceptives prevent pregnancy by providing a barrier against sperm, interfering with sperm movement or creating an unfriendly environment for sperm. These methods don’t use hormones so they don’t usually interfere with your menstrual cycle.

Type	How to use	Effectiveness (perfect use)	Best for women who	Skip this if *	Also consider
Copper IUD	Inserted into the uterus; can remain for 10 years; regular menses every 28 days	99%	Want long-term contraception	History of reproductive cancers; allergy to copper; unexplained vaginal bleeding	Increased cramping for the first 6 months; cost $800
Male condom	Partner must wear every time during sex	98%	Trust partner to wear effectively; want to prevent sexually transmitted infections (STIs)	Your partner will not use	Best as a second method; prevents STI transmission
Female condom	Insert every time before sex	95%	Have latex allergies; want control; want to prevent STIs	You don’t feel comfortable touching yourself	Prevents STIs; cost $3
Diaphragm or cervical cap	Insert every time before sex (up to 2 hours)	94% (cap slightly less—91%)	Feel comfortable having control	You don’t feel comfortable touching yourself	Needs to be fitted by healthcare provider
Contraceptive sponge	Insert up to 24 hours before sex; keep in place for 6 hours after sex	80% to 91%	Feel comfortable having control; available over the counter	You don’t feel comfortable touching yourself	Does not need to be fitted by healthcare provider; available over the counter
Spermicides	Apply every time before sex; many varieties—foams, creams, etc.	82%	Want convenience; use with condoms; monogamous relationships	You are with more than one partner; want reliable contraception	May increase transmission of STIs
Surgical sterilization	No action required after surgery	99.9%	Don’t want more children	You aren’t sure if you don’t want any more children	Failures still do occur; new Essure method may be more effective

About the Author: Jeanne M. Wilton, RN, MS, WHNP-BC, is a nurse practitioner at Wheaton Franciscan Healthcare–All Saints in Racine, WI.