Choosing a contraception method is a clinical decision, not a shopping decision. This guide is informational only and is not medical advice. Talk to a board-certified OB-GYN or qualified prescriber before starting, stopping, or switching any contraceptive. What it does do is lay out the seven methods you are most likely to be offered in a US clinical setting, so you can walk into that appointment with informed questions and a sense of what each option asks of you day to day.
Quick comparison
| Method | Type | Duration | Typical-use efficacy | Fit |
|---|---|---|---|---|
| Mirena IUD | Hormonal IUD | Up to 8 yrs | Over 99% | Set-and-forget, lighter periods |
| Paragard Copper IUD | Non-hormonal IUD | Up to 12 yrs | Over 99% | Hormone-free, longest duration |
| Nexplanon Implant | Hormonal implant | Up to 3 yrs | Over 99% | Arm placement, no daily action |
| Yaz Birth Control Pill | Combined oral pill | Daily | Approx 91% | Cycle control, daily routine |
| Depo-Provera Shot | Progestin injection | Every 3 mo | Approx 94% | Quarterly clinic visit |
| Kyleena IUD | Lower-dose hormonal IUD | Up to 5 yrs | Over 99% | Smaller frame, lower hormone load |
| Phexxi Vaginal Gel | Non-hormonal pH gel | Per use | Approx 86% | On-demand, hormone-free |
Mirena IUD - Best Overall for Long-Term Use
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Mirena is a hormonal intrauterine device that releases levonorgestrel locally in the uterus and is approved for up to eight years of continuous use. It is one of the most-prescribed contraceptives in the US because it covers a long window, has typical-use efficacy above 99 percent, and reduces menstrual bleeding for most users over the first year. Many people stop having periods entirely after 12 to 24 months, which is a side effect some welcome and others do not.
Mirena is also FDA-approved as a treatment for heavy menstrual bleeding, so it carries clinical value beyond contraception alone. Insertion is a brief in-office procedure performed by an OB-GYN or trained nurse practitioner, and removal is straightforward.
Trade-off: insertion can be uncomfortable, particularly for people who have not given birth. Irregular bleeding is common in the first three to six months. Discuss your bleeding history and any pelvic conditions with your prescriber before scheduling.
Best for: people wanting long-duration, low-maintenance contraception with the added benefit of lighter periods.
Paragard Copper IUD - Best Hormone-Free Long-Term Option
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Paragard is the only copper IUD approved in the US and works without any hormones. The copper itself creates a uterine environment that is hostile to sperm. It is approved for up to 12 years of use, the longest single-method duration on this list, and has typical-use efficacy above 99 percent. It is also the only IUD that can be used as emergency contraception when inserted within five days of unprotected sex.
For people who cannot take hormonal contraception because of migraines with aura, breast cancer history, or personal preference, Paragard is the standout option.
Trade-off: Paragard often causes heavier periods and more menstrual cramping, especially in the first six months. People with already-heavy periods or anemia should weigh this carefully with their OB-GYN.
Best for: hormone-free preference, longest duration, or anyone with contraindications to estrogen and progestin.
Nexplanon Implant - Best No-Daily-Action Method
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Nexplanon is a matchstick-sized progestin-only rod inserted under the skin of the upper arm. It releases etonogestrel for up to three years and has typical-use efficacy above 99 percent. Insertion takes a few minutes in a clinical setting and requires no pelvic procedure, which some users prefer over an IUD.
The implant is fully reversible. Fertility typically returns within weeks of removal. It is appropriate for people who cannot tolerate estrogen because it contains only progestin.
Trade-off: unpredictable bleeding patterns are the most common reason users discontinue. Some people get no periods, some get prolonged spotting, and the pattern is hard to predict in advance.
Best for: people who want a long-acting method without an intrauterine procedure and can tolerate unpredictable bleeding.
Yaz Birth Control Pill - Best Daily Combined Option
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Yaz is a combined oral contraceptive containing drospirenone and ethinyl estradiol. It is one of several modern combined pills, alongside Yasmin and Loestrin, that offer cycle control, predictable bleeding, and additional FDA-approved indications for moderate acne and premenstrual dysphoric disorder. Typical-use efficacy lands near 91 percent because the pill must be taken daily within a consistent window.
Combined pills are well-studied, widely covered by insurance, and reversible the moment a user stops. For people who want predictable, regular periods and are not ready for a long-acting method, daily pills remain a sensible starting point.
Trade-off: combined pills carry a small increased risk of venous thromboembolism, particularly in smokers over 35, people with migraines with aura, or those with clotting disorders. Screening with your OB-GYN is non-negotiable.
Best for: people who want monthly cycle control, can take a daily pill reliably, and have no contraindications to estrogen.
Depo-Provera Shot - Best Quarterly Visit Option
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Depo-Provera is a progestin-only injection given every 12 to 13 weeks. It contains medroxyprogesterone acetate and has typical-use efficacy near 94 percent. Because it is administered in a clinical setting, the user only has to remember a quarterly appointment rather than a daily pill.
It is appropriate for people who cannot use estrogen and is sometimes used for endometriosis-related symptom management under clinical guidance.
Trade-off: Depo-Provera is associated with reversible bone mineral density loss with long-term use, so duration of use is something to discuss with your prescriber. Weight gain is reported by some users. Return to fertility after stopping can take 6 to 12 months.
Best for: people who prefer a quarterly clinic visit, cannot use estrogen, and are not trying to conceive in the near term.
Kyleena IUD - Best Lower-Dose Hormonal IUD
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Kyleena is a smaller-frame hormonal IUD that releases a lower dose of levonorgestrel than Mirena. It is approved for up to five years and has typical-use efficacy above 99 percent. Its smaller frame is sometimes more comfortable for people who have not given birth.
Bleeding pattern changes are similar to Mirena but with a higher chance of continued light monthly bleeding rather than full cessation. For users who want some hormonal contraception but a lower total dose, Kyleena is the typical step-down option from Mirena.
Trade-off: shorter duration than Mirena, and some users report more breakthrough bleeding because of the lower hormone load. Insertion discomfort is comparable to Mirena.
Best for: users who want a long-acting hormonal method at the lowest available local dose.
Phexxi Vaginal Gel - Best On-Demand Non-Hormonal Option
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Phexxi is a prescription non-hormonal vaginal gel that contains lactic acid, citric acid, and potassium bitartrate. It works by maintaining vaginal pH at a level inhospitable to sperm motility. It is applied with an applicator up to one hour before sex and is dosed per act of intercourse rather than continuously. Typical-use efficacy is near 86 percent.
It is appropriate for people who want a hormone-free, on-demand method and do not want a daily medication or a procedure. It can be combined with condoms for higher efficacy and STI protection.
Trade-off: per-act dosing means it must be remembered every time, and the per-use cost adds up for sexually active users. Vaginal irritation or urinary tract infection is reported by some users.
Best for: people who want on-demand, hormone-free contraception and have infrequent or unpredictable need.
How to choose the right contraception method
Match the method to your cycle and routine. Daily pills require a daily reminder. IUDs and implants require almost nothing after insertion. Depo-Provera requires quarterly appointments. Phexxi requires action before each act. There is no objectively best option, only the one that matches the user's life.
Screen for contraindications first. Smoking, migraines with aura, clotting disorders, breast cancer history, and uncontrolled hypertension can rule out estrogen-containing methods. Your OB-GYN runs through this checklist before prescribing.
Decide hormone tolerance. Some users feel fine on any hormonal method. Others are sensitive to progestin or estrogen and feel better on Paragard or Phexxi. There is no way to predict this in advance, which is why reversibility matters.
Plan for the next 1 to 5 years. Trying to conceive soon makes a quarterly shot or long-acting method less ideal. Wanting a decade of coverage points to Paragard or Mirena.
This article is informational and does not replace clinical guidance. Always consult a board-certified OB-GYN or qualified prescriber before starting, switching, or stopping any contraceptive method. For related health-and-personal-care reading, see our contraceptive gel comparison and the full contraceptives overview. Our editorial approach is documented in our methodology.
Frequently asked questions
Which contraception method has the highest typical-use effectiveness?+
Long-acting reversible contraceptives (LARCs) lead the table. Hormonal IUDs like Mirena and Kyleena, the Paragard copper IUD, and the Nexplanon implant all sit above 99 percent typical-use effectiveness because there is nothing for a user to remember or skip. Pills, patches, and rings depend on consistent use and drop to roughly 91 percent in typical use because of missed doses. Phexxi vaginal gel is closer to 86 percent in typical use. Your OB-GYN can confirm which methods are medically appropriate for your history.
Is hormonal contraception safe for people over 35?+
It can be, but the risk profile shifts. Combined hormonal methods that contain estrogen carry a higher venous thromboembolism risk in people who smoke, have migraines with aura, or have a personal or family history of clotting disorders. Progestin-only options like the mini-pill, Mirena, Kyleena, Nexplanon, and the Depo-Provera shot are often preferred above 35, especially for smokers. This is exactly the conversation a board-certified OB-GYN should walk you through before any prescription decision.
How long does each method take to start working?+
Combined pills started on the first day of a period work immediately. Started later in the cycle, they need 7 days of backup. The Paragard copper IUD works immediately on insertion. Hormonal IUDs need 7 days unless inserted in the first 7 days of a cycle. Nexplanon needs 7 days unless inserted in the first 5 days. Depo-Provera needs 7 days unless given in the first 7 days. Phexxi works immediately when applied within 1 hour before sex.
Can I switch between contraception methods?+
Yes, and many people do across their reproductive years. Switching from a pill to an IUD, from an IUD to an implant, or from any hormonal method to a non-hormonal option like Paragard or Phexxi is routine. The transition usually involves a brief overlap or a short backup period to avoid a gap in coverage. Your prescriber maps this out based on the method you are leaving and the one you are starting.
Are non-hormonal options as effective as hormonal ones?+
Paragard, the copper IUD, is the standout non-hormonal option with over 99 percent typical-use effectiveness, comparable to hormonal IUDs. Beyond Paragard, non-hormonal effectiveness drops. Phexxi gel sits near 86 percent, condoms near 87 percent typical use, and fertility awareness methods vary widely with training. If hormone-free and high efficacy both matter, Paragard is the option to discuss with your OB-GYN.
Priya Sharma
Priya Sharma writes for The Tested Hub.