This factsheet gives a brief overview of all of the birth control (contraception) methods that are available in Canada. Everyone is different and you need to find the method that is right for you.

What is birth control (contraception)?

• In order to get pregnant, sperm must enter the vagina*, swim up into the uterus and fertilize an egg that has been released from your ovaries during ovulation.
• Birth control methods prevent or interfere with this process in a variety of different ways, depending on the method.

Things to consider when choosing a birth control method

• Effectiveness
• Potential side effects
• How often you need to use the method
• Whether or not you need to do something every time you have vaginal sex
• How much the method costs
• The level of cooperation it requires of your sexual partner(s)
• How permanent the method is or how long you can use it
• Your values (cultural, religious, etc.)
• Whether or not you have any medical conditions, take medications or smoke (these may rule out certain options for you)
• How comfortable you are touching your genitals
• The impact of the method on the environment
• When or if you want to have (more) children

*We know that these aren’t the words everyone uses for their bodies (e.g. trans folks), and support you using the language that feels best for you.

Categories of birth control

• Hormonal methods: the pill, patch, ring, injection and the hormonal IUD (intrauterine device).
• Non-hormonal methods: the copper IUD, external condoms (sometimes referred to as male condoms), internal condoms (sometimes referred to as female condoms), vaginal contraceptive film, diaphragms, FAMs (Fertility Awareness Methods) and withdrawal.
• Not included in this booklet: progestin-only pills and sterilization (talk to your clinician for more info), implants and spermicidal jelly (not available in Canada), cervical caps and spermicidal foam (not readily available in Canada).
• Remember: only condoms (external and internal) protect you from both pregnancy and sexually transmitted infections (STIs). Condoms can be used in combination with hormonal or non-hormonal methods of birth control to protect you from STIs.

Hormonal Methods

Birth Control Pill

• What: a pill that contains 2 hormones (estrogen and progestin) that you take every day at the same time.
• How: the pill primarily prevents your ovaries from releasing an egg during ovulation.
• Effectiveness: the pill is 99% effective. Because it may be used incorrectly, it is 92%-97% effective with typical use.
• Possible Side Effects: nausea, breast tenderness, moodiness or spotting between periods, which should go away within the first 3 months. The pill slightly increases your risk of a blood clot, heart attack or stroke. Smoking increases that risk
• Advantages: you don’t have to do anything before or after sex; lighter/shorter periods; reduced menstrual cramps; reduced acne; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: you have to take something every day; you need a prescription; you may experience side effects.
• Cost: at pharmacies, about $20-35/month. At PPT Health Services and sexual health clinics, about $7-23/month.

Birth Control Patch/Evra

• What: a thin plastic patch that contains 2 hormones (estrogen and progestin) that you wear on your skin.
• How: the patch primarily prevents your ovaries from releasing an egg during ovulation.
• Effectiveness: the patch is 99% effective. Because it may be used incorrectly, it is 92%-97% effective with typical use.
• Possible Side Effects: skin irritation where the patch is worn; nausea, breast tenderness, moodiness or spotting between periods, which should go away within the first 3 months. The patch slightly increases your risk of a blood clot, heart attack or stroke. Smoking increases that risk.
• Advantages: you don’t have to do anything before or after sex; you only have to change it once a week; lighter/shorter periods; reduced menstrual cramps; reduced acne; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: the patch is visible; it is a peach colour; you need a prescription; you may experience side effects.
• Cost: at pharmacies, about $20/month. At PPT Health Services and sexual health clinics, about $10/month.

Birth Control Ring/Nuvaring

• What: a thin plastic ring that contains 2 hormones (estrogen and progestin) that you put inside your vagina.
• How: the ring primarily prevents your ovaries from releasing an egg during ovulation.
• Effectiveness: the ring is 99% effective. Because it may be used incorrectly, it is 92%-97% effective with typical use.
• Possible Side Effects: nausea, vaginal irritation, moodiness, breast tenderness and spotting between periods, which should go away within the first 3 months. The ring slightly increases your risk of a blood clot, heart attack or stroke. Smoking increases that risk.
• Advantages: you don’t have to do anything before or after sex; you only have to change it once a month; lighter/shorter periods; reduced menstrual cramps; reduced acne; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: you must be comfortable putting something inside your vagina; you need a prescription; you may experience side effects.
• Cost: at pharmacies, about $30/month. At PPT Health Services and sexual health clinics, about $10/month.

Injection/Depo Provera

• What: a shot or injection that contains one hormone (progestin) that you receive from a clinician in your arm or upper butt once every 12-13 weeks/3 months.
• How: the injection primarily prevents your ovaries from releasing an egg during ovulation.
• Effectiveness: the injection is 99.7% effective. Because it may be used incorrectly, it is 97% effective with typical use.
• Possible Side Effects: irregular periods for the first few months and eventually, for most people, no period at all while using the injection. Other possible side effects are weight gain; decreased bone strength; it can delay your ability to get pregnant for up to 9 months after the last injection.
• Advantages: you don’t have to do anything before or after sex; you only have to do something once every 3 months; the injection can lighten, reduce and eventually stop your periods; you can use it if you can’t use methods with estrogen in them.
• Disadvantages: you have to get an injection; you need to get to a clinic every 3 months; you need a prescription; you may experience side effects; you must be comfortable without a monthly period.
• Cost: at pharmacies, about $35/3 months. At PPT Health Services and sexual health clinics, about $18/3 months.

Hormonal IUD (intra-uterine device)/Mirena/Kyleena

• What: a small “T-shaped” piece of plastic with a band around it containing one hormone (progestin) that gets inserted into your uterus by a clinician. It is effective for up to 5 years.
• How: the hormonal IUD changes the chemistry of your uterus making it difficult for sperm to fertilize an egg. It also makes it harder for sperm to get through the mucus in your cervix (the opening to your vagina) and into your uterus to fertilize an egg and in some people, it may interfere with ovulation.
• Effectiveness: the hormonal IUD is 99.8% effective.
• Possible Side Effects: lighter periods, irregular periods, and eventually for some people no period at all while the IUD is in place. Other possible but uncommon side effects are moodiness & acne.
• Advantages: you don’t have to do anything before or after sex; you can leave it in for up to 5 years; once it is inserted you don’t have to do anything to make it work; it can lighten, reduce and eventually stop your periods; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: it must be inserted and removed by a clinician; insertion can be uncomfortable and comes with potential risks; there is a small risk your body will expel (push out) the IUD; you may experience side effects.
• Cost: at pharmacies, about $375-$550. At PPT Health Services and sexual health clinics, about $300-$380. PPT Health Services sells and inserts hormonal IUDs.

Implant/Nexplanon/Implanon

• What: a 4cm plastic rod containing one hormone (progestin) that gets inserted under the skin of your upper arm by a clinician.
• How: the implant primarily prevents your ovaries from releasing an egg during ovulation.
• Effectiveness: the implant is 99.6% effective.
• Possible Side Effects: lighter periods, irregular periods, and eventually for some people no period at all while the implant is in place, longer or heavier periods, bleeding or spotting between periods. Other possible side effects include headaches, acne, breast/chest tenderness, mood changes.
• Advantages: you don’t have to do anything before or after sex; you can leave it in for up to 3 years; once it is inserted you don’t have to do anything to make it work; it can lighten, reduce and eventually stop your periods; you can use it if you can’t use methods with estrogen; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: it must be inserted and removed by a clinician; insertion can cause pain or irritation and comes with potential risks; there is a small risk the implant could move inside your body; it can be visible on some people; you may experience side effects.
• Cost: at pharmacies, about $350-$450. PPT Health Services places implants and sells them for around $300.

Non-hormonal Methods

Copper IUD (intra-uterine device)

• What: a small “T-shaped” piece of plastic with a coil of copper around it that gets inserted by a clinician into your uterus.
• How: the copper IUD changes the chemistry of your uterus making it difficult for sperm to fertilize an egg.
• Effectiveness: the copper IUD is 99% effective.
• Possible Side Effects: heavier periods with increased cramping.
• Advantages: you don’t have to do anything before or after sex; you can leave it in for up to 5 years; once it is inserted you don’t have to do anything to make it work; there are no hormonal side effects; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: it must be inserted and removed by a clinician; insertion can be uncomfortable and comes with potential risks; there is a small risk your body will expel (push out) the IUD; getting an IUD can take 2 appointments; you may experience side effects.
• Cost: at pharmacies, about $75-170. At PPT Health Services and sexual health clinics, about $50-75. PPT Health Services sells and inserts copper IUDs.

External (sometimes referred to as “male”) condom

• What: a thin covering, usually made of latex, worn over an erect penis.
• How: the condom catches the semen (cum) that contains the sperm and prevents it from entering the vagina.
• Effectiveness: the condom is 97% effective. Because condoms may be used incorrectly, they are 86% effective with typical use.
• Possible Side Effects: none. If you or your partner experience any irritation with condom use, use non-latex external condoms.
• Advantages: you only need to use it when you have sex; it’s easy to carry; you don’t need a prescription; there are no side effects; it is inexpensive/free; it protects you from STIs; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: you have to do something right before you have sex every time; a partner’s penis has to be fully erect to put one on; you have to check periodically to make sure it’s still on; a partner must be willing to wear one.
• Cost: at pharmacies, about $8-15/box of 6. At PPT Health Services and sexual health clinics, free.

Internal (sometimes referred to as “female”) condom

• What: a loose fitting non-latex pouch that is inserted into the vagina up to 4 hours before vaginal sex.
• How: the internal condom catches the semen (cum) that contains the sperm and prevents it from entering the vagina.
• Effectiveness: the internal condom is 95% effective. Because it may be used incorrectly, it is 80% effective with typical use.
• Possible Side Effects: none.
• Advantages: you only need to use it when you have sex; you can insert it up to 4 hours in advance; it’s easy to carry; you don’t need a prescription; there are no side effects; it protects you from STIs; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: you have to do something before you have sex; you have to check periodically to make sure it hasn’t been pushed inside of you; it can be expensive.
• Cost: at pharmacies, about $10 for a box of 3. At PPT Health Services and sexual health clinics, free.

Vaginal Contraceptive Film

• What: a thin square of clear film that you put inside your vagina.
• How: the film dissolves into a spermicidal gel, which kills sperm.
• Effectiveness: VCF is 94% effective. Because it may be used incorrectly, it is 72% effective with typical use.
• Possible Side Effects: vaginal irritation or penile irritation. It can increase your risk of getting vaginal and urinary tract infections.
• Advantages: you only need to use it when you have sex; you don’t need a prescription; it’s easy to carry; there are minimal side effects; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: you have to use one for each act of vaginal sex; you have to wait 15 minutes after you put it in before having vaginal sex; you must be comfortable putting it inside your vagina; you may experience side effects.
• Cost: at pharmacies, about $13/box of 9. At sexual health clinics, about $1-2 per film.

Diaphragm with Spermicidal or Barrier Gel

• What: a reusable silicone dome that you fill with spermicidal or barrier gel and put inside your vagina. It can last for up to 2 years.
• How: the diaphragm filled with gel covers the cervix, making it difficult for sperm to get through it. The spermicidal gel inside it kills sperm, or the barrier gel traps them.
• Effectiveness: the fitted diaphragm with spermicidal or barrier gel is 96% effective. The non-fitted diaphragm with spermicidal or barrier gel is 92% effective. Because both kinds may be used incorrectly, they are 75-80% effective with typical use.
• Possible Side Effects: vaginal irritation or penile irritation. It can increase your risk of getting vaginal and urinary tract infections.
• Advantages: you only need to use it when you have sex; it’s reusable; there are minimal side effects; it doesn’t affect your ability to get pregnant in the future.
• Disadvantages: you have to use it each time you have sex; you have to wait 6 hours before removing it; you may have to be fitted by a clinician; spermicidal gel must be bought from the US or online; barrier gel has to be bought online or from specialty shops; you must be comfortable putting it inside your vagina; you may experience side effects.
• Cost: Fitted: at the Bay Centre for Birth Control (416-351-3700) about $75. Non-fitted: online or at specialty shops for about $100. Spermicidal gel: from the US/online about $15-18. Barrier gel: online or at specialty shops for about $25. PPT Health Services doesn’t sell or fit the diaphragm.

Fertility Awareness Methods

• What: different methods that help track your fertility/menstrual cycle and your body’s fertility signs to predict when you are fertile.
• How: involves recording your waking body temperature, viewing/recording your cervical mucus/position and avoiding vaginal sex/using another birth control method during fertile times.
• Effectiveness: FAMs can range from 78%-98% effective at preventing pregnancy if used correctly and consistently.
• Possible Side Effects: none.
• Advantages: you don’t need a prescription; there are no side effects; it’s low/no cost; you learn about your body; it can help you get pregnant in the future.
• Disadvantages: you have to do something every day; you have to abstain from vaginal sex or use another method during fertile times; it can take time to learn how to use FAMs properly; FAM consultants can be hard to find.
• Cost: FAM consultant fees vary. Otherwise free.

Withdrawal

• What: pulling the penis out of the vagina before ejaculation (cumming) and ejaculating away from the vulva/vagina.
• How: withdrawal prevents sperm from entering the vagina and fertilizing an egg.
• Effectiveness: withdrawal is 96% effective at preventing pregnancy. Because it may be used incorrectly, it is 81% effective with typical use.
• Possible Side Effects: none.
• Advantages: you don’t need a prescription; you only need to do it when you have sex; there are no side effects; it’s free.
• Disadvantages: you have to do it every time you have sex; your partner may not be able to/or know when to pull out in time; you don’t have control over using it.
• Cost: free.

Getting Your Partner’s Support

There are many things your partner(s) can do to support you in using a birth control method correctly and consistently including:

• Coming to appointments to discuss birth control options.
• Helping pay for birth control.
• Having emergency contraception (Plan B) and condoms on hand/at their place for back-up.
• Offering to send gentle reminders to use the method, like a text reminder to take the pill, or help keep track of when to book your appointment at the clinic to get the injection, etc.
• Being understanding if you experience side effects that may temporarily interfere with your sexual activity together.
• When a method hasn’t been used correctly (e.g. you’ve missed a pill, you forgot to put your ring in on time, etc.), using condoms or other back-up until the original method is effective again.

Remember

• Condoms are the only method of birth control that also protects against transmission of sexually transmitted infections (STIs). Use condoms in addition to your birth control method to reduce your risk of getting or passing on an STI.
• If you forget to use your method or use it incorrectly, you can take emergency contraception (Plan B or a copper IUD) to prevent a pregnancy.
• For more detailed information about a particular method, see the individual fact sheet for that method.