I remember the day of my wedding…when I started feeling my contraception ring coming out of my vagina. I had only recently started using the ring even though I was more used to taking the pill. There I was in the bathroom stall with one of my bridesmaids, and she was literally helping to guide my ring back up into my vagina because I could feel it slipping out of me. Although quite embarrassing, let's just say that we're forever bonded by that experience. So, have you ever tried a new birth control method that wasn't the best for you but it seemed to work well for others?
During a recent interview with Board Certified Obstetrician & Gynecologist, Dr. Chimsom Oleka, she provided a list of all of the birth control methods currently available, which can potentially serve as a starting point for those of you who may be exploring new contraceptive methods.* As you continue reading, you'll notice that the list is organized based on what Dr. Oleka refers to as Short-acting (hormonal and non-hormonal), to Long-acting, to Barriers of Protection.
Before we dive into the list, let's first clarify specifically what birth control does. As. Dr. Oleka explained, for most methods, birth control releases certain hormones in your body which contributes to the ultimate end goal: block ovulation or keep an egg from being released, thicken the mucus in the cervix so that sperm can't pass through, and/or thin the lining of the uterus, which decreases chances of implantation. Each birth control method is designed to do each or all of these things, but depending on the method, they will either do them better, worse, or not at all.
Choosing The Best Birth Control Method For You
SHORT-ACTING BIRTH CONTROL METHODS
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Note: Throughout this section, you will notice references related to "continuous" or "extended" usage. As Dr. Oleka explained, many of us have a false idea of what the period is supposed to do. Contrary to popular belief in terms of what our menstrual cycle does and why it's "necessary" every month, ultimately its main purpose is for pregnancy. That's it.
As Dr. Oleka expertly pointed out, "It's the birth control's period, not your period. Your birth control will start stimulating the lining and doing all of the things that cause you to bleed." So, as long as you have a hormone that's assisting with protecting and keeping your uterus lining thin, and as long as you've consulted your physician beforehand, then you don't have to necessarily worry about shedding the lining every month (i.e. having a period).
Consider, for example, women who have bleeding disorders (i.e. their bodies bleed too much or won't stop bleeding), female athletes, as well as those who may suffer with things such as menstrual migraines…situations like these support the case for continuous or extended methods.
Method: Birth Control Pill (Hormonal - Estrogen and Progesterone)
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How It's Administered: Self-ingested orally, daily
Efficacy: 7 to 9% failure rate (i.e., approximately 1 in 10 will get pregnant)
Description & Overview:
Birth control pills usually come in 28-day pill packs (four rows of seven pills) including a week of placebo, non-active pills. There are different variations as well, but it's critical that you take it every day at the same time.
The most commonly used pill has both estrogen and progesterone. With estrogen, it tends to help provide more stability of the lining. However, some people may not want estrogen or they may have an underlying medical issue that conflicts with the estrogen. There is a risk of blood clots, although fairly low, but the risk of this goes up when you're pregnant. With the pill, it helps regulate the bleeding, which in turn, helps make it predictable. It's known to have protective benefits such as helping to decrease risk of certain cancers and it can help reduce symptoms related to fibroids.
Also, you can use this method, as well as other methods, continuously or in an extended way so that you can delay or skip the bleeding (i.e. going on vacation). For example, if you wanted to try an extended use, then you could delay the withdrawal bleeding (period) for a set number of weeks or months by skipping the last row for let's say two months. Then, you would take the last row of inactive pills the third month, so that you would only bleed approximately every 10 weeks.
On the other hand, if you're someone who decides "I don't want to bleed at all," then you could skip the last row of inactive pills and move forward with starting the new pack each month. Keep in mind, if you don't bleed or you bleed too heavily already, there may be other medical issues going on, so as always, you'll want to consult your physician about this.
Side effects can vary, but some of the most common side effects include: nausea, breast tenderness, and initial irregular bleeding.
Method: Birth Control Pill (Hormonal - Progesterone Only)
How It's Administered: Self-ingested orally, daily
Efficacy: 7 to 9% failure rate
Description & Overview:
This method basically works pretty much the same as the first pill mentioned above, but it doesn't include estrogen. It only includes progesterone.
Progesterone-only pills can be harder for some women to use because you have to be really consistent. If the daily pill ingestion time is missed by as little as three hours, then it loses its efficacy. Hence, it's critical that you take the pill every day at the same time.
With the progesterone-only pill, there's also a greater chance of irregular bleeding. Hence, this method is usually recommended by the physician if there are estrogen-related conflicting medical issues.
Method: Vaginal Ring (Hormonal – Estrogen and Progesterone)
Michael Kraus/Shutterstock
How It's Administered: Self-inserted through Vagina
Efficacy: 7 to 9% failure rate
Description & Overview:
The vaginal ring is a soft, flexible ring approximately two inches wide and four centimeters thick that is self-inserted and removed in/out of the vagina. Some women will tie a string to the ring and there's also an applicator that can be used to assist with insertion and removal.
The vaginal ring stays in for three weeks and releases hormones every day. Once removed for seven days, it allows withdrawal bleeding (period) to occur. Then, a new ring is inserted every four weeks. This method can be used continuously if you bypass the seven days and move forward with inserting the new ring every three or four weeks, or in an extended way if you bypass the seven days every few months or so.
The ring has been known to cause breakthrough or irregular bleeding. Not to mention, there are times when the ring can slip out during sex, which of course can directly impact the efficacy.
Method: Progesterone-Only Shot (Hormonal - commonly referred to as “Depo”, short for Depo Medroxyprogesterone Acetate)
How It's Administered: Injected in arm by physician
Efficacy: 6% failure rate
Description & Overview:
The progesterone-only shot is usually injected every three months (or every 11 to 13 weeks). Although the failure rate is approximately 6%, that's also related to the fact that patients are late with getting their scheduled shot.
Depo is known to decrease bone mineral density (contributes to the risk of fractures) within the first two years, but you start to recover it within 30 months after you stop taking it.
Also, because the shot can linger in your system up to nine months after your last shot (not the efficacy), it has the propensity to delay the return to your normal fertility state.
Some of the most common side effects include weight gain with research showing that it can act as an appetite stimulant.
Method: The Patch (Hormonal – Estrogen and Progesterone)
Michael Kraus/Shutterstock
How It's Administered: Self-adhesive
Efficacy: 7 to 9% failure rate
Description & Overview:
The patch is a small, square-shaped band-aid like adhesive or patch that can be applied to your upper arm, abdomen, or butt. You receive a new patch every three weeks and the fourth week is when you're patch free to allow for withdrawal bleeding.
This method is not recommended for extended or continuous cycles like with the pill and ring because it has higher levels of estrogen, which means increased risk for blood clots. Also, if you have sensitive skin or you're prone to breakouts and rashes, then you may want to avoid this method as well.
The patch can cause irregular or breakthrough bleeding or no bleeding at all depending on the individual. During the first few months of use, you may experience that as well as nausea, but it usually improves over time.
Method: Family Planning (Non-hormonal)
How It's Administered: N/A - Personal planning and scheduling
Efficacy: Up to 40% failure rate
Description & Overview:
There are a variety of options as it relates to family planning including: use of calendars, basal body temperature, cervical mucus, and more. There are a lot of useful tracking apps that can help with these methods as well.
Family planning can be taught and is a pretty well-accepted method. However, it can only be used if you have a regular cycle. Also, it has a very high failure rate because it requires extensive tracking and managing certain records such as time, ovulation, and temperature. So, you have to be extremely detailed-oriented, organized, and highly motivated to be successful with family planning. Otherwise, it can be extremely overwhelming for some people.
Due to the excessive planning and stringent scheduling, it can potentially decrease sexual spontaneity and/or convenience.
LONG-ACTING BIRTH CONTROL METHODS
Method: IUD (Hormonal - Progesterone Only)
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How It's Administered: Inserted vaginally by physician (through opening of cervix, into the uterus)
Efficacy: Less than 1% failure rate
Description & Overview:
The IUD has varying brands (Mirena has been around the longest), costs, and dosages. The IUD is a small, t-shaped plastic piece, approximately 3 cm in size, although the size can vary as well. In addition to women who have had children, the IUD can be used in teenagers as well as women who have not have had babies.
Remember, this is a longer-acting method, so this is ideal for someone who wants to hold off on having children for a longer period of time.
Some of the most common side effects include insertional discomfort (I'm a personal witness to this) and irregular bleeding although it tends to help those who suffer from painful periods and heavy flow. The longer you leave it in, the less likely you'll bleed.
Method: Copper IUD (Non-hormonal)
How It's Administered: Inserted vaginally by physician (through opening of cervix, into the uterus)
Efficacy: Less than 1% failure rate
Description & Overview:
Similar to the IUD previously mentioned, the copper IUD is a latex-free, t-shaped, plastic piece but it also includes areas of exposed copper. By releasing copper salts into your body, the copper tricks the uterus into thinking something foreign is inside, creating an appearance of a "chaotic" environment in your system, which ultimately blocks sperm and prevents reproduction. It can last for 10 years, but it has been known to be effective for up to 12 years.
The copper IUD is ideal for someone who doesn't want to deal with hormones, or someone who is certain they don't want children for a long time. There are instances where it can be used as emergency contraception but it won't work if something has already been implanted.
Because this method doesn't affect ovulation, this method is also ideal for women who want to continue bleeding or women within certain cultures where the idea of contraception isn't readily accepted. This can serve as contraception method without anyone else truly knowing that you're taking it because you will still have a period as normal.
The most common side effects usually include more painful cramping or heavier bleeding.
Method: Contraceptive Implant (Hormonal – Progesterone Only)
Michael Kraus/Shutterstock
How It's Administered: Implanted in arm by physician
Efficacy: Less than 1% failure rate (the most effective method)
Description & Overview:
The contraceptive implant is a flexible, plastic rod that's placed inside the upper arm. It's small and thick - approximately 4 cm long and 2 mm thick. It releases hormones daily, and lasts for three years, although recent data shows it may last longer than that. After three years, you get a new one if you choose to do so. Otherwise, you will return back to your baseline fertility.
Some of the most common side effects can include irregular bleeding, no bleeding (approximately 6%), or heavier bleeding. For those who experience irregular bleeding, there are ways to decrease it and make it more manageable. Also, there are rare occasions where, if placed improperly, it can shift or migrate.
BARRIERS OF PROTECTION** BIRTH CONTROL METHODS
The most common effects for any of the following methods can include vaginal discharge and irritation. After the use of these, the return to fertility is usually fairly quick.
As it relates to a lot of these barriers of protection, Dr. Oleka likes to think of it this way, "Condoms should be used more so for STD and HIV/AIDS protection, and less for pregnancy prevention." Nevertheless, they are still considered methods for both pregnancy and STD/HIV prevention.
Method: Male Condom (Non-hormonal)
Michael Kraus/Shutterstock
How It's Administered: Applied by male on his penis
Efficacy: 15% failure rate (research across the board states this although it seems quite questionable by both the expert and the writer)
When to Apply: Right before sex
Description & Overview:
Condoms are usually latex or you can opt for lambskin if you're allergic to latex. However, anything non-latex has been known to be less effective in preventing pregnancy as well as STDs. With condoms, common things like inconsistent use, slippage during sex, and the risk of it tearing are a few factors that can directly impact the overall efficacy.
Method: Female Condom (Non-hormonal)
How It's Administered: Self-inserted vaginally
Efficacy: 21% failure rate
When to Apply: Right before sex
Description & Overview:
Similar to the male condom, the female condom has a thick ring that's used for placement within the vagina along with the pouch that goes in when it's time to have sex. There's also a thin ring that goes outside of the vagina. With this method, proper placement is just as important because it helps prevent condom slippage during sex. Also, the male condom should not be used when the female condom is used because it can cause tearing.
Method: Diaphragm
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How It's Administered: Self-inserted vaginally
Efficacy: 16% failure rate
When to Apply: Up to six hours before sex.
Description & Overview:
The Diaphragm is reusable silicon disk that's self-inserted through the vagina. Similar to the cervical cap, it should be inserted up to six hours before you have sex and should remain in your vagina at least six hours after sex. A spermicide should also be used in conjunction with the diaphragm to help ensure efficacy. It's also possible for the diaphragm to become dislodged during sex.
Method: Cervical Cap (Non-hormonal)
How It's Administered: Self-inserted vaginally
Efficacy: 14 to 20% failure rate
When to Apply: Up to six hours before sex
Description & Overview:
The cervical cap is a reusable silicone rubber cup that sits on the cervix while you're having sex. Think of it as a "hat" that comes in different sizes and sits on your cervix. It's usually inserted into the vagina up to six hours prior to sex, it should remain in there for at least six hours after sex (and can remain there up to 48 hours). Of note, it only works if used with a spermicide. There's usually only one brand available in the United States.
One thing to consider is proper placement of the cap, and making sure you're comfortable with putting it in your vagina. Also, if you've already had a baby, then you'll have a higher risk of contraception failure.
Additionally, here are a few things Dr. Oleka suggests women should consider before choosing a contraceptive:
- What are your chances of getting pregnant with this method (efficacy)?
- What do you want your bleeding profile to look like (i.e. how often do you want your "withdrawal bleeding" or menstrual cycle to occur)? How will this affect my bleeding profile?
- What does your lifestyle look like (i.e. will it be difficult to remember to take the pill every day versus another option that may not require as much involvement)?
- What are your priorities? What does the timeline for trying, starting, or growing your family look like?
- How long do you want it to be in effect or control?
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As always, Dr. Oleka reminds everyone to be sure and consult your physician* when deciding on a method because hormones affect individuals differently. Not to mention, there's certain criteria and health/risk factors that doctors review and consider when determining contraception needs for their patients.
With most methods, efficacy is usually effective within a week or so, but to be safe, Dr. Oleka suggests giving the new contraception at least a month or two to allow enough time to confirm efficacy on your side and to see how well your body reacts to it.
*Before taking any medications, over-the-counter drugs, supplements or herbs, consult a physician for a thorough evaluation. xoNecole does not endorse any medications, vitamins or herbs. A qualified physician should make a decision based on each person's medical history and current prescriptions. The prescribing physician should be consulted concerning any questions that you have.
**Quick note about Plan B: Plan B is NOT a standard contraceptive like those mentioned above. Conversely, it is an emergency contraceptive, and should be used as soon as possible after sex (within 72 hours, up to 5 days). Dr. Oleka recommends that you already have some beforehand to prevent from panicking or having to run around to find in the middle of the night trying to find an open local pharmacy.
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"For example, if you’ve fundamentally changed what your product is and does, it’s likely that your brand is out of alignment with the business. Or, if you find your company is developing a reputation that doesn’t serve it, it might be time to pump the brakes and figure out what needs to change.
She continues, "Sometimes you’ll see companies (especially startups) announce a name change that comes with updated messaging, visuals, etc. That usually means their vision has changed or expanded, and their previous branding was too narrow/couldn’t encompass everything they planned to do."
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The Brand Doula was born in 2019, and its focus is on putting "the experiences, goals, and needs of women of color founders first," as well as brands with "culture-shifting missions."
According to Lola, culture-shifting is "the act of influencing dominant behavior, beliefs, or experiences in a community or group (ideally, for the better)."
"At The Brand Doula, we work with companies and leaders that set out to challenge the status quo in their industries and communities. They’re here to make an impact that sends ripples across the market," she says.
"We help the problem solvers of the world — the ones who aren't satisfied with 'this is how it's always been' and instead ask 'how could this be better?' Our clients build for impact, reimagining tools, systems, and ways of living to move cultures forward."
The Brand Doula has worked with many brands, including Too Collective, to assist with their collaboration with Selena Gomez's Rare Beauty and Balanced Black Girl for a "refresh," aka rebrand. For businesses looking to rebrand, Lola shares four essential steps.
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While determining whether the rebrand was successful may take a few months, Lola says a clear sign that it is unsuccessful is negative feedback from your target audience. "Customers are typically more vocal about what they don’t like more than what they do like," she says.
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For more information about Lola and The Brand Doula, visit her website, thebranddoula.com.
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I remember calling my grandmother, who has since transitioned, and hearing the passion in her voice when she explained how she’d never thought she’d see something like this happen and how much it meant to her. As I reflect, I realize it’s a combination of memories like this that undoubtedly encouraged my will to vote.
However, as an adult, my reasoning behind the practice has developed. It’s no longer just about “the right thing to do.” I feel a responsibility to myself and my future to know the issues, how they impact me, and make a difference for others.
In the times we’re in, there's so much “news” everywhere. It’s hard to distinguish fact from opinion and bias from beliefs. This is why it was such a pleasure speaking with Jara Butler, Chief Impact Officer of Supermajority. Supermajority is an organization focused on making women the most powerful voting bloc in the country. During this authentic and informal conversation, we talked about so much.
I learned about her time working with the Obama campaign and how she masterfully worked in multiple industries, and we shared some of our favorite female rap moments. However, in the snapshot you’ll read, we focused on the issues. Jara walked xoNecole through what’s most affecting women of color in this election and what we can do to be more aware. Whether you’re a politics girlie or like me, just trying to gain more insight, hopefully this convo connects with you.
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xoNecole: Let’s just jump right in. What are some of the most popular issues that you hear Black women discussing related to this election?
Jara Butler: Our sister organization, the Supermajority Education Fund, recently did some research specifically looking at young women in the age group 18 to 35, and young Black women identified their economic well-being as a priority. Right now, we're in a place where a lot of us, especially young Black women, are finding that meeting those basic needs are harder and harder.
Secondly, is Project 2025. I think Black women see it as not just something that could happen, but actively happening. For example, we’ve all been watching the case with the Fearless fund, and how it's been targeted. We know Black women are very entrepreneurial. We can go back to Madam C.J. Walker and others who have opened the door for all of us to achieve. But if those barriers are in place, we're just not going to be able to meet that.
Lastly, Repro is a very big issue. But I think looking at it holistically and not just about abortion is important. Black women are more likely to talk about this from a perspective of our reproductive health care and the lack of access due to medical racism. As a Black woman myself, who's over 40, a lot of the changes that I am making in my life are because I have to do everything I can to put myself in a position, because I know no matter what my economic status is, if I walk into a medical office, there's a good chance I'm gonna face medical discrimination. Breast cancer screenings, colon cancer screening, ovarian cancer screening, cervical cancer screenings - all of those are part of that network of reproductive health.
xoN: Another issue I’d love your insight into is our missing girls. I think it's so unbelievable how much this is swept under the rug. There are so many stories about Black women that are continuing to go missing; I don’t understand how that’s not a bigger conversation. Is this something that can be pursued on the government level and what can we do to bring more attention to this issue?
Jara: We have this list of majority rules on our website, and my favorite one is: that our government represents us. I think that we have to continue to apply pressure to our government to meet our needs. And again, women are the majority of voters. Black women, especially, are the most reliable voting bloc across all groups, and our interests right now are not being met. So yes, there is something that we can do, but I also am a big proponent of us having these conversations.
My great-grandmother was enslaved, my grandmother was born into Jim Crow, and I watched my mother face economic insecurity. I say that because, as a Black community, we have to have an internal conversation to talk about these issues, and we have to do it upfront. I think we have to get into a position of realizing that we do have power, and how we activate that power.
Our power comes from being Black folks because Black people organizing has been enough to shake up and scare people. There were laws that prevented us from congregating together, even at church, because they knew what would happen when we got together. We have to get back into that. It's not that we are not doing it, but the urgency needs to be greater. And finally, we have to get away from depending on one individual to take us there. It's gonna take all of us.
"Our power comes from being Black folks because Black people organizing has been enough to shake up and scare people. There were laws that prevented us from congregating together, even at church, because they knew what would happen when we got together. We have to get back into that. It's not that we are not doing it, but the urgency needs to be greater."
xoN: I agree completely. Now, when we started, you mentioned money. So let’s talk about it. So many of us are starting businesses and getting degrees, and I love to see it. But everyone seems to still be having a lot of the same issues around finances. What are some of the underlying reasons behind this debt that we're dealing with, and how can voting influence these challenges without getting into the individual candidates?
Jara: Hello! Let’s talk about the money! Black women have been told that if we want to move ahead, we have to have that master's degree. We have to be twice as good. So we met that measure, right? But in order to do that, we have to pay for it. Up until about the 1970s college was absolutely affordable. You could work one job and pay for college with some money left over. That has changed.
Realistically, student loans are a barrier. They are a barrier to access housing. They impact our credit, and really and truthfully, depending on how much your loans are, they could affect you paying rent. It basically creates a cycle of debt. And I have real problems with people who say, get a degree in something that's going to make money. It’s about your skills, and if you have the skills, you should be able to earn a living. That covers that.
But the fact is that student loan debt continues to increase, and there have been attempts, more than once, to try to relieve some of that pressure. The reality is that this is a squeeze. It is a conundrum, and we see efforts by the current White House administration to try to alleviate those things, even when they are stopped.
But truly, Congress needs to step in and support this, but I would take it a step further. We should be considering and looking at what it would look like if we had free community colleges. Because what we have now is two generations of borrowers, because older millennials’ children are beginning to age. Black women have the highest degree of second-degree secondary education, but we carry like 1.7 trillion in debt or something like that. I can't remember the exact number, but basically, the majority of the student loan debt is ours.
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xoN: Speaking of college, obviously there’s a lot of discussion around affirmative action in the schools and the undergoing changes. How important is it to consider this topic, and are there any new laws or policies being proposed around this that we should be aware of?
Jara: Oh my goodness, affirmative action is one of the things that we saw that our sister site, the Supermajority Education Fund, found last year as a number two issue for young women. I actually hypothesized that it was a real thing, and it was. And the reason for that is that affirmative action as a whole has been something that benefited white women more than any other group.
However, what is happening is that we’re using the word DEI in a way that is derogatory. I’ve heard people refer to it as: “didn't even earn it.” And as a Black woman who attended an amazing school, I remember being in class and having someone make that comment, knowing my grades were higher than theirs.
The fact of the matter is that we would not need these policies if we lived in an equal and equitable society. It doesn't do us any harm for us to face the facts that this country was built off the backs of enslaved people and the blood of indigenous people, and off the sweat and the tears of immigrants. But because we are unwilling to face that, we now are demonizing programs that are actually meant to create some symbol of balance.
xoN: Finally, I’ll close with this, what can we do to provide information to young people, and how do we combat all of the less than researched info?
Jara: One thing I encourage is to look at the source. At Supermajority, our social channels are information-based. We strive to provide up-to-date accurate information that is digestible to all. Media literacy is something I believe in, and unfortunately, it is something that we have a responsibility to continue to share with the community at large. So much of our world is centered on immediate info, a lie spreads faster than the truth.
We just saw that with the Olympic women's boxers, and we have to ask ourselves often: is this information accurate? Who is telling the story? Most importantly, how am I an original contributor? Not everything said needs to be shared, and not every thought needs to be public.
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