Intrauterine contraceptives (IUCs) are long-acting reversible contraceptive (LARC) methods that are used by over 150 million women worldwide. They are the most effective forms of birth control available. IUCs are small T-shaped devices that are inserted in the uterus by a health care provider in a clinic. There are two types of intrauterine contraception: the Copper intrauterine device (copper IUD) and the levonorgestrel-releasing intrauterine system (hormonal IUD), which contains a progestin.

Pros:

• Highly effective
• Reversible, safe and cost-effective
• Long term, forgettable and invisible
• May be suitable for women who cannot take estrogen
• May be suitable for breastfeeding women
• Reduces risk of endometrial cancer
• May be used as emergency contraception within 7 days of unprotected sex
• Does not contain hormones

Cons:

• Initially, irregular bleeding or spotting may occur
• Potentially high upfront costs
• Some pain or discomfort during insertion
• Rare risks with the insertion could include infection, perforation of the uterus, or expulsion of the IUC
• May increase menstrual flow and cramps
• May increase pain during periods
• Does not protect against STIs

Male sterilization by vasectomy is a permanent surgical procedure to close or block the vas deferens (the tubes that carry sperm to the penis). Since it is permanent, this option is especially for those who have decided that their family is complete or that they don’t want to have children. Compared to tubal ligation, vasectomy is safer, more effective, less expensive, and less invasive.

Pros:

• Safe and highly effective
• Long-lasting – permanent
• Simple procedure, no follow up required (aside from sperm analysis)
• Does not interfere with sex
• No hormones
• Discreet and cost-effective
• Does not affect sexual function
• Less invasive and fewer complications than female sterilization
• No significant long-term side effects
• Allows the male partner to assume some responsibility for contraception

Cons:

• Permanent and irreversible
• Risk of having regrets later on
• Not effective immediately – must use another contraception method for 3 months and do a follow-up sperm analysis that shows no sperm are present in the semen
• Possible short-term surgery-related complications: pain, bleeding, vasovagal reaction, infection at the incision site, bruising and swelling of the scrotum
• Rarely, the vas deferens could reconnect by themselves
• Does not protect against STIs

Female sterilization by tubal ligation is a permanent surgical procedure where the two fallopian tubes, which transport the eggs from the ovaries to the uterus, get disconnected. Tubal ligation is considered permanent, because reversal is costly, difficult, and not guaranteed.

Pros:

• Safe and highly effective
• Long-lasting – permanent
• Simple procedure
• Does not interfere with sex
• Does not affect sexual function
• Discreet and cost-effective
• No hormones
• May reduce the risk of ovarian cancer

Cons:

• Permanent and irreversible
• Risk of having regrets later on
• Possible short-term surgery-related complications: pain, bleeding, infection at the incision site, trauma to adjacent organs in the abdomen
• Risk of ectopic pregnancy if failure occurs
• Follow-up may be required (x-ray)
• Rarely, the fallopian tubes could reconnect by themselves
• Does not protect against STIs

Male condoms are inexpensive, readily available without a prescription, and used only at the time of sexual activity. They are worn over the penis during sexual intercourse or oral sex and they come in a variety of sizes, thinness, textures, and colours/flavours. They are also available with a wide selection of lubricants on the condom to help enhance sensitivity and pleasure for both partners (i.e. warming/tingling sensations, premium silicone-base, climax-control).

Most condoms are made of latex, but non-latex condoms are also available in polyurethane and polyisoprene. Latex, polyurethane and polyisoprene condoms are also effective for preventing most sexually transmitted infections (STIs).

Pros:

• Widely available without a prescription
• Inexpensive, safe and effective
• Protect against most STIs
• Non-latex options available for those with latex allergies or sensitivities
• Both partners participate in their use – shared responsibility
• Hormone-free
• May decrease the risk of cervical cancer
• May help the wearer avoid premature ejaculation
• May be used with other contraception methods to increase their contraceptive effectiveness

Cons:

• Must be available at time of sexual activity
• Must be stored and handled properly – be sure to check the expiration date
• May reduce sexual spontaneity
• May slip or break during intercourse
• May reduce sensitivity for either partner
• May interfere with the maintenance of an erection
• People with latex allergies or latex sensitivity cannot use latex condoms, but may be able to use non-latex condoms
• Requires participation of both partners

The female condom is a soft, loose-fitting, seamless nitrile polymer sheath containing two flexible rings, one at each end. It is inserted into the vagina before sex and works by holding in the sperm, preventing it from entering the vagina.

Pros:

• Protects against most STIs
• The woman has control and autonomy in placing the condom
• Can be used by people with latex allergies
• Can be used with oil-based lubricants
• Male partner may find it more comfortable and less constricting than male condoms
• The internal and external rings of the female condom may increase sexual stimulation
• Available at pharmacies without a prescription

Cons:

• Some women may have trouble inserting it correctly
• More expensive than male condoms
• Potential challenges include slippage and breakage
• The rings on the female condom may cause discomfort during sex
• Female condoms maybe noisier than male condoms during sex

The diaphragm is a cap, made of latex or silicone and nylon, that covers the cervix and prevents sperm from entering. The diaphragm should always be used with a water-based gel after each act of intercourse to immobilize or kill sperm.

Pros:

• No hormones
• Can be used by women who are breastfeeding
• The diaphragm is one size and fits most women
• Available at pharmacies without a prescription

Cons:

• Higher failure rate compared to other types of contraception
• Increased risk of recurrent urinary tract infections
• Increased risk of toxic shock syndrome
• Some women may have trouble inserting it correctly
• Water-based gel must be reapplied after each act of intercourse
• A latex or silicone allergy may prevent some women from using some types of diaphragms. There are latex and silicone free options available.
• Does not protect against STIs

The cervical cap is a deep silicone cap that fits against the cervix and prevents sperm and bacteria from entering.

Pros:

• No hormones
• Can be used by women who are breastfeeding
• Available in three different sizes

Cons:

• Higher failure rate compared to other types of contraception
• Increased risk of recurrent urinary tract infections
• Increased risk of toxic shock syndrome
• Some women may have trouble inserting it correctly
• Gel must be reapplied after each act of intercourse
• A poor fit or silicone allergy will prevent some women from using the cap
• Does not protect against STIs

The contraceptive sponge is a small, disposable, polyurethane foam device that is placed in the vagina. It fits over the cervix to provide a physical barrier to prevent sperm from entering. The sponge also contains a spermicide, which helps to absorb and trap sperm.

Pros:

• It offers a barrier method and spermicide in one
• Provides 12-hour protection, and doesn’t need to be replaced for repeated sex during this time
• Enhances the effectiveness of other forms of contraception such as condoms
• No hormones
• Available at pharmacies without a prescription

Cons:

• Increases the risk of vaginal and cervical irritation or abrasions, which increases the risk of transmission of HIV
• Some women may have trouble inserting it correctly
• Higher failure rate compared to other types of contraception
• Does not protect against STIs

A chemical called nonoxynol-9 comes in the form of cream (only for use with diaphragms), gel, foam, film, or suppository. By inserting spermicide in front of the cervix, in the vagina, it destroys sperm on contact. Spermicides should be used along with another method of contraception, such as a condom, because alone they are not highly effective.

Pros:

• No hormones
• When used with another barrier method, effectiveness increases
• May also protect against bacterial infections and pelvic inflammatory disease

Cons:

• Not highly effective
• Using spermicide can be messy
• Must be inserted right before sex, because it’s only effective for one hour
• May irritate the entrance of the vagina or the tip of the penis
• May increase the risk of HIV transmission
• Does not protect against STIs

Pros:

• It is considered a natural method
• Safe and convenient
• No cost
• No hormones
• It is immediate for partners who have entered into a sexual act without having an alternative method
• No consultation or prescription required

Cons:

• It’s not easy, it takes a lot of self-control
• It is a risky practice – even if a man pulls out in time, pregnancy can still happen
• Does not protect against STIs

Pros:

• Safe
• No side effects
• Little cost
• These methods are considered natural
• No hormones
• Allows you to learn about your own body

Cons:

• This method is the least effective in preventing pregnancy
• Requires a lot of practice to learn how to use this method correctly
• It can be tricky, because not all menstrual cycles are regular
• Can be challenging to avoid sex at certain times
• Requires both partners to be fully committed to using the method
• Does not protect against STIs

Pros:

• Theoretically the most effective method of contraception
• Safe and no cost
• No side effects

Cons:

• Can be challenging over time
• Partners are unprepared if a change of mind suddenly occurs
• Requires both partners to be fully committed to using the method

Pros:

• It is a natural way to prevent pregnancy after giving birth
• Safe and convenient
• No cost
• Breastfeeding has many other advantages for the mother and the baby

Cons:

• Effectiveness is limited to only 6 months following childbirth
• Breastfeeding may reduce vaginal lubrication when a woman is having sex
• Does not protect against STIs

Intrauterine contraceptives (IUCs) are long-acting reversible contraceptive (LARC) methods that are used by over 150 million women worldwide. They are the most effective forms of birth control available. IUCs are small T-shaped devices that are inserted in the uterus by a health care provider in a clinic. There are two types of intrauterine contraception: the Copper intrauterine device (copper IUC) and the levonorgestrel-releasing intrauterine system (hormonal IUC), which contains a progestin.

Pros:

• Highly effective, reversible and safe
• Long term, forgettable and invisible
• Cost-effective
• May be suitable for women who cannot take estrogen
• May be suitable for breastfeeding women
• Reduces risk of endometrial cancers
• A minimal amount of hormones is absorbed in your blood
• May reduce menstrual flow and cramps
• May lead to absence of period
• Regulates menstrual cycle
• Improves symptoms of endometriosis

Cons:

• Initially, irregular bleeding or spotting may occur
• Potentially high upfront costs
• Some pain or discomfort during insertion
• Rare risks with the insertion could include infection, perforation of the uterus, or expulsion of the IUC
• Some women may experience hormonal side effects: acne, headaches, breast tenderness, mood issues
• Irregular periods, light or no menstrual periods – which some think of as an advantage, others as a disadvantage
• Does not protect against STIs

Injectable contraception, also known as the birth control shot, is a highly effective and reversible method of contraception. The injection contains a progestin, but does not contain estrogen. It is administered four times a year, so it may be a good choice for women who have trouble following a daily, weekly, or monthly routine.

Pros:

• Highly effective and long lasting
• Reversible
• Safe, convenient and discreet
• Does not interfere with sex
• Effectiveness is not affected by most medications
• May be suitable for women who cannot take estrogen
• May be suitable for breastfeeding women
• May be suitable for women over the age of 35 who smoke
• Reduces or eliminates periods
• Reduces menstrual cramps and PMS
• Reduces the risk of endometrial cancer and fibromas
• May improve symptoms of endometriosis and chronic pelvic pain
• May decrease the incidence of seizures in women who have epilepsy

Cons:

• Initially, irregular bleeding is the most common side effect
• Less/lighter bleeding, to no periods
• Heavier and more frequent bleeding, including spotting in between periods
• Causes a decrease in bone mineral density which may return to normal when a woman stops using the injection
• May be associated with a change of appetite and/or weight gain in some women
• Some women may have hormonal side effects: acne, headaches, breast sensitivity, mood issues/depression and a change in sex drive
• It can take a longer time to get pregnant after getting your last shot. For some, it can be approximately 6 to 10 months after the last injection for the ovaries to start releasing eggs again
• Must be administered by a health care provider every 3 months
• Does not protect against STIs

The vaginal ring is a soft, flexible, clear plastic ring that measures 54 mm in diameter and is inserted into a woman’s vagina where it slowly releases the hormones, estrogen and progestin, for three weeks.

Pros:

• Highly effective, reversible and safe
• May reduce menstrual flow and cramps
• Regulates menstrual cycle
• Decreases premenstrual symptoms
• Reduces the risks of endometrial, ovarian and colon cancers
• Reduces the risk of fibroids and ovarian cysts
• Does not have to be remembered each day

Cons:

• May cause irregular bleeding or spotting
• May cause breast tenderness, nausea, or headaches
• May cause vaginal irritation, discomfort, or discharge
• Requires remembering to change the ring once per month
• May increase the risk of blood clots, particularly in women who have certain blood disorders or a family history of blood clots
• Does not protect against STIs

The contraceptive patch is a contraception method that has been available in Canada since January 2004. It is a 4 x 4 cm beige patch that sticks to a woman’s skin and continuously releases the hormones estrogen and progestin into the bloodstream.

Pros:

• Highly effective, reversible and safe
• Does not interfere with sex
• May reduce menstrual flow and cramps
• Regulates menstrual cycle
• Decreases premenstrual symptoms
• Reduces the risks of endometrial, ovarian and colon cancers
• Reduces the risk of fibroids and ovarian cysts

Cons:

• May cause irregular bleeding or spotting
• May cause breast tenderness, nausea, or headaches
• May cause skin irritation
• May be less effective in women who weigh more than 90 kg
• May increase the risk of blood clots, particularly in women who have certain blood disorders or a family history of blood clots
• Does not protect against STIs

The oral contraceptive pill, also known as birth control pill, is suitable for most healthy women, regardless of age, and can be used long-term. It is one of the world’s most prescribed medications – over 100 million women across the globe rely on it. There are two kinds of oral contraceptives, the combined oral contraceptive (COC), which contains both estrogen and progestin, and the progestin-only contraceptive (POP). The Pill is available at pharmacies but requires a prescription.

Pros:

• Highly effective
• Reversible
• Does not interfere with sex
• May reduce or eliminate menstrual flow and cramps
• Regulates menstrual cycle
• Decreases premenstrual symptoms
• Decreases acne
• Decreases body and facial hair growth
• Reduces the risks of endometrial, ovarian and colon cancers
• Reduces the risk of fibroids and ovarian cysts
• May reduce perimenopausal symptoms

Cons:

• Effectiveness may be reduced by other medications
• May cause irregular bleeding or spotting
• May cause breast tenderness, nausea, or headaches
• Must be taken every day, at the same time
• May increase the risk of blood clots, particularly in women who have certain blood disorders or a family history of blood clots
• Should not be used by women over the age of 35 who smoke
• Does not protect against STIs

The oral contraceptive pill, also known as birth control pill, is suitable for most healthy women, regardless of age, and can be used long-term. It is one of the world’s most prescribed medications – over 100 million women across the globe rely on it. There are two kinds of oral contraceptives, the combined oral contraceptive (COC), which contains both estrogen and progestin, and the progestin-only contraceptive (POP). The Pill is available at pharmacies but requires a prescription.

Pros:

• Highly effective
• Reversible
• Does not interfere with sex
• May reduce or eliminate menstrual flow and cramps
• Regulates menstrual cycle
• Decreases premenstrual symptoms
• May be suitable for women who cannot take estrogen
• May be suitable for breastfeeding women
• May be suitable for women over 35 years old who smoke

Cons:

• Effectiveness may be reduced by other medications
• May cause irregular bleeding or spotting
• May cause breast tenderness, nausea, or headaches
• Must be taken every day, at the same time
• Some women may have hormonal side effects: acne, headaches, breast sensitivity, mood issues
• Does not protect against STIs

The contraceptive implant is a contraceptive method that was approved for use in Canada in May 2020. It has been used in many other countries, including the United States, for many years. It is a 4cm long and 2mm wide flexible rod that sits just below the skin and continuously releases a progestin hormone into the bloodstream. It is inserted in the office by a health care provider using local anaesthetic to numb the skin and provides reversible and highly effective birth control for up to three years by preventing ovulation.

How does it work?

• The implant is placed by a health-care professional in the upper inner arm just below the skin. The procedure is fairly simple and takes only a few minutes. It is done using local anaesthesia (“freezing”) to numb the skin. Once it is placed, the implant is not visible but can be felt just under the skin. The implant provides highly effective birth control for up to three years. At that time, the implant can either be removed or replaced.
• The progestin hormone prevents the ovaries from releasing an egg. It also thickens the cervical mucus making it difficult for sperm to reach the egg.

How effective is it?

Pros:

• Highly effective
• Reversible
• Long term, forgettable, and discreet
• Cost effective
• Safe
• Does not interfere with sex
• May be suitable for women who cannot take estrogen
• May be suitable for breastfeeding women
• May be suitable for women over the age of 35 who smoke
• Reduces menstrual cramps and PMS
• Reduces or eliminates periods

Cons:

• Initially irregular bleeding is the most common side effect
• Some women may have hormonal side effects: acne, headaches, breast sensitivity, mood issues
• Does not protect against STIs
• Some pain or discomfort during insertion
• After insertion there may be some soreness or bruising of the upper arm