Contraception Options with High Efficacy

Comparative Efficacy Data

The American Academy of Pediatrics recommends that both Mirena and Nexplanon prevent 99 out of 100 women from getting pregnant, with typical use failure rates of 0.2% and 0.05% respectively, making them the most effective reversible contraceptive options available 1, 2, 3, 4
Nexplanon has a typical use failure rate of 0.05% (5 pregnancies per 10,000 women) and a perfect use failure rate of 0.05%, translating to 99.95% effectiveness 1, 2, 3, 4
Mirena has a typical use failure rate of 0.2% (20 pregnancies per 10,000 women) and a perfect use failure rate of 0.2%, translating to 99.8% effectiveness 1, 2, 3, 4
Depo-Provera has a typical use failure rate of 3-6% and a perfect use failure rate of 0.2-0.3%, resulting in 94-97% effectiveness with typical use 1, 2, 3, 4
NuvaRing has a typical use failure rate of 8-9% and a perfect use failure rate of 0.3%, resulting in 91-92% effectiveness with typical use 1, 2, 3, 4

The American Academy of Pediatrics recommends counseling patients about LARC methods first when discussing contraceptive options, ordered from most to least effective 1
LARC methods have typical use and perfect use failure rates that are nearly identical because they don't require daily adherence 1, 2, 3
LARC methods have extended duration of protection, with Nexplanon lasting 3 years and Mirena lasting 5-8 years 1
LARC methods allow for rapid return to fertility after removal 1
LARC methods have higher continuation rates at 1 year (80-84%) compared to other methods 1, 2, 3

Typical‑use failure rate is approximately 6 %, reflecting pregnancies that occur when quarterly injections are missed or delayed. This rate is derived from CDC MMWR recommendations. 5
Perfect‑use failure rate ranges from 0.2 % to 0.3 % when injections are administered exactly every 12 weeks, indicating >99 % effectiveness under optimal adherence. Reported by CDC MMWR and corroborated by additional CDC data. 5
Combined oral contraceptives have a typical‑use failure rate of about 9 %, making them slightly less effective than Depo‑Provera in real‑world use. CDC MMWR data. 6

One‑year continuation rate is 56 %, the lowest among highly effective reversible methods, meaning nearly half of users discontinue within the first year. CDC MMWR evidence. 7

Depo‑Provera must be administered every 12 weeks (84 days ± 5 days) to maintain contraceptive efficacy; delays beyond this window are the primary driver of the 6 % typical‑use failure rate. Recommendations from Hepatology publications. 8

Fertility may be delayed for up to 18 months after stopping Depo‑Provera, which can influence subsequent unintended pregnancy risk. Hepatology evidence. 9