Birth Control Methods: Your Complete Guide to Contraception

What Is Birth Control and How Does It Work?

Birth control, also called contraception, refers to methods and devices used to prevent pregnancy. These methods work by preventing ovulation (release of eggs), blocking sperm from reaching the egg, or preventing a fertilized egg from implanting in the uterus. The effectiveness of birth control varies widely from 72% to over 99% depending on the method and how consistently it is used.

Contraception has been used throughout human history, but modern birth control methods offer unprecedented levels of effectiveness and safety. Today, individuals and couples have access to more than 15 different contraceptive methods, allowing them to choose an option that best fits their health needs, lifestyle, relationship status, and family planning goals.

Understanding how birth control works begins with understanding the basics of reproduction. For pregnancy to occur, a sperm must fertilize an egg, and the fertilized egg must implant in the uterine lining. Birth control methods interrupt this process at various stages. Hormonal methods primarily work by preventing ovulation, which means no egg is released for sperm to fertilize. Barrier methods physically block sperm from reaching the egg. Some methods, like copper IUDs, create an environment in the uterus that is hostile to sperm and prevents implantation.

The choice of contraception is deeply personal and should be made in consultation with a healthcare provider who can evaluate your medical history, discuss your preferences, and help you understand the benefits and risks of each option. What works well for one person may not be ideal for another, and many people try several methods before finding the one that suits them best.

Effectiveness: Perfect Use vs. Typical Use

When comparing birth control methods, it's important to understand the difference between "perfect use" and "typical use" effectiveness. Perfect use refers to how well a method works when used exactly as directed every single time. Typical use reflects real-world effectiveness, accounting for human error such as forgetting pills, not using condoms correctly, or missing appointments for injections.

For example, birth control pills are 99% effective with perfect use but only 91% effective with typical use because many people occasionally forget to take their pill at the same time every day. In contrast, IUDs and implants have nearly identical perfect and typical use effectiveness because once they're in place, there's no daily action required from the user.

What Are the Different Types of Birth Control Methods?

Birth control methods fall into several categories: hormonal methods (pills, patches, rings, injections, IUDs, implants), barrier methods (condoms, diaphragms), long-acting reversible contraceptives (IUDs, implants), permanent methods (sterilization), emergency contraception, and fertility awareness-based methods. Each category offers different effectiveness levels, convenience factors, and health considerations.

The landscape of contraceptive options has expanded significantly over the past several decades, giving people more choices than ever before. Each type of birth control has unique characteristics that make it more suitable for certain individuals and situations. Understanding these categories helps narrow down which methods might work best for your specific needs.

Hormonal Contraceptives

Hormonal contraceptives contain synthetic versions of the naturally occurring hormones estrogen and progestin, or progestin alone. These hormones work primarily by preventing ovulation, but they also thicken cervical mucus to block sperm and thin the uterine lining to reduce the likelihood of implantation.

Combined hormonal contraceptives contain both estrogen and progestin and include the pill, patch, and vaginal ring. These methods offer additional benefits beyond pregnancy prevention, including more regular, lighter, and less painful periods. They may also help with acne and reduce the risk of certain cancers. However, estrogen-containing methods are not suitable for everyone, particularly those who smoke and are over 35, have a history of blood clots, or experience migraines with aura.

Progestin-only methods include the mini-pill, hormonal IUDs, the implant, and the contraceptive injection. These options are safer for people who cannot take estrogen and are suitable for use during breastfeeding. Progestin-only methods may cause irregular bleeding patterns, especially initially, but many users eventually experience lighter periods or no periods at all.

Long-Acting Reversible Contraceptives (LARCs)

LARCs represent some of the most effective contraceptive options available and are recommended as first-line options by major medical organizations including the WHO and ACOG. These methods include intrauterine devices (IUDs) and the contraceptive implant. Once inserted, they provide continuous protection for years without requiring any daily, weekly, or monthly action from the user.

The "set it and forget it" nature of LARCs eliminates the risk of user error, which is why their typical use effectiveness is virtually identical to their perfect use effectiveness. Despite their high upfront cost and the need for a healthcare provider visit for insertion, LARCs are highly cost-effective over time and have high satisfaction rates among users.

Barrier Methods

Barrier methods physically prevent sperm from reaching the egg. The most well-known barrier method is the external (male) condom, which also provides protection against sexually transmitted infections. Internal (female) condoms, diaphragms, cervical caps, and contraceptive sponges also fall into this category.

Barrier methods are generally less effective at preventing pregnancy than hormonal methods or LARCs, but they are available without a prescription (in the case of condoms), have no hormonal side effects, and can be used on demand. Many people use barrier methods in combination with other contraceptives for dual protection against both pregnancy and STIs.

How Do Hormonal IUDs Work?

Hormonal IUDs are small, T-shaped devices inserted into the uterus that release a low dose of the hormone levonorgestrel. They prevent pregnancy primarily by thickening cervical mucus to block sperm and thinning the uterine lining. Hormonal IUDs are over 99% effective and can last 3-8 years depending on the brand, making them one of the most effective contraceptive methods available.

The hormonal intrauterine device represents one of the most significant advances in contraceptive technology. Unlike birth control pills that release hormones into the bloodstream, hormonal IUDs deliver progestin directly to the uterus, resulting in much lower systemic hormone levels. This localized delivery means fewer body-wide side effects while maintaining exceptional effectiveness.

Several hormonal IUD brands are available, differing in size, hormone dose, and duration of use. Larger-dose IUDs can last up to 8 years, while lower-dose versions last 3-5 years but may be better suited for people with smaller uteruses or those who haven't had children. The insertion process involves a healthcare provider placing the device through the cervix into the uterus, which can cause temporary cramping but typically takes only a few minutes.

Many people experience a significant reduction in menstrual bleeding with hormonal IUDs, and some stop having periods altogether after a few months of use. This effect is safe and reversible once the IUD is removed. The reduction in bleeding can be particularly beneficial for those with heavy or painful periods, and hormonal IUDs are sometimes prescribed specifically to treat these conditions.

Common initial side effects include irregular spotting and cramping, which typically improve over the first 3-6 months. The IUD can be removed at any time by a healthcare provider, and fertility returns almost immediately afterward. While rare, potential complications include perforation during insertion, expulsion (the IUD coming out on its own), and infection. Regular check-ups help ensure the IUD remains properly positioned.

How Does a Copper IUD Work?

The copper IUD is a non-hormonal intrauterine device wrapped in copper wire that prevents pregnancy by creating an environment toxic to sperm. Copper ions released by the device impair sperm motility and prevent fertilization. The copper IUD is 99.2% effective, can last up to 10-12 years, and can also be used as emergency contraception if inserted within 5 days of unprotected sex.

For individuals seeking highly effective, long-term contraception without hormones, the copper IUD offers an excellent solution. This device works through the natural spermicidal properties of copper ions, which create an inflammatory reaction in the uterus that is toxic to sperm. The copper also affects the movement and viability of eggs, providing multiple mechanisms of protection against pregnancy.

The copper IUD is the only highly effective non-hormonal contraceptive method that doesn't require daily attention or use at the time of intercourse. It can be particularly appealing for people who experience side effects from hormonal contraception, those who prefer to maintain their natural menstrual cycle, or individuals with medical conditions that contraindicate hormonal methods.

One notable characteristic of copper IUDs is that they may increase menstrual bleeding and cramping, especially during the first few months of use. For most users, these effects diminish over time, though periods may remain somewhat heavier than before. This side effect makes copper IUDs less suitable for people who already experience heavy or painful periods.

A unique advantage of the copper IUD is its effectiveness as emergency contraception. When inserted within 120 hours (5 days) of unprotected intercourse, the copper IUD is over 99% effective at preventing pregnancy - significantly more effective than emergency contraception pills. It can then remain in place for ongoing contraception for up to 12 years.

What Is a Contraceptive Implant?

The contraceptive implant is a thin, flexible plastic rod about the size of a matchstick that is inserted under the skin of the upper arm. It releases a steady dose of the hormone etonogestrel to prevent pregnancy for up to 3-5 years. With an effectiveness rate of 99.95%, the implant is the most effective reversible contraceptive method available.

The contraceptive implant offers the highest level of protection against pregnancy of any reversible method. Its remarkable effectiveness stems from the continuous, steady release of progestin, which prevents ovulation and creates multiple barriers to pregnancy. Because there's no user action required after insertion, the implant's typical use effectiveness equals its perfect use effectiveness.

Insertion of the implant is a simple procedure performed by a trained healthcare provider. After numbing a small area on the inner upper arm, the provider uses a special applicator to place the rod just under the skin. The procedure takes only a few minutes, and the implant begins working immediately if inserted during the first five days of your menstrual cycle.

Changes in menstrual bleeding are the most common side effect of the implant. About one-third of users experience irregular bleeding, one-third have infrequent or no bleeding, and one-third have normal or prolonged bleeding. For most people, bleeding patterns become more predictable over time. Other potential side effects include headaches, acne, breast tenderness, and mood changes, though many users experience no significant side effects.

The implant can be felt under the skin but is not visible except in very thin individuals. It can be removed at any time by a healthcare provider through a small incision, and fertility returns within days. Many people choose the implant specifically because it eliminates the need to remember daily pills or prepare for each sexual encounter, providing peace of mind and spontaneity.

How Do Birth Control Pills Work?

Birth control pills are oral contraceptives taken daily that contain hormones to prevent pregnancy. Combined pills contain estrogen and progestin, while mini-pills contain only progestin. Pills work primarily by preventing ovulation, and when taken correctly every day, they are 99% effective. However, typical use effectiveness is around 91% due to missed pills.

Birth control pills remain one of the most widely used contraceptive methods worldwide, offering a well-established, user-controlled approach to pregnancy prevention. Since their introduction in the 1960s, formulations have been refined to reduce side effects while maintaining effectiveness. Today's pills contain much lower hormone doses than early versions, making them safer and better tolerated.

Combined oral contraceptives (COCs) work through multiple mechanisms. The estrogen and progestin together prevent the surge of hormones that normally triggers ovulation, meaning no egg is released for fertilization. Additionally, these hormones thicken cervical mucus to impede sperm movement and thin the uterine lining to reduce the likelihood of implantation.

The mini-pill, or progestin-only pill, works primarily by thickening cervical mucus and thinning the uterine lining. Because it doesn't reliably prevent ovulation, timing is more critical with the mini-pill - it should be taken at the same time every day. The mini-pill is an appropriate option for people who cannot take estrogen, including those who smoke and are over 35, are breastfeeding, or have certain medical conditions.

Beyond contraception, birth control pills offer several health benefits. They can regulate irregular periods, reduce menstrual cramps and bleeding, improve acne, decrease the risk of ovarian and endometrial cancers, and manage conditions like polycystic ovary syndrome (PCOS) and endometriosis. Some people use pills continuously to skip periods entirely for convenience or to manage menstrual-related conditions.

The key to pill effectiveness is consistent, correct use. Missing pills, taking them at irregular times, or taking certain medications that interfere with pill absorption can reduce effectiveness. Common side effects include nausea, breast tenderness, and spotting between periods, which typically improve after the first few months. Serious side effects like blood clots are rare but more likely in smokers over 35 and those with certain risk factors.

How Do the Patch and Vaginal Ring Work?

The contraceptive patch and vaginal ring deliver the same hormones as combined birth control pills but through different routes. The patch is applied to the skin weekly and releases hormones that absorb through the skin. The ring is inserted into the vagina monthly and releases hormones that absorb through the vaginal lining. Both are 91-99% effective depending on how consistently they're used.

For people who want the benefits of combined hormonal contraception but struggle with daily pill-taking, the patch and ring offer convenient alternatives. These methods provide steady hormone levels without the peaks and valleys that can occur with pills, potentially reducing side effects for some users.

The contraceptive patch is a small, adhesive square worn on the skin of the buttocks, abdomen, upper arm, or upper torso (not the breasts). A new patch is applied weekly for three weeks, followed by one patch-free week during which withdrawal bleeding occurs. The patch delivers hormones continuously through the skin, eliminating the need to remember a daily pill while providing the same mechanism of pregnancy prevention.

The vaginal ring is a flexible, transparent ring about two inches in diameter that you insert into the vagina yourself. It stays in place for three weeks and is then removed for one week, during which you'll have a period. The exact position of the ring in the vagina doesn't affect its effectiveness. Most users and their partners cannot feel the ring during intercourse, and it can be temporarily removed for up to three hours if needed.

Both methods have similar effectiveness to pills and share the same benefits and risks associated with combined hormonal contraception. The patch may be less effective in people who weigh more than 198 pounds (90 kg). Patch-specific side effects may include skin irritation at the application site. Ring-specific side effects may include vaginal irritation or increased discharge. Both methods require a prescription and regular healthcare visits to obtain refills.

How Does the Birth Control Shot Work?

The contraceptive injection (Depo-Provera) is a shot containing the hormone progestin given every 12-13 weeks. It prevents pregnancy primarily by stopping ovulation and thickening cervical mucus. The injection is 94-99% effective depending on how timely shots are received. A unique consideration is that fertility may take 6-12 months to return after stopping.

The contraceptive injection offers a discreet, highly effective method that requires attention only once every three months. For people who value privacy, struggle with daily or weekly methods, or prefer not to have a device inserted, the injection provides an excellent option. Each shot protects against pregnancy for 12 weeks, though it remains effective for up to 15 weeks to allow for scheduling flexibility.

The injection contains depot medroxyprogesterone acetate (DMPA), a long-acting form of progestin. After injection, DMPA is slowly released from the injection site into the bloodstream, maintaining pregnancy prevention for the entire 12-week period. The injection is typically given in the arm or buttock at a healthcare provider's office, though self-injection options are becoming available in some areas.

Most users experience significant changes in menstrual bleeding with the injection. Irregular bleeding and spotting are common in the first few months. With continued use, many users stop having periods altogether - by the end of the first year, about half of users have no menstrual bleeding. This absence of periods is not harmful and is often seen as a benefit.

A unique consideration with the injection is its effect on fertility after discontinuation. Unlike other methods where fertility returns quickly, it may take 6-12 months for fertility to return after the last shot. This doesn't indicate any permanent impact on fertility, but it means the injection isn't ideal for people who may want to become pregnant soon. The injection has also been associated with a small decrease in bone density, which is typically reversible after stopping.

How Do Condoms Protect Against Pregnancy and STIs?

Condoms are barrier methods that prevent sperm from entering the vagina or rectum during intercourse. External (male) condoms fit over the penis, while internal (female) condoms line the vagina or rectum. When used correctly, external condoms are 98% effective and internal condoms are 95% effective. Condoms are the ONLY contraceptive method that also protects against sexually transmitted infections.

Condoms hold a unique position among contraceptive methods as the only option that provides dual protection against both pregnancy and sexually transmitted infections. This makes them an essential component of sexual health, particularly for people with new partners, multiple partners, or partners whose STI status is unknown. Healthcare providers often recommend using condoms alongside another contraceptive method - an approach called dual protection.

External condoms, commonly called male condoms, are thin sheaths typically made of latex, polyurethane, or polyisoprene that unroll over an erect penis. They work by collecting semen and preventing it from entering the partner's body. A new condom must be used for each act of intercourse. Proper use includes checking the expiration date, using appropriate lubricant (water-based with latex condoms), leaving space at the tip, and holding the base during withdrawal.

Internal condoms, also called female condoms, are pouches with flexible rings at each end that line the vagina or rectum. They can be inserted up to eight hours before intercourse, giving users more control over their protection. Internal condoms may feel different than external condoms during intercourse, and some couples find them less intrusive of sensation. They are made of nitrile, making them suitable for people with latex allergies.

The effectiveness gap between perfect use and typical use for condoms is significant, reflecting that condoms must be used correctly with every sexual encounter. Common mistakes include not using a condom for the entire duration of intercourse, using oil-based lubricants with latex condoms (which can cause breakage), and improper storage. With correct and consistent use, condoms are highly effective, but they do have higher failure rates than LARCs or hormonal methods.

Beyond preventing pregnancy and STIs, condoms have several advantages: they're widely available without a prescription, affordable, have no hormonal side effects, and allow both partners to participate in pregnancy prevention. For people with latex allergies, polyurethane and polyisoprene options are available. Spermicide-coated condoms are no longer recommended as they don't significantly increase effectiveness and may cause irritation.

What Emergency Contraception Options Are Available?

Emergency contraception prevents pregnancy after unprotected sex or contraceptive failure. Options include emergency contraceptive pills (morning-after pills) containing levonorgestrel or ulipristal acetate, which should be taken as soon as possible, and the copper IUD, which can be inserted up to 5 days after unprotected sex. The copper IUD is the most effective form of emergency contraception at over 99%.

Emergency contraception provides a critical safety net for preventing pregnancy after unprotected intercourse, condom breakage or slippage, missed birth control pills, or sexual assault. Despite being called the "morning-after pill," emergency contraception can be taken up to several days after unprotected sex, though effectiveness decreases with time. Emergency contraception is not the same as abortion - it prevents pregnancy from occurring rather than ending an existing pregnancy.

Levonorgestrel-based emergency contraception (Plan B One-Step and generics) is available over-the-counter without age restrictions in many countries. It works primarily by preventing or delaying ovulation if taken before ovulation occurs. For maximum effectiveness, it should be taken within 72 hours (3 days) of unprotected sex, though it provides some protection up to 120 hours (5 days). Its effectiveness may be reduced in people weighing over 165 pounds (75 kg).

Ulipristal acetate (ella) is a prescription emergency contraception that works by delaying ovulation. It maintains its effectiveness better than levonorgestrel throughout the 5-day window and is effective for people of all weights. Because it works differently, ulipristal acetate can prevent ovulation even when levonorgestrel would be too late to be effective. However, it should not be used if you've taken hormonal contraception in the past 5 days.

The copper IUD is the most effective form of emergency contraception, preventing over 99% of pregnancies when inserted within 5 days of unprotected sex. It can then be left in place for ongoing contraception for up to 10-12 years. While it requires a healthcare visit for insertion, it's the best option when highest effectiveness is needed or when the person wants long-term contraception.

Emergency contraception is safe for almost everyone and can be used multiple times if needed, though it should not be used as a regular method of contraception because it's less effective than using contraception before or during sex. Common side effects include nausea, headache, and changes to the next menstrual period. Emergency contraception does not affect future fertility.

What Is Sterilization and Who Should Consider It?

Sterilization is a permanent surgical procedure that prevents pregnancy. For people with uteruses, this involves tubal ligation or removal (blocking or removing the fallopian tubes). For people with testes, vasectomy blocks or cuts the vas deferens. Both procedures are over 99% effective. Sterilization should only be considered by those certain they do not want future pregnancies.

Sterilization offers a permanent solution for individuals or couples who have completed their families or are certain they don't want children. Unlike reversible methods, sterilization is intended to be lifelong, though reversal procedures exist, they are not always successful and are expensive. Anyone considering sterilization should be thoroughly counseled about its permanence and should feel confident in their decision regardless of potential life changes like divorce or death of a child.

Tubal ligation, commonly called "getting your tubes tied," is a procedure that blocks, cuts, or removes the fallopian tubes, preventing eggs from reaching the uterus and sperm from reaching eggs. It's typically performed laparoscopically under general anesthesia and can be done at any time, though it's often performed immediately after childbirth or during cesarean section. Modern approaches increasingly involve removing the tubes entirely (salpingectomy), which may reduce the risk of ovarian cancer.

Vasectomy is a simpler, safer, and less expensive procedure than tubal ligation. It involves cutting or blocking the vas deferens - the tubes that carry sperm from the testes. Vasectomy is typically performed in a doctor's office under local anesthesia and takes about 20 minutes. Recovery is quick, though another form of contraception must be used until a follow-up test confirms no sperm are present in the semen, usually after about 3 months.

Neither sterilization procedure affects sexual function, hormone production, or the experience of orgasm. Vasectomy does not affect ejaculation - semen is still produced, it simply doesn't contain sperm. Tubal ligation does not affect menstruation or menopause timing. The main "side effect" is the psychological benefit of permanent protection against pregnancy.

What Are Fertility Awareness Methods?

Fertility awareness-based methods (FABMs) involve tracking signs of fertility to identify the fertile window when pregnancy is possible. These signs include basal body temperature, cervical mucus changes, and menstrual cycle length. When used correctly, FABMs can be 95-99% effective, but typical use effectiveness is around 76-88%. These methods require consistent tracking and avoiding intercourse or using barriers during fertile days.

Fertility awareness methods, also called natural family planning, work by identifying the approximately 6 days per menstrual cycle when pregnancy is possible - the 5 days before ovulation and the day of ovulation itself. During this fertile window, couples either abstain from vaginal intercourse or use barrier methods. Outside the fertile window, pregnancy is not possible, and unprotected intercourse is considered safe.

Several approaches exist for identifying the fertile window. Temperature-based methods involve taking your basal body temperature every morning before getting out of bed, as temperature rises slightly after ovulation. Cervical mucus methods involve monitoring changes in vaginal discharge throughout the cycle, as mucus becomes clear, stretchy, and slippery around ovulation. Calendar-based methods use past cycle lengths to predict future fertile windows.

The most effective approach combines multiple indicators - called the symptothermal method - which can be over 99% effective with perfect use. However, fertility awareness methods require significant commitment, daily tracking, and partner cooperation. They're less reliable for people with irregular cycles, and the learning curve takes several cycles. Modern fertility apps and devices have made tracking easier, though app-based prediction alone is less reliable than monitoring physical signs.

Fertility awareness methods are chosen by people who prefer to avoid hormones and devices, have religious or personal objections to other methods, want to learn more about their bodies, or are also interested in achieving pregnancy in the future. These methods have no side effects and are free after initial education. However, they require daily attention, cannot be used effectively during certain life stages (like breastfeeding or perimenopause), and may require abstinence or barrier use for 10-14 days per cycle.

How Do I Choose the Right Birth Control Method?

Choosing the right birth control involves considering several factors: how important it is to avoid pregnancy, whether you want hormonal or non-hormonal options, how often you want to think about contraception, your health history, potential side effects, cost and accessibility, and whether you need STI protection. A healthcare provider can help evaluate your personal needs and medical history to find the best fit.

Selecting a contraceptive method is a personal decision that should account for your individual circumstances, values, and preferences. There is no single "best" method - the right choice varies from person to person and may change over your lifetime as your relationships, health, and family planning goals evolve. Many people try several methods before finding the one that works best for them, and that's completely normal.

Consider your priorities when choosing contraception. If avoiding pregnancy is your top concern, long-acting methods like IUDs and implants offer the highest effectiveness with the least effort. If you prefer a method you can stop at any time, pills, patches, or rings give you control but require regular attention. If you want to avoid hormones, the copper IUD, condoms, or fertility awareness methods are your options. If STI protection is important, condoms should be part of your strategy regardless of other methods used.

Your health history affects which methods are safe for you. Certain conditions, like a history of blood clots, uncontrolled high blood pressure, or breast cancer, may rule out estrogen-containing methods. Smoking and age over 35 is a significant risk factor for blood clots with combined hormonal contraception. A healthcare provider will review your medical history to ensure any method you choose is safe. Be honest about your health conditions and habits to receive appropriate guidance.

Practical considerations also matter. Think about whether you can realistically take a pill at the same time every day, whether you have access to healthcare for insertions or injections, whether you can afford the upfront cost of an IUD even if it saves money over time, and whether your partner will cooperate with methods like condoms or fertility awareness. The most effective method is one you'll use correctly and consistently.

Side effects vary widely between methods and between individuals. Some people experience significant side effects with hormonal methods while others have none. The only way to know how you'll respond is to try a method, though previous experiences with hormones (like in puberty or pregnancy) may provide clues. Give any new method at least 3-6 months for your body to adjust before deciding it's not right for you, unless you have concerning symptoms that require immediate attention.

When Should You See a Healthcare Provider?

See a healthcare provider to start a new contraceptive method, for methods requiring insertion or prescription, if you experience concerning side effects, if your method fails and you need emergency contraception or pregnancy testing, and for regular check-ups to ensure your method is working well. You should seek immediate care for severe headaches, chest pain, leg swelling, or severe abdominal pain while using hormonal contraception.

While some contraceptive methods are available without a prescription, seeing a healthcare provider ensures you choose a safe method based on your complete health history. A provider can answer questions, address concerns, and help you troubleshoot issues that arise. Building a relationship with a reproductive healthcare provider supports your overall sexual and reproductive health.

Certain methods require healthcare visits by design. IUDs and implants must be inserted by trained providers. The injection is given at a provider's office or clinic. Prescriptions are needed for pills, patches, rings, and some forms of emergency contraception. Regular visits allow providers to check that IUDs are still properly positioned and address any concerns about side effects or effectiveness.

Contact your healthcare provider if you experience side effects that concern you or don't improve after a few months. Persistent breakthrough bleeding, mood changes, weight gain, decreased sex drive, or any symptoms that affect your quality of life warrant a discussion. Your provider may suggest waiting longer for adjustment, trying a different formulation, or switching to another method entirely.