Men and women need to consider birth control if they want to avoid pregnancy. There are many options to consider. The choice of birth control changes depending on your circumstances. For example, if you are not monogamous you may need to consider more than one type of birth control that includes a condom (male or female) to avoid sexually transmitted infections (STIs). Here we will learn about the options based on the Tier. Tier refers to the effectiveness, where Tier one has the highest effectiveness and Tier 3 has the least.

Tier 1

Tier 1 options have the highest level of effectiveness with less than 1 pregnancy per 100 users over one year. These options include permanent sterility. Vasectomy for men and Tubal ligation or tubal occlusion for women. Either option blocks the sperm from reaching the ovaries/eggs. These methods require traditional in-person appointments. You must sign a consent to get sterility. The amount of time between signing the consent and the procedure varies but the minimum is 30 days. With a vasectomy, you must use another form of birth control for 3 months. Then the man provides a sample to make sure there is no sperm present.

Also in the Tier 1 category are Intrauterine Device (IUD) and implants such as Nexplanon. Nexplanon is effective for three years ( The Nexplanon is a simple procedure going in but, takes a little more time coming out. A local injection of numbing medicine is used to painlessly place the implant. A new implant can be placed the same day the old one is removed.

The IUDs are placed into the uterus and are good from 3-10 years, depending on the one you get. The copper IUD is the most affordable. It is good for 5-10 years depending on the model you get. There are no hormones in the copper IUD and, it must be placed during menses. The copper does not allow a fertilized egg to implant. Failure rate is 8 pregnancies per 1000 users. The downside is more days of bleeding and heavier bleeding. Once removed, conception is possible immediately.

The remainder of the IUDs are hormone-based, containing progesterone only. The Mirena and Kyleena are good for 5 years. Their failure rate is 2 pregnancies per 1000 users. The Jaydess is good for 3 years and has a failure rate of 4 pregnancies per 1000 users. These are hormone-based so the risk are irregular/unpredictable bleeding for the first 3-6 months.

Tier 2

Tier 2 has 4-7 pregnancies per 100 users in 1 year: Higher if used incorrectly. The Tier 2 options are the injectables, pills, patches, and ring. The only injectable available in the United States is Depo-Provera. Injections are repeated every 3 months. Birth control pills are convenient and can be prescribed through a virtual appointment. You must be either under 21, or have your pap up to date to have them virtually prescribed. Remember to take it at the same time every day for the best effectiveness. Also, there are some pills that allow you to adjust your menses to every 3 months.

You place the patch and ring yourself. They must be replaced on time to maintain effectiveness. As a provider, I have seen the popularity of the ring increase. Women like the option of choosing when they have their periods, which is an option with the ring. A risk of the patch is if you swim, sweat a lot, and jacuzzi or tub frequently.

Tier 3

The third Tier is the least effective. The failure rate is more than 13 pregnancies per 100 users in 1 year. Tier 3 options include the male condom, fertility awareness-based methods, diaphragm, sponge, spermicides, female condom, and withdrawal. Each of the Tier 3 methods is over the counter; if not taken correctly the effectiveness decreases.

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Sharon Zell NP