Birth Control Methods Counseling Tool

Other
 Contraception Title X Family Planning Program
Last Reviewed
Source
RHNTC
Save

This interactive counseling tool supports providers when having real-time conversations with clients about their contraceptive options. It provides multiple starting points to center a client’s preferences on what is most important to them in a birth control method and which options might feel right. Use the filters below to view birth control methods that align with the client’s preferences and priorities around effectiveness, how the method is used, how frequently the method is used, period changes, side effects the client wants to avoid, and other considerations. This tool provides new and additional information, including the non-contraceptive benefits of each method, beyond what can be found in the RHNTC’s Birth Control Methods Chart.  

As you use the tool, the list of methods will be ordered from most effective to least effective. Within a filter category (e.g., Use or Frequency), clicking multiple options adds more methods. Selecting options under multiple filter categories will limit methods shown. Note: The side effects filter does not limit results when more than one filter option is selected. 

This interactive counseling tool can be used in conjunction with the Birth Control Methods Chart and the accompanying Actual Size and Body Placement Charts during contraceptive counseling sessions with clients. Download these charts under Supplemental Materials.

Glossary and Filter Definitions

Glossary

Acronyms

  • Basal body temperature (BBT)
  • Estrone-3-glucuronide (E3G)
  • Fertility awareness-based methods (FABM)
  • Food and Drug Administration (FDA)
  • Luteinizing hormone (LH)
  • Sexual transmitted infection (STI)
  • Urinary tract infection (UTI)

Filter Definitions

  • Client Autonomy (Starting and Stopping a Method) 
    This filter helps clients identify methods that align with how much control they want over starting and stopping a chosen method. Client-led methods tend to have fewer side effects and require more frequent use, while provider-involved methods are the most effective and require little client action.
  • Effectiveness/Number of Pregnancies Expected
    This filter sorts methods by the number of pregnancies that occurred per 100 users in one year with typical use of the method. Most effective methods expect <1 pregnancy out of 100 users; moderately effective methods expect 1–7 pregnancies out of 100 users; less effective methods expect more than 8 pregnancies out of 100 users.
  • Use 
    This filter includes information on whether client action, an in-office visit, or surgical procedure is required.
  • Frequency 
    This filter includes how often a method should be used: with sex, daily, weekly, every 1–3 months, up to 5–12 years, or permanent.
  • Period Changes
    This filter includes the potential impact of a contraceptive on menstruation: no change, lighter period or spotting, or heavier period.
  • Potential Side Effects Client Wants to Avoid
    This filter includes common reactions to contraceptive methods and allows the client to select for methods based on potential side effects they wish to avoid.
  • Other Considerations 
    This filter includes a wide range of additional information that providers may find useful in counseling clients, including if the method can be used for emergency contraception or for extended cycling (skipping periods), does not contain hormones, is an FABM, affects the return to fertility after discontinuation, or if the method prevents STIs.
  • Privacy
    This filter includes information about whether a method can be used privately, could be found by a partner or someone else, or must be used with a partner. This information can improve counseling clients with privacy concerns or those facing reproductive coercion.
Additional Notes and Citations

The RHNTC drew inspiration from birth control charts from Partners in Contraceptive Choice and Knowledge (PICCK), Illinois Contraceptive Access Now (ICAN!), CAI’s “Your Body. Your Birth Control.”; as well as Power to Decide’s Bedsider tool, and UCSF’s Beyond the Pill Birth Control: What’s Important to You? Flip Chart when developing this interactive counseling tool.

Cason P, Cwiak C, Edelment A, et al.[Eds.] Contraceptive Technology. 22nd edition. Burlington, MA:Jones-Bartlett Learning, 2023.

Find a Birth Control Method

Filter Categories

Reset

Displaying 30 method(s).

Implant (progestin-only)

Client Autonomy (Starting and Stopping a Method): Requires provider for clients to start and stop (reversible methods).
Number of Pregnancies Expected: <1 out of 100
Use: Provider inserts rod under skin in upper arm.
Frequency: Up to 5 years
Period Changes: Unpredictable spotting, lighter period, or no period. Reduces painful menstrual periods.
Privacy: Most private. Not visible but can be felt in someone's arm.
Icon for implant (progestin-only)

Non-contraceptive benefits

May lower risk of diabetes and lower risk of insulin resistance and high cholesterol compared with baseline risk prior to implant use.

Potential Side Effects and Other Considerations

Side Effects: Acne, breast tenderness, headache, mood swings, stomach pain, weight gain
Other Considerations: Return to fertility may be delayed by up to 2 menstrual cycles after discontinuation. Mild pain with placement.

Levonorgestrel IUD (progestin-only)

Client Autonomy (Starting and Stopping a Method): Requires provider for clients to start and stop (reversible methods).
Number of Pregnancies Expected: <1 out of 100
Use: Provider inserts device into uterus.
Frequency: Up to 8 years
Period Changes: Spotting, lighter period, or no period. Reduces painful menstrual periods.
Privacy: Most private. Not visible. IUD strings might be felt by partner.
Icon for levonorgestrel iud (progestin-only)

Non-contraceptive benefits

Associated with reduced risk of endometrial cancer, and lower rates of ovarian cancer, pancreatic cancer, and lung cancer.

Potential Side Effects and Other Considerations

Side Effects: Acne, breast tenderness, hair loss, mood changes
Other Considerations: Return to fertility may be delayed by up to 2 menstrual cycles after discontinuation. Cramping pain with placement.

Non-hormonal copper IUD

Client Autonomy (Starting and Stopping a Method): Requires provider for clients to start and stop (reversible methods).
Number of Pregnancies Expected: <1 out of 100
Use: Provider inserts device into uterus.
Frequency: Up to 12 years. Studies have shown this product to be effective for up to 12 years, however duration beyond 10 years has not been approved by the FDA.
Period Changes: Spotting for 1–3 months after placement and heavier periods.
Privacy: Most private. Not visible. IUD strings might be felt by partner.
Icon for non-hormonal copper iud

Non-contraceptive benefits

Associated with lower rates of cervical cancer and reduced risk of endometrial cancer.

Potential Side Effects and Other Considerations

Side Effects: See "Period Changes" above.
Other Considerations: Immediate return to fertility after discontinuation. Cramping pain with placement. Effective as emergency contraception within 5 days of unprotected sex. Use of the non-hormonal copper IUD for emergency contraception has not been approved by the FDA.

Tubal ligation

Client Autonomy (Starting and Stopping a Method): Requires provider to perform procedure
Number of Pregnancies Expected: <1 out of 100
Use: Surgical procedure done at hospital
Frequency: Permanent
Period Changes: None
Privacy: Most private
Icon for tubal ligation

Non-contraceptive benefits

Associated with reduced risk of ovarian cancer. No need for partner compliance. Removal of contraceptive burden from the partner. Long-term cost-effectiveness. No need to buy anything. No need to interrupt sex.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Permanent contraception. Possible bleeding and surgical pain with procedure. Requires anesthesia and up to 2 weeks of recovery.

Vasectomy

Client Autonomy (Starting and Stopping a Method): Requires provider to perform procedure
Number of Pregnancies Expected: <1 out of 100
Use: Single outpatient surgical procedure
Frequency: Permanent
Period Changes: Not applicable
Privacy: Most private
Icon for vasectomy

Non-contraceptive benefits

No need for partner compliance. Removal of contraceptive burden from the partner. Long-term cost-effectiveness. No need to buy anything. No need to interrupt sex.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Permanent contraception. Possible bleeding and surgical pain with procedure. Up to 2 days for recovery.

Fertility awareness-based methods (FABM): Sensiplan Method

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 2 out of 100. Typical use pregnancy rates for FABMs are not definitive, and these rates should be interpreted with caution due to limitations of the evidence. There are only a few studies evaluating effectiveness of some FABMs, and for other FABMs there are no studies evaluating their effectiveness.
Use: Client tracks their menstrual cycle, cervical mucus, and basal body temperature (BBT) daily, and abstains from sex or uses an alternative method of contraception on fertile days. During the fertile window, secretions typically first appear scant, whitish in color, sticky, and thick, and then become abundant, clear, stretchy, and slippery. Ovulation is likely to occur 1 day before, during, or 1 day after the last day of abundant, clear, stretchy, slippery secretions. Take BBT using a basal thermometer (not a regular, fever-detecting thermometer) at the same time each day before getting out of bed and after 6 hours of uninterrupted sleep. When client records 3 continuous temperatures above baseline, they are no longer in the fertile window. Some clients observe a drop in BBT 12–24 hours before ovulation. Clients should be referred to a trained instructor to learn how to use the Sensiplan Method.
Frequency: Daily
Period Changes: None
Privacy: Moderately private. Someone could find the BBT thermometer.
Icon for fertility awareness-based methods (fabm): sensiplan method

Non-contraceptive benefits

With the information gained from regular tracking of fertility indicators, FABMs are an opportunity to learn about the body, menstrual cycle, and fertility. Better understanding one’s menstrual cycle may help with managing menstrual cycle symptoms, identifying irregularities, such as abnormal bleeding patterns, and monitoring health conditions such as polycystic ovarian syndrome.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Clients with irregular menstrual cycles may use observation of cervical secretions as a fertility indicator. May require negotiation with partner(s) to avoid sex or use an alternative method during the fertile window.

Shot intramuscular (DMPA-IM) progestin-only

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 4 out of 100
Use: Provider administers shot.
Frequency: Every 12–15 weeks
Period Changes: Spotting, lighter period, or no period. Decreases painful periods.
Privacy: Most private.
Icon for shot intramuscular (dmpa-im) progestin-only

Non-contraceptive benefits

In people with endometriosis, IM shot effectively decreases painful periods, nonmenstruation-related pelvic pain, and pain with sex. Decreased risk of new or recurrent uterine fibroid development. Decreased risk of ovarian and endometrial cancer.

Potential Side Effects and Other Considerations

Side Effects: Bone density loss, headache, weight gain
Other Considerations: Return to fertility may be delayed by up to 5–8 cycles upon discontinuation.

Shot subcutaneous (DMPA-SC) progestin-only

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 4 out of 100
Use: Client self-administers shot.
Frequency: Every 12–15 weeks
Period Changes: Spotting, lighter period, or no period. Decreases painful periods.
Privacy: Moderately private. Someone could find the shot or its packaging.
Icon for shot subcutaneous (dmpa-sc) progestin-only

Non-contraceptive benefits

In people with endometriosis, SC shot effectively decreases painful periods, nonmenstruation-related pelvic pain, and pain with sex. Decreased risk of new or recurrent uterine fibroid development. Decreased risk of ovarian and endometrial cancer.

Potential Side Effects and Other Considerations

Side Effects: Bone density loss, headache, weight gain
Other Considerations: Return to fertility may be delayed by up to 12 months. Stored at room temperature.

Opill (progestin-only pill)

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client takes by mouth at same time every day.
Frequency: Daily
Period Changes: Spotting or bleeding between periods
Privacy: Moderately private. Someone could find the pill or its packaging.
Icon for opill (progestin-only pill)

Non-contraceptive benefits

May reduce incidence of painful crises in people with sickle cell disease; may relieve pelvic pain associated with endometriosis; may reduce frequency and severity of migraines.

Potential Side Effects and Other Considerations

Side Effects: Acne, breast tenderness, headache, nausea, weight gain
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. Safe for people with high blood pressure, blood clot history, and those who cannot take estrogen. Available over the counter.

Patch (transdermal system estrogen + progestin)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client places patch on back, butt, or belly.
Frequency: Weekly
Period Changes: Temporary spotting or lighter period. Predictable scheduled bleeding. Decreases painful periods.
Privacy: Moderately private. Someone could find the patch or its packaging. Consider where to place on the body if privacy is a concern.
Icon for patch (transdermal system estrogen + progestin)

Non-contraceptive benefits

Decreases symptoms of endometriosis, period-related migraines, premenstrual symptoms; decreases endometrial and ovarian cancer risk, and risk of benign breast conditions. Improves acne and excessive hair growth, provides relief for hot flashes and other perimenopausal symptoms; increases bone mineral density in certain high-risk clients. Can be used by clients who cannot swallow a pill and by those with abnormal intestinal absorption.

Potential Side Effects and Other Considerations

Side Effects: Breast tenderness, headache, nausea, skin irritation, stomach pain
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. May be less effective in people with a body mass index of 30 or over. A new patch is applied every week. Extended/continuous use option. Use of this product for an extended duration has not been approved by the FDA.

Pill (drospirenone progestin-only, Slynd)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client takes by mouth at same time every day.
Frequency: Daily
Period Changes: May decrease spotting or bleeding between periods. May shorten duration of bleeding.
Privacy: Moderately private. Someone could find the pill or its packaging.
Icon for pill (drospirenone progestin-only, slynd)

Non-contraceptive benefits

May reduce incidence of painful crises in clients with sickle cell disease; may relieve pelvic pain associated with endometriosis; may reduce frequency and severity of migraines. Before periods, may result in decreased: water retention, weight gain, and breast tenderness.

Potential Side Effects and Other Considerations

Side Effects: Acne, breast tenderness, headache, nausea, weight gain
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. Safe for people with high blood pressure, blood clot history, and those who cannot take estrogen.

Pill (estrogen + progestin)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client takes by mouth daily.
Frequency: Daily
Period Changes: Temporary spotting or lighter period. Predictable scheduled bleeding. Decreases painful periods.
Privacy: Moderately private. Someone could find the pill or its packaging.
Icon for pill (estrogen + progestin)

Non-contraceptive benefits

Decreases symptoms of endometriosis, period-related migraines, premenstrual symptoms; decreases endometrial and ovarian cancer risk, and risk of benign breast conditions. Improves acne and excessive hair growth, provides relief for hot flashes and other perimenopausal symptoms; increases bone mineral density in certain high-risk clients.

Potential Side Effects and Other Considerations

Side Effects: Breast tenderness, headache, nausea, risk for blood clots
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. May reduce acne, cramping, and premenstrual symptoms. Routine blood pressure checks recommended. Extended/continuous use option.

Pill (norethindrone or norgestrel progestin-only, mini-pill)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client takes by mouth at same time every day.
Frequency: Daily
Period Changes: Spotting or bleeding between periods. May not have traditional withdrawal bleeding.
Privacy: Moderately private. Someone could find the pill or its packaging.
Icon for pill (norethindrone or norgestrel progestin-only, mini-pill)

Non-contraceptive benefits

May reduce incidence of painful crises in people with sickle cell disease; may relieve pelvic pain associated with endometriosis; may reduce frequency and severity of migraines.

Potential Side Effects and Other Considerations

Side Effects: Acne, breast tenderness, headache, nausea, weight gain
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. Safe for people with high blood pressure, blood clot history, and those who cannot take estrogen.

Ring – annual (estrogen + progestin)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client places ring into vagina.
Frequency: Monthly
Period Changes: Lighter period or temporary spotting. Predictable scheduled bleeding. Decreases painful periods.
Privacy: Moderately private. Not visible but may be felt by partners. Someone could find the ring or its packaging.
Icon for ring – annual (estrogen + progestin)

Non-contraceptive benefits

Decreases symptoms of endometriosis, period-related migraines, premenstrual symptoms; decreases endometrial and ovarian cancer risk, and risk of benign breast conditions. Improves acne and excessive hair growth, provides relief for hot flashes and other perimenopausal symptoms; increases bone mineral density in certain high-risk clients. Can be used by clients who cannot swallow a pill and by those with abnormal intestinal absorption.

Potential Side Effects and Other Considerations

Side Effects: Breast tenderness, nausea
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. May reduce acne, cramping, and premenstrual symptoms. Can be used concurrently with tampons. Can be removed for up to 2 hours in any 24-hour period without compromising effectiveness. One ring is used for up to 13 cycles (1 year). Extended/continuous use of this ring has not been studied.

Ring – monthly (estrogen + progestin)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 100
Use: Client places ring into vagina.
Frequency: Monthly
Period Changes: Lighter period or temporary spotting. Predictable scheduled bleeding. Decreases painful periods.
Privacy: Moderately private. Not visible but may be felt by partners. Someone could find the ring or its packaging.
Icon for ring – monthly (estrogen + progestin)

Non-contraceptive benefits

Decreases symptoms of endometriosis, period-related migraines, premenstrual symptoms; decreases endometrial and ovarian cancer risk, and risk of benign breast conditions. Improves acne and excessive hair growth, provides relief for hot flashes and other perimenopausal symptoms; increases bone mineral density in certain high-risk clients. Can be used by clients who cannot swallow a pill and by those with abnormal intestinal absorption.

Potential Side Effects and Other Considerations

Side Effects: Breast tenderness, nausea
Other Considerations: Return to fertility may be delayed 3–4 menstrual cycles upon discontinuation. May reduce acne, cramping, and premenstrual symptoms. Can be used concurrently with tampons. Can be removed for up to 2–3 hours in any 24-hour period without compromising effectiveness. A new ring is used with every cycle. Extended/continuous use option.

Fertility awareness-based methods (FABM): Marquette Model

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 2–7 out of 100. Typical use pregnancy rates for FABMs are not definitive, and these rates should be interpreted with caution due to limitations of the evidence. There are only a few studies evaluating effectiveness of some FABMs, and for other FABMs there are no studies evaluating their effectiveness.
Use: Client tracks their menstrual cycle and urinary hormones and abstains from sex or uses an alternative method of contraception on fertile days. To predict ovulation, use an ovulation test that monitors luteinizing hormone (LH). To identify the fertile days before ovulation begins, use a test that monitors LH and urine estrone-3-glucuronide (E3G), or use other indicators. Urinary LH rises 24–36 hours before ovulation begins. A rise in E3G, the urinary metabolite of estradiol, precedes the rise in LH. Clients should be referred to a trained instructor to learn how to use the Marquette Method.
Frequency: Daily
Period Changes: None
Privacy: Moderately private. Someone could find the LH and/or E3G test supplies.
Icon for fertility awareness-based methods (fabm): marquette model

Non-contraceptive benefits

With the information gained from regular tracking of fertility indicators, FABMs are an opportunity to learn about the body, menstrual cycle, and fertility. Better understanding one’s menstrual cycle may help with managing menstrual cycle symptoms, identifying irregularities, such as abnormal bleeding patterns, and monitoring health conditions such as polycystic ovarian syndrome.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. May require negotiation with partner(s) to avoid sex or use an alternative method during the fertile window.

Fertility awareness-based methods (FABM): Natural Cycles Method

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 6–7 out of 100. Typical use pregnancy rates for FABMs are not definitive, and these rates should be interpreted with caution due to limitations of the evidence. There are only a few studies evaluating effectiveness of some FABMs, and for other FABMs there are no studies evaluating their effectiveness.
Use: Client tracks their menstrual cycle and basal body temperature (BBT) and abstains from sex or uses an alternative method of contraception on fertile days. Client records daily BBT on a menstrual cycle chart or app to identify when ovulation happened and when the fertile window ended. Take BBT using a basal thermometer (not a regular, fever-detecting thermometer) at the same time each day before getting out of bed and after 6 hours of uninterrupted sleep. When client records 3 continuous temperatures above baseline, they are no longer in the fertile window. Some clients observe a drop in BBT 12–24 hours before ovulation. Clients should refer to specific instructions for the Natural Cycles Method.
Frequency: Daily
Period Changes: None
Privacy: Moderately private. Someone could find the BBT thermometer and menstrual cycle tracking documentation.
Icon for fertility awareness-based methods (fabm): natural cycles method

Non-contraceptive benefits

With the information gained from regular tracking of fertility indicators, FABMs are an opportunity to learn about the body, menstrual cycle, and fertility. Better understanding one’s menstrual cycle may help with managing menstrual cycle symptoms, identifying irregularities, such as abnormal bleeding patterns, and monitoring health conditions such as polycystic ovarian syndrome.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. May require negotiation with partner(s) to avoid sex or use an alternative method during the fertile window.

Condom (external)

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 13 out of 100
Use: Client rolls onto erect penis before sex.
Frequency: With sex
Period Changes: None
Privacy: Least private. Use with a partner. Someone could find the condom or its packaging.
Icon for condom (external)

Non-contraceptive benefits

Prevents STIs, easily and/or discreetly carried, widely available over the counter, low cost; for some, condoms may help prolong sex and also prevent premature ejaculation.

Potential Side Effects and Other Considerations

Side Effects: Allergic reaction, vaginal irritation
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Method prevents STIs. Requires a cooperative partner. Available over the counter.

Fertility awareness-based methods (FABM): Standard Days Methods

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 11–14 out of 100. Typical use pregnancy rates for FABMs are not definitive, and these rates should be interpreted with caution due to limitations of the evidence. There are only a few studies evaluating effectiveness of some FABMs, and for other FABMs there are no studies evaluating their effectiveness.
Use: Client tracks their menstrual cycle daily and abstains from sex or uses an alternative method of contraception on fertile days. Clients with cycles that are 26–32 days long should consider days 8–19 of the menstrual cycle as the fertile window. Clients should refer to specific instructions for the Standard Days Method.
Frequency: Daily
Period Changes: None
Privacy: Most private unless someone could find menstrual cycle tracking documentation.
Icon for fertility awareness-based methods (fabm): standard days methods

Non-contraceptive benefits

With the information gained from regular tracking of fertility indicators, FABMs are an opportunity to learn about the body, menstrual cycle, and fertility. Better understanding one’s menstrual cycle may help with managing menstrual cycle symptoms, identifying irregularities, such as abnormal bleeding patterns, and monitoring health conditions such as polycystic ovarian syndrome.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. This method is appropriate for clients with regular menstrual cycles that are 26–32 days long. May require negotiation with partner(s) to avoid sex or use an alternative method during the fertile window.

Fertility awareness-based methods (FABM): Two-Day Method

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 14 out of 100. Typical use pregnancy rates for FABMs are not definitive, and these rates should be interpreted with caution due to limitations of the evidence. There are only a few studies evaluating effectiveness of some FABMs, and for other FABMs there are no studies evaluating their effectiveness.
Use: Client tracks cervical mucus changes to identify the beginning and end of the fertile window, and abstains from sex or uses an alternative method of contraception on fertile days. Client observes vaginal secretions throughout the day, particularly before and after urination, and identifies changes that indicate fertility, such as the appearance of sticky, thick, clear, stretchy or slippery secretions. During the fertile window, secretions typically first appear scant, whitish in color, sticky, and thick, and then become abundant, clear, stretchy, and slippery. Ovulation is likely to occur 1 day before, during, or 1 day after the last day of abundant, clear, stretchy, slippery secretions. Clients should refer to specific instructions for the Two-Day Method.
Frequency: Daily
Period Changes: None
Privacy: Most private.
Icon for fertility awareness-based methods (fabm): two-day method

Non-contraceptive benefits

With the information gained from regular tracking of fertility indicators, FABMs are an opportunity to learn about the body, menstrual cycle, and fertility. Better understanding one’s menstrual cycle may help with managing menstrual cycle symptoms, identifying irregularities, such as abnormal bleeding patterns, and monitoring health conditions such as polycystic ovarian syndrome.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Clients with irregular menstrual cycles may use observation of cervical secretions as a fertility indicator. May require negotiation with partner(s) to avoid sex or use an alternative method during the fertile window.

Spermicidal contraceptive sponge

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 17 out of 100
Use: Client inserts into vagina before sex.
Frequency: With sex
Period Changes: None
Privacy: Moderately private. Someone could find the sponge or its packaging.
Icon for spermicidal contraceptive sponge

Non-contraceptive benefits

Easily and/or discreetly carried; sponge material absorbs ejaculate and may be less messy. Method may be difficult to access.

Potential Side Effects and Other Considerations

Side Effects: Vaginal irritation
Other Considerations: Immediate return to fertility after discontinuation. Pair with another method for back-up.

Diaphragm with spermicide

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 17 out of 100
Use: Client inserts into vagina with spermicide before sex. Must add more spermicide vaginally before each subsequent act of vaginal sex.
Frequency: With sex
Period Changes: None
Privacy: Moderately private. Someone could find the diaphragm, spermicide, or the packaging.
Icon for diaphragm with spermicide

Non-contraceptive benefits

Easily and/or discreetly carried; easy to clean, and silicone does not absorb odors; spermicide may provide additional lubrication; may be placed in advance so sex is not interrupted.

Potential Side Effects and Other Considerations

Side Effects: Allergic reaction, UTI, vaginal irritation
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Same device may be used for 2 years.

Condom (internal)

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 21 out of 100
Use: Client inserts into vagina before sex.
Frequency: With sex
Period Changes: None
Privacy: Least private. Use with a partner. Someone could find the condom or its packaging.
Icon for condom (internal)

Non-contraceptive benefits

Prevents STIs, easily and/or discreetly carried, can be placed up to 8 hours in advance, one size, no need for spermicide; can be used when external condoms cannot be used; has pleasure positive features (nitrile warms to body temperature and avoids cold shock associated with latex condoms; user can add more silicone-based, petroleum-based, or water-soluble lubricant as needed; internal and external rings of condom have been reported as sources of heightened sexual pleasure with use).

Potential Side Effects and Other Considerations

Side Effects: Allergic reaction, vaginal irritation
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Method prevents STIs. Requires a cooperative partner.

Vaginal contraceptive gel (Phexxi)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 21 out of 100
Use: Client inserts into vagina before sex.
Frequency: With sex
Period Changes: None
Privacy: Most private.
Icon for vaginal contraceptive gel (phexxi)

Non-contraceptive benefits

Easily and/or discreetly carried; easy to administer by individually wrapped prefilled single-use applicators; can be placed immediately before or up to 1 hour before sex so it is not interrupted; gel may provide additional lubrication; design of gel ensures less leakage and may make product less messy; does not contain nonoxynol-9 spermicide; can be initiated postpartum as soon as it is safe to resume vaginal sex.

Potential Side Effects and Other Considerations

Side Effects: Allergic reaction, UTI, vaginal irriration
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Can be used immediately before or up to 1 hour before sex. Additional application needed vaginally before each subsequent act of vaginal sex. May act as a lubricant for vaginal dryness.

Fertility awareness-based methods (FABM): Billings Ovulation Method

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 11–23 out of 100. Typical use pregnancy rates for FABMs are not definitive, and these rates should be interpreted with caution due to limitations of the evidence. There are only a few studies evaluating effectiveness of some FABMs, and for other FABMs there are no studies evaluating their effectiveness.
Use: Client tracks cervical mucus changes to identify the beginning and end of the fertile window, and abstains from sex or uses an alternative method of contraception on fertile days. Client observes vaginal secretions throughout the day, particularly before and after urination, and identifies changes that indicate fertility, such as the appearance of sticky, thick, clear, stretchy or slippery secretions. During the fertile window, secretions typically first appear scant, whitish in color, sticky, and thick, and then become abundant, clear, stretchy, and slippery. Ovulation is likely to occur 1 day before, during, or 1 day after the last day of abundant, clear, stretchy, slippery secretions. Clients should be referred to a trained instructor to learn how to use the Billings Ovulation Method.
Frequency: Daily
Period Changes: None
Privacy: Most private.
Icon for fertility awareness-based methods (fabm): billings ovulation method

Non-contraceptive benefits

With the information gained from regular tracking of fertility indicators, FABMs are an opportunity to learn about the body, menstrual cycle, and fertility. Better understanding one’s menstrual cycle may help with managing menstrual cycle symptoms, identifying irregularities, such as abnormal bleeding patterns, and monitoring health conditions such as polycystic ovarian syndrome.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Clients with irregular menstrual cycles may use observation of cervical secretions as a fertility indicator. May require negotiation with partner(s) to avoid sex or use an alternative method during the fertile window.

Cervical cap (FemCap)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 22–23 out of 100
Use: Client inserts into vagina with spermicide before sex. May be used for up to 48 hours for multiple sex acts without adding more spermicide.
Frequency: With sex
Period Changes: None
Privacy: Moderately private. Someone could find the cervical cap, spermicide, or its packaging.
Icon for cervical cap (femcap)

Non-contraceptive benefits

Easily and/or discreetly carried; easy to clean and silicone does not absorb odors; may be placed in advance so sex is not interrupted; compatible with silicone-based, petroleum-based, or water-soluble lubricants.

Potential Side Effects and Other Considerations

Side Effects: Allergic reaction, UTI, vaginal irriration
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Same device may be used for up to 2 years.

Withdrawal

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 20–25 out of 100
Use: Client ejaculates outside of and away from vagina.
Frequency: With sex
Period Changes: None
Privacy: Least private. Easier to use with partner’s help.
Icon for withdrawal

Non-contraceptive benefits

No cost, requires no devices, involves no chemicals, available in most situations.

Potential Side Effects and Other Considerations

Side Effects: None
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Requires a cooperative partner.

Spermicide

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 21–28 out of 100
Use: Client inserts into vagina before sex.
Frequency: With sex
Period Changes: None
Privacy: Least private. Easier to use with partner’s help.
Icon for spermicide

Non-contraceptive benefits

Easily and/or discreetly carried; readily available over the counter; may provide additional lubrication; can be placed immediately before or up to 1 hour prior to sex so it is not interrupted; can be used postpartum after bleeding has stopped.

Potential Side Effects and Other Considerations

Side Effects: Vaginal irritation
Other Considerations: Immediate return to fertility after discontinuation. Does not contain hormones. Pair with another method for back-up. Available over the counter.

Emergency contraceptive pill: Levonorgestrel 1.5 mg pill (Plan B)

Client Autonomy (Starting and Stopping a Method): Clients start and stop on their own.
Number of Pregnancies Expected: 7 out of 8 who would have become pregnant will not.
Use: Client takes by mouth one time.
Frequency: Within 5 days after sex
Period Changes: May induce spotting or period
Privacy: Moderately private. Someone could find the pill or its packaging.
Icon for emergency contraceptive pill: levonorgestrel 1.5 mg pill (plan b)

Non-contraceptive benefits

No non-contraceptive benefits identified.

Potential Side Effects and Other Considerations

Side Effects: Breast tenderness, dizziness, headache, nausea, stomach pain, tiredness, vomiting
Other Considerations: Immediate return to fertility upon discontinuation. Effective as emergency contraception within 5 days of unprotected sex. May be less effective in people over 165 pounds. Available over the counter.

Emergency contraceptive pill: Ulipristal acetate (ella)

Client Autonomy (Starting and Stopping a Method): Provider prescription to start; clients can stop on their own.
Number of Pregnancies Expected: 7 out of 10 who would have become pregnant will not.
Use: Client takes by mouth one time.
Frequency: Within 5 days after sex
Period Changes: Spotting or period at new time
Privacy: Moderately private. Someone could find the pill or its packaging.
Icon for emergency contraceptive pill: ulipristal acetate (ella)

Non-contraceptive benefits

No non-contraceptive benefits identified.

Potential Side Effects and Other Considerations

Side Effects: Dizziness, headache, nausea, stomach pain
Other Considerations: Immediate return to fertility upon discontinuation. Effective as emergency contraception within 5 days of unprotected sex. May be less effective in people over 194 pounds. Requires prescription.
Feedback icon

Share Your
Feedback

Did you find this resource helpful?