Reproductive rights are in the news these days, which has this Nerdy Girl thinking – this is a nice time to take a quick break to review options to prevent pregnancy. Babies are wonderful and it’s also pretty great to be able to choose if and when you become a parent. Luckily you have many good choices to pick from which are still readily available. Let’s learn! 
Condoms
One of the most easily accessible options to prevent pregnancy, this physical barrier is designed to be used internally inside the vagina or externally covering a penis. This method relies on a physical barrier of latex or polyurethane that blocks sperm. When used perfectly, condoms have a pregnancy prevention rate of 98%, although people aren’t perfect in real life. The actual effectiveness is about 85%. Condoms have the added bonus of being the only method on this list that also prevent the spread of sexually transmitted infections, including HIV.
Oral contraceptive pills
Available as both combo pills with estrogen + progestin or progestin only, each comes in a pack and is taken once daily. The hormones block ovulation and prevent pregnancy. Ovulation is the release of a mature egg from the ovary triggered by hormones. The mature egg then travels down the fallopian tube to the uterus. If there is no ovulation, no egg is released, and pregnancy cannot occur. Birth control pills offer some other benefits including less painful periods, improved acne, the ability to skip periods, and reduction in risk of ovarian and endometrial cancer. Some pills are formulated with iron to help replace what people who menstruate lose with their period. Birth control pills have some drawbacks, including a slightly increased risk of blood clots with estrogen-containing pills and potential for interaction with other prescription medications, like some antibiotics, which can reduce the effect of the pill. With typical use, birth control pills prevent pregnancy with 91% effectiveness.
Birth control rings
These are small flexible plastic rings inserted into the vagina by the user at home for about 21 days then removed and replaced after 7 days, during which menstrual bleeding occurs. There is a once monthly version that gets tossed at the end of each use or a reusable ring that is inserted and removed then reinserted for 12 months. The rings sit inside the vagina but outside the uterus and do not pass through the cervix. They are an internal method to prevent pregnancy that do not require a healthcare provider to insert or remove. The rings contain hormones similar to birth control pills that are released throughout the month to block ovulation and increase cervical mucus production, making it hard for sperm to travel. It’s recommended to leave them in place even during intercourse, and most users or their partners can’t feel the ring once inserted. They are 91% effective at preventing pregnancy when used correctly.
Birth control injection
Depo-Provera is an intramuscular injection of progestin given by a health care provider in the arm, upper thigh or buttocks once every 3 months. Progestin, just like in the birth control pills, prevents ovulation and thickens cervical mucus. You do need a health care provider to administer in most cases, so this requires a visit to the clinic every 90 days. It has a 96% success rate in preventing pregnancy.
Long-Acting Removable Contraceptives, or LARCs
The most effective pregnancy prevention options available are LARCs which come in 2 forms: under the skin implants and IUDs. Both are inserted and later removed as a minor procedure performed in a doctor’s office by a healthcare provider.
Implants, such as Nexplanon
These are tiny flexible plastic rods about the size of a match inserted under the skin of the upper arm. The rod secretes a hormone called etonogestrel that suppresses ovulation and prevents pregnancy. To have it placed, the health care provider numbs the skin on the upper arm and then the device is inserted just under the skin with a needle. Implants can be effective for up to 5 years, and offer 99% protection from pregnancy. When it’s time to take the device out, the arm is again numbed and then a tiny incision is made through which the rod is removed. The cut is covered with a bandage and heals in a few days.
IUDs, or Intrauterine Devices
These are tiny T shaped flexible plastic devices that sit just inside the opening to the uterus, called the cervix. They are inserted during a vaginal exam during a visit to your health care provider’s office. They come coated with a small amount of slowly released hormone called progestin or wrapped in a thin thread of copper. Both types work by reducing the ability of sperm to get to the egg to cause pregnancy. Copper is released in tiny ions into the uterus, which changes the environment enough that sperm can’t function. For the progestin type, the hormone can block ovulation while also thickening mucus around the cervix, which prevents sperm from passing through. IUDs may be tiny, but the protection they provide against pregnancy is powerful – depending on the type of IUD used, it can remain in place, working for you for up to 10 years! IUDs and implants both are 99% effective at preventing pregnancy, so these are some of our very best options for protection.
Hormone-free vaginal gel contraception
Phexxi is the new kid on the block, approved by the FDA in 2020. Phexxi is a prescription, hormone-free gel made of lactic acid, citric acid and potassium bitartrate. It’s inserted into the vagina up to an hour before vaginal intercourse and lowers the surrounding pH, which limits the ability of sperm to move, so they can’t travel up the fallopian tubes to fertilize an egg. It’s up to 93% effective at preventing pregnancy in studies, when people are using perfectly, although in real life use it’s closer to 86% effective.
When used correctly, all of the options here are pretty great at preventing pregnancy! However, you can increase the effectiveness of most contraceptive methods by using more than one – for example, condoms + birth control pills are superior to either method alone in preventing pregnancy.
What about permanent options, if you know you don’t want to be pregnant ever? For females, a surgery called a tubal ligation can cut or block the fallopian tubes between the ovary and uterus, permanently preventing release of an egg. Males can have a vasectomy, which cuts the vas deferens, the tube that allows sperm to travel from the testicle. Each is considered close to 100% effective at preventing pregnancy.
What about emergency contraception, or “the morning after” pill?
Even with all the great options above, sometimes we find ourselves in situations where everything did not go as planned. There are 3 options:
-The first option is a pill called Plan B which contains levonorgestrel that delays release of an egg and prevents ovulation, reducing pregnancy by about 80%. This is available over the counter at the pharmacy in the US without a prescription.
-The second option is a pill called Ella, which contains ulipristal acetate. 85% effective at blocking pregnancy, this works by blocking production of progesterone which delays ovulation and can prevent an egg from attaching to the uterine wall. It’s available by prescription.
-The third option is an IUD, either copper or hormone containing, up to 99.9% effective!
Each can be used for up to 5 days after unprotected sex, although they work best when you use them as soon as possible – ideally within 3 days, especially for Plan B.
You can get most birth control methods from either a primary care provide or women’s health provider. In the US, you can even obtain birth control prescriptions directly from a pharmacist in 19 states and the District of Columbia (although not in every pharmacy, and a lot of regulations apply). Online retailers are also popping up that can assess your needs and provide a prescription to keep you covered.
Keep in mind that of these options, ONLY condoms can reduce the risk of sexually transmitted infections including HIV. And if you are sexually active, consider seeking regular STD testing, even if you don’t have symptoms, to ensure you stay healthy and keep your partners healthy, too.
Stay safe, stay well.
Those Nerdy Girls
