What birth control method is best? A look at hormone and hormone-free, plus risks and benefits

Woman thinking about birth control options

Choosing a birth control method is an important, personal decision.

With so many options, knowing what's best for your health and lifestyle can be confusing. What you choose at this point in your life may be different than what you need later on. 

Because different types work differently, having an open conversation with your doctor will help you make an informed decision with your health in mind. To help bring some clarity, the University Health Center provides an overview of hormonal and nonhormonal birth control methods they offer, their risks and benefits.

Hormonal birth control methods

Combination pill

Birth control pills are not all the same. Their formulas and composition vary. The combination pill contains an estrogen and progestin combo. When used as directed, it is about 99% effective.

Progestin only minipill

The minipill only has progesterone and can be a good option for women who can't take estrogen, like women with a history of deep vein thrombosis or those who are breastfeeding. Used as directed, the minipill is 99% effective.


The transdermal contraceptive patch releases combination hormones, is over 99% effective and works the same way as birth control pills. The patch is replaced once a week and worn for three weeks, with no patch on the fourth week. 

Progesterone intrauterine device

Once placed in the uterus by a medical professional, a progesterone IUD provides long-lasting birth control. Mirena®, for example, is one IUD option that is available at the health center and approved for preventing pregnancy up to seven years. It also treats heavy periods for up to five years. Over 99% effective, it can be removed by your doctor anytime. The health center also offers Kyleena®, Liletta® and Skyla® brands. Some women who don't qualify for the use of birth control pills or injections may be able to use an IUD.

Vaginal ring

The vaginal ring is sometimes referred to by one of the common brand names, NuvaRing® is a hormone combination like the combo pill. It's worn for three weeks and replaced every fourth week. There are monthly and yearly options available. The ring is 96% to 99% effective when used correctly.

Progestin injection

The progestin injection is sometimes commonly referred to by the brand name, Depo-Provera®. The injection releases progestin into the buttocks or arm and is 96% effective. Shots must be taken every 12 weeks to remain fully protected.


Also known by the brand name Nexplanon®, the implant releases progestin. It is a single, thin rod inserted under the skin of the upper arm. Implants are 99.95% effective and must be replaced every three years.

Risks and benefits of hormonal birth control methods

Benefits include:

  • Pregnancy prevention if taken as directed, without intercourse interruption
  • Some relief of period pain, heavy periods and menstrual headaches
  • Fewer skin breakouts and mood changes 
  • A decrease in circulating testosterone in women with polycystic ovarian syndrome, or PCOS, when taking a combo hormonal pill
  • More flexibility with hormonal combo methods to manipulate the time of your period and perhaps skipping a period

Risks include:

  • No protection against sexually transmitted infections (STIs) or HIV
  • May be affected by certain medicines
  • May delay the return of regular menstrual cycles
  • May cause irregular periods or spotting
  • May cause weight gain, breast tenderness, headaches or irritability

Nonhormonal birth control

Copper IUD

Paragard® is the brand name for this hormone-free, copper IUD that is over 99% effective. Once inserted by a doctor, it provides pregnancy prevention for 10 years. The copper IUD may also be placed right after childbirth, removed anytime, and used in women with certain medical conditions.

Vaginal gel

There is only one vaginal gel (brand name Phexxi®) on the market. It is a relatively new, on-demand birth control method. It prevents pregnancy by taking advantage of the vagina's natural acidity and sperm's vulnerability to acidic environments. A prefilled applicator is inserted immediately before or up to one hour before vaginal intercourse. When used as directed, Phexxi® is 93% effective.

  • Gel can be combined with other birth control methods but is not recommended for use with vaginal rings
  • Side effects may include burning, itching, discomfort or pain
  • There is a slight risk of bladder inflammation, kidney infection or urinary tract infection 
  • Gel is not recommended for people with a history of recurrent UTIs or urinary tract abnormalities

Barrier methods

Barrier methods are the least effective overall. Pregnancy prevention is highly dependent on correct usage if spermicide is used and if more than one method is used together. These include external or internal condoms (90% effective), diaphragms (80% to 95% effective), cervical caps (86% effective) and sponges (76% effective). To be the most effective, barrier methods must be used properly, fit well, and be used with a spermicide. Most importantly, external condoms are the only method that helps to prevent STIs.

Regular checkups and screenings are necessary for every phase of life. When considering what birth control method may be right for you, your doctor will most likely:

  • Perform an exam and review your health history
  • Discuss any health risks that may rule out certain options
  • Have a conversation about all your options, along with the risks and benefits
  • Discuss how long you desire birth control, family planning goals and what may fit your lifestyle

Ready to discuss what birth control options may be right for you? Call 402.472.5000 to make an appointment at the University Health Center.