Download Birth control methods

Birth control methods:
types, effectiveness and side effects
Published: Monday 17 August 2015 at 12am PST
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With so many choices when it comes to birth control, how do you decide which
method is best?
The decision to use birth control and the method of choice is a personal one. With
guidance from your health care provider on which method best suits your needs, you can
safely and effectively prevent pregnancy.
While most methods of birth control are highly effective when used correctly, there is
always a chance that the method will fail. Weighing the options yourself and with your
partner and health care provider is an important part of the decision-making process.
Some things to consider when choosing a birth control method are:1

Your health status

Your desire for children in the future

Frequency of sexual contact and number of sex partners

Safety and efficacy of chosen method

Level of personal comfort with the chosen method.
Contents of this article:
1. Abstinence
2. Natural family planning
3. Breastfeeding
4. Outercourse
5. Hormonal contraception
6. Implanted devices
7. Permanent sterilization
8. Emergency contraception
9. Barrier methods
10. Spermicide
11. Withdrawal method
You will also see introductions at the end of some sections to any recent developments
that have been covered by MNT's news stories. Also look out for links to information
about related conditions.
Fast facts on birth control
Here are some key points about birth control. More detail and supporting information is in
the main article.4
 There are 61 million US women in their childbearing years (15-44).
 About 43 million of them (70%) are at risk of unintended pregnancy.
 Couples who do not use any method of contraception have an approximately 85%
chance of experiencing a pregnancy over the course of a year.
 The typical US woman wants only two children. To achieve this goal, she must use
contraceptives for roughly three decades.
 More than 99% of women aged 15-44 who have ever had sexual intercourse have used at
least one contraceptive method.
 Some 62% of all women of reproductive age are currently using a contraceptive method.
 10% of women at risk of unintended pregnancy are not currently using any contraceptive
method.
 The proportion of women at risk who are not using a contraceptive method is highest
among 15-19-year-olds (18%) and lowest among women aged 40-44 (9%).
 67% of women who practice contraception currently use nonpermanent methods,
primarily hormonal methods (the pill, patch, implant, injectable and vaginal ring), IUDs
and condoms. The rest rely on female (25%) or male (8%) sterilization.
 The pill and female sterilization have been the two most commonly used methods since
1982.
 Some 762,000 women who use the pill (9% of all pill users) have never had sex and use
the method almost exclusively for noncontraceptive reasons.
What are my birth control options?
There are several methods of birth control that meet the unique needs of each person and
include:
There are several issues to consider when deciding which method of contraception is right for
you. Your health care provider can help you find the right method for you.
Abstinence
Abstinence is a method of birth control that can be defined in different ways and includes
no intercourse at all to simply no vaginal penetration.2 However you describe or perceive
abstinence, it is important to determine if and how this method will work for you.
Not having any sexual intercourse including vaginal, anal or oral, is referred to as
continuous abstinence and is the only way to 100% avoid both pregnancy and
contracting an STD.1,2
Abstinence is both safe and effective and has many benefits including no side effects and
it is free. However, there are times when abstinence is difficult to maintain.2
Natural family planning
Also known as the "rhythm method" or "fertility awareness-based methods" allow for
couples to use abstinence or other forms of birth control, such as withdrawal or barrier
methods to prevent pregnancy during certain fertile times of a woman's menstrual cycle.
Women who menstruate normally will experience approximately 7-9 fertile days per
month - meaning if she has unprotected vaginal sexual intercourse, she can
conceive/become pregnant.1-3
On average, the most fertile days of a woman's menstrual cycle include the 5 days prior to
ovulation (release of an egg), the day of and 2-3 days following ovulation.1,2
There are various ways to track your fertile days including the calendar, temperature or
cervical mucus method; when used in combination it is referred to as the "symptothermal
method." The "Standard Days Method" can also be used in this type of birth control.2
When used correctly, this method of birth control will provide effective pregnancy
prevention and has no side effects.1,2
The benefits of natural family planning are numerous and include its safety, efficacy, low
cost and it is easily discontinued. Additionally, there is no need for medication. As with
any method of birth control there are disadvantages where the method does not work in
all life situations, such as with more than one sex partner, an inability to abstain, or with
side effects of certain medicines. Additionally, difficulty accurately tracking days,
breastfeeding and age (nearing menopause) may make this method more challenging.2
The number of unintended pregnancies with this method are approximately 24-25%.
Breastfeeding
In order to be used as an effective method of contraception, you must exclusively
breastfeed your baby so that your body's hormones do not produce eggs to ovulate.2
The benefits this method of birth control are numerous with some including its safety,
efficacy, convenience, low cost (free) and reduced post-partum bleeding.
Some of its disadvantages include the need for exclusive breastfeeding and reduced
vaginal lubrication.2
As with all methods of birth control, it is imperative for it to be implemented correctly
to prevent pregnancy. When used correctly, less than 1% of women will experience an
unintended pregnancy.
Outercourse
The definition of "outercourse" is variable and can be described in one of two ways.
One definition is no vaginal intercourse but the practice of other forms of sexual activity;
the other definition is no oral, anal, or vaginal penetration.2
Examples of outercourse include kissing, masturbation, manual stimulation, body-tobody rubbing, fantasy, sex toys, oral and anal sex.1
This method of birth control is a nearly 100% effective, however, this can be lessened
in cases in which semen or pre-ejaculate comes in contact with the vulva leading to
the possible introduction of sperm into the vagina.2
There are several benefits to using outercourse as birth control and include its safety, lack
of side effects, decreased risk of fluid exchange, as well as, relationship and sexual
experience enhancement. The disadvantages include difficulty abstaining and the
potential for vaginal contact with sperm.
Hormonal contraception
Hormonal contraception can be administered in a variety of methods including pills,
patches, injections and vaginal rings. Each of these methods provides an effective form of
birth control when used correctly; the decision of which method is best for you should be
discussed with your health care provider.
Some contraceptives work by using hormones that are similar to the hormones that women
produce naturally. These hormones are estrogen and progestogen.
Serious risks associated with hormonal contraception include heart attack, stroke, blood
clots (higher in patch users), high blood pressure, liver tumors, gallstones, jaundice (skin
yellowing).
These risks are higher in some women including those women who are: 35 or older,
overweight, have a history of certain inherited blood-clotting disorders, high blood
pressure, high cholesterol, on prolonged bed rest and those who are smokers.2
Pills
Contraceptive pills contain either a combination of the hormones estrogen and progestin
or progestin only to prevent pregnancy.2
Contraceptive pills are an extremely effective method of pregnancy prevention, however,
as with all other methods, it must be used correctly.
With correct use, only 1% women will experience an unintended pregnancy. However,
this increases significantly to 9% failure in women when taken incorrectly or
inconsistently.2,3
The efficacy of the pill is decreased in women who are overweight, those on certain
antibiotics, antifungals, some medications used to treat HIV and anti-seizure medications,
St. John's wort and gastrointestinal disturbances such as diarrhea and vomiting.1,2
Common side effects experienced with pill use which may be seen as a disadvantage to
pill use include intermenstrual bleeding, breast tenderness, nausea/vomiting, dizziness, GI
disturbances, weight gain, mood changes and visual problems.
Benefits of taking the pill include improved menstrual cramps, lighter periods, some
pelvic inflammatory disease (PID) protection, reduced bone thinning, improved acne,
protection against certain cancers, ectopic pregnancy and benign breast growths.
Additionally, the pill can help reduce iron deficiency anemia and PMS symptoms.2
Patches
Hormonal patches deliver certain hormones through the skin providing an effective form
of birth control.
When used as directed, the patch is very effective with less than 1% of women having
an unintended pregnancy, however, with incorrect use this increases to 9% failure.2,3
The efficacy of the patch is decreased in women who are overweight (over 198 lb.), those
on certain antibiotics, antifungals, some medications used to treat HIV, some anti-seizure
medications and St. John's wort.2,3
Common side effects experienced with patch that may be seen as a disadvantage to patch
use include intermenstrual bleeding, breast tenderness and nausea/vomiting.2
Injections
Given every 3 months, DepoProvera, is an injectable form of birth control that uses the
hormone progestin to prevent pregnancy.1-3
When used correctly, this is a highly effective method of birth control with less than
1% of women experiencing an unintended pregnancy; this rises to 6% failure when
taken inconsistently.
Benefits of injectable birth control include its safety and convenience, uterine cancer
prevention, safety with breastfeeding and lack of estrogen.2
Side effects may include irregular bleeding, heavy menses, libido changes, weight gain,
depression, abnormal hair growth, headaches, nausea, and breast tenderness.1,2
Additionally, there is generally a delay in return of normal fertility after discontinuing the
injection.
Risks associated with DepoProvera include bone thinning with an increased risk of
fracture and osteoporosis and ectopic pregnancy.
Vaginal rings
NuvaRing, is a flexible plastic ring that is inserted and left in the vagina for 3 weeks out of
each 4-week menstrual cycle. Estrogen and progestin are released into the vagina,
providing effective birth control.
When used correctly, this is a highly effective method of birth control, with less than
1% of women experiencing an unintended pregnancy; this increases to 9% failure
when used incorrectly.
Benefits of use include its safety and convenience, as well as quick restoration of fertility,
lighter periods, some pelvic inflammatory disease (PID) protection, reduced bone
thinning, improved acne, protection against certain cancers, ectopic pregnancy and
benign breast growths. Additionally, the NuvaRing can help reduce iron deficiency
anemia and PMS symptoms.2
In addition to intermenstrual bleeding, breast tenderness, and GI disturbances, the
NuvaRing can cause vaginal discharge, irritation and infection.1,2
Recent developments on hormonal contraception from MNT news
Birth control pill protects against endometrial cancer for decades
A new study published in The Lancet Oncology claims the birth control pill offers longterm protection against endometrial cancer. Researchers say that over the past decade
alone, the pill has prevented 200,000 cases of the disease in developed countries.
10 Most Common Birth Control Pill Side Effects
The oral contraceptive pill, commonly referred to as "the pill," is a form of hormonal
contraception taken by approximately 12 million women in the United States each year to
prevent pregnancy. What are the most common side effects?
Implanted devices
Intrauterine devices
The intrauterine device (IUD) is a T-shaped device inserted into the uterus by a qualified
health care provider. Currently, there are three IUDs available in the United States and
include the hormonal Mirena and Skyla IUDs and the non-hormonal copper IUD,
ParaGuard.
An IUD is a small T-shaped plastic and copper device that is inserted into your womb (uterus)
by a specially trained health care professional.
With less than 1% of women experiencing an unintended pregnancy, the IUD, which is
left in the uterus for several years, is an effective birth control method.1-3
The Mirena can be left in place for 5 years, Skyla for 3 and ParaGuard for 10-12 years.1,2
While generally safe, the IUD cannot be used by all women, and you should speak with
your health care provider to see if it safe for you personally. Some women may not be
able to use one or another IUD dependent on personal medical history.
As with any medication or device, there are risks and side effects. Depending on the IUD
used, it can fall out, cause uterine cramps, heavy menses, intermenstrual bleeding, an
infection called pelvic inflammatory disease (PID), infertility and uterine perforation.1,2
In addition, women who become pregnant are at a higher risk of having an ectopic
pregnancy, pelvic infection, miscarriage, pre-term labor.
The benefits of having an IUD include long-term pregnancy prevention, they are safe
when used during breastfeeding, fertility is easily restored following removal, hormonal
IUDs can help with menstrual cramps and bleeding, and if hormonal birth control is not
desired, Paraguard does not have an effect on your hormone levels.
Implantable rod
Another form of implanted birth control is the small implantable rod, Implanon or
Nexplanon.
Placed under the skin in the upper arm, this form of implantable hormonal birth control
provides pregnancy prevention for 3 years.
This is a safe and highly effective form of birth control with less than 1% of women
experiencing an unintended pregnancy during use.1-3 Some women may not be able
to use the implantable rod, so speaking with your health care provider is imperative.
The benefits of this method of birth control are numerous and include easy fertility
restoration following its removal, safe to use during breastfeeding, does not contain
estrogen, long-lasting and does not require daily medication.2
As with any method of birth control there are disadvantages including side effects such as
menstrual changes irregular bleeding, at times with intermenstrual spotting or long,
heavy menses, acne, weight gain, ovarian cysts, mood changes/depression, hair loss,
headaches, upset stomach/nausea, dizziness, breast soreness and decreased libido (sex
drive) and insertion site pain, skin scarring or infection.1,2 Also, certain medications may
decrease the efficacy of the rod and should be discussed with your health care provider.
Recent developments on implanted devices from MNT news
Intrauterine device (IUD) birth control method
An IUD is a small T-shaped plastic and copper birth control device that is inserted into the
uterus by a health care professional. IUDs are safe, effective and long-lasting.
Permanent sterilization
When choosing permanent sterilization, it is important to be sure that you have
completed child bearing or do not desire to become pregnant.
Permanent sterilization in women can occur by way of surgery such as getting your "tubes
tied" or the non-surgical approach using an implant. Men can undergo a vasectomy.
Benefits of female sterilization include its permanency and the fact that it is accomplished
without disturbing your natural hormones. Its permanency and limited reversibility can
also be seen as disadvantages if you change your mind following sterilization.2
The fallopian tubes rarely re-connect and place the woman at a higher risk of developing
an ectopic pregnancy.1
Types of female sterilization are discussed below and include:
Tubal ligation
During a tubal ligation, the fallopian tubes are surgically severed by several methods
including tying and cutting, sealing, clamping or removing a portion of the tube itself.2
Tubal ligation is highly effective with approximately less than 1% of women
experiencing an unintended pregnancy.1-3 Tubal ligation will immediately prevent an
unintended pregnancy.3
Tubal implant (Essure):
This non-surgical method of sterilization involves the placement of a coiled implant into
the fallopian tube which will scar over - blocking the tubes - approximately 3 months
following insertion.
Essure, a highly effective form of birth control, takes 3 months to be fully effective,
with less than 1% of women experiencing an unintended pregnancy.
Risks associated with this form of sterilization include incorrect placement, implant
dislodgement, incomplete scarring within the expected timeframe. Rarely women will
experience menstrual changes, infection, pain and bloodstream fluid build-up. Let other
health care providers know about the placement of Essure as certain medical procedures
can at times damage the implant.
Male sterilization
Men can undergo permanent sterilization by undergoing a vasectomy. During this
procedure, a man's vas deferens, which transport sperm, are blocked or closed to prevent
conception.
Vasectomy works by stopping sperm from getting into a man's semen. This means that when
a man ejaculates, the semen has no sperm and a woman's egg cannot be fertilized.
After 3 months, there should be no sperm in the fluid a man ejaculates during orgasm and
a man will need to undergo a semen analysis to ensure that there is no sperm present in
the ejaculate.
Vasectomy is a very effective form of birth control with a nearly 100% efficacy rate;
less than 1% of men will experience their vas deferens re-connecting.
Having a vasectomy has many benefits including its permanency (which can also be a
drawback), non-hormonal approach, does not affect erection or sex organs.
As with any procedure, there are some risks and include infection, bruising, hematoma,
hydrocele, granuloma, pain, tube re-connection (rare), decreased libido or inability to
have an erection (rare).2
At times, male sterilization can be reversed, however, there is no guarantee that there will
be successful restoration of fertility.2
Recent developments on sterilization from MNT news
30-day wait before tubal sterilization is unjust, say Ob/GYN experts
An article in the American Journal of Obstetrics & Gynecology urges obstetricians to
advocate for change to eliminate health care injustice in access to elective tubal
sterilization.
Vasectomy linked with aggressive prostate cancer risk
the largest and most comprehensive study of its kind, researchers from Harvard School of
Public Health in Boston, MA, find that vasectomy is associated with a small increased risk
of prostate cancer, and a larger increased risk for advanced or lethal prostate cancer.
Emergency contraception
Morning after pill
Levonorgestrel (e.g. Next Choice One Dose and Plan B) or ulipristal acetate (Ella) are
available forms of the morning after pill and should be taken as soon as possible following
unprotected intercourse to prevent an unintended pregnancy.1,2
Emergency contraception such as the morning after pill prevents pregnancy if you have not
used contraception or if you think your usual method of contraception has failed.
Many single dose morning after pills are available over-the-counter, however, some pills,
such as those with 2 doses, require a prescription in women under 16; Ella requires a
prescription for any woman, regardless of age.2
While the morning after pill prevents ovulation, it does not induce an abortion. Both types
of pills are effective up to 120 hours after unprotected sex. However, the pills containing
levonorgestrel are most effective when taken prior to 72 hours.1,2
When used within 72 hours after unprotected intercourse, the levonorgestrel
containing pills are about 89% effective in preventing an unwanted pregnancy.
Although they can be taken up to 120 hours following unprotected sex, the pills
efficacy decreases.2
Ella, on the other hand, is about 85% effective in preventing an unwanted pregnancy for
up to 120 hours.
Side effects of the pill are minor and include menstrual changes, breast tenderness,
dizziness, headaches, fatigue, and nausea and/or vomiting.1,2
In some cases, your regular birth control pill can be used as a form of emergency
contraception; speak with your health care provider to see if this is an option for you.
IUD
The ParaGard IUD, can not only provide long-term birth control as discussed here, but can
also be placed by your health care provider within 120 hours of unprotected intercourse to
avoid pregnancy.2,3
The IUD is 99.9% effective.2 See the section discussing IUDs for more detailed
information on risks, benefits and disadvantages.
Barrier methods
Barrier methods include the male condom, female condom, diaphragm, cervical cap,
shield and sponges.
There are two types of condoms: male condoms, which are worn on the penis, and female
condoms, which are worn inside the vagina.
Condoms
Male and female condoms are currently available.
Male condom
Male condoms are a safe and effective method of birth control and sexually transmitted
disease prevention, and are most effective when used in combination with spermicide.1,2
(Note: natural/lambskin condoms do not protect against STDs.)1,3
Due to its potentially irritative properties leading to skin breakdown, the spermicide,
Nonocynol-9, can increase some people's risk of contracting an STD if used several times
per day by those with an increased risk of contracting HIV and when used for anal sex.2
Male condoms can be used for vaginal, anal and oral sex.2
When used correctly, only 2% of women will experience an unintended pregnancy,
however, when used incorrectly this significantly rises to 18% failure.2,3
The benefits of condom use include safety, low cost, protection from both pregnancy and
STDs, and are widely available over-the-counter.2
Some disadvantages to condom use include latex allergy, cumbersome to use and change
in sexual sensation.
Female condom
Female condoms are a safe and effective method of birth control and sexually transmitted
disease prevention, which work by lining the vagina or anus with a rubber device.1-3
When used correctly, only 5% of women will experience an unintended pregnancy,
which rises to 20-21% failure when used incorrectly.
There are several benefits of using a female condom including safety, convenience,
availability to be purchased over-the-counter, can be used with latex allergy, safe with
both oil and water based lubricants, and sexual enhancement.2
Disadvantages to female condom use include irritation, change in sensation and possible
displacement of the condom.2
Diaphragm
Diaphragms are shallow silicone specially fitted cups used with spermicide that are
inserted into the vagina to prevent pregnancy.1-3
When used correctly, 6% of women will experience an unintended pregnancy,
however, when used incorrectly this rises to 12-15% failure.1-3
Benefits to diaphragm use include safety, efficacy, convenience, ability to be used when
breastfeeding, and no effect on hormones.2
Some disadvantages include insertion, timing of placement, potential for dislodging,
need for re-fitting by a health care provider.
Side effects include, potential for allergic reaction, frequent urinary tract infections,
vaginal irritation and the potential for toxic shock syndrome.1,2 (Note: The diaphragm
must remain in the vagina for 6 to 8 hours following sex and removed within 24 hours.)1
Cervical cap
Cervical cap, marketed in the US as FemCap, is a silicone cup fitted by a health care
provider, which sits in the vagina and covers the cervix.2
Efficacy of the cap is determined by a history of having a prior pregnancy or vaginal
delivery. In women who have never had a vaginal birth or been pregnant, 14% will
experience an unintended pregnancy, rising to 29% with a prior vaginal birth.2
Benefits to cervical cap use include safety, convenience, use when breastfeeding and that
it is non-hormonal.2
Disadvantages include inability to use when menstruating, insertion challenges, timing of
placement, potential for dislodging, abnormal pap smears, allergic reactions, potential
need for size change following pregnancy and risk of toxic shock syndrome.1,2
Spermicide is recommended when using the cap.1,2 (Note: The cervical cap must remain
in the vagina for 6 to 8 hours following sex and removed within 48 hours.)1
Cervical shield
Cervical shield, marketed as Lea's Shield, is a one-size silicone cup inserted into the vagina
covering the cervix. It is recommended that spermicide be used with use.1 (Note: The
cervical shield must remain in the vagina for 6 to 8 hours following sex and removed
within 48 hours.)1
Contraceptive sponge
Contraceptive sponges are spermicide-containing, plastic foam disks that are inserted
into the vagina; in the US, it is marketed under the name Today's Sponge.1,2
When used correctly, there is a 9% chance a woman who has never had a baby will
experience an unintended pregnancy, which rises to 12% failure when used
incorrectly.2
When used correctly in women who have given birth in the past, 20% of women will
experience an unintended pregnancy which rises to 24% failure when used incorrectly.2
Benefits of sponge use include safety and convenience, no hormones or need to be fitted
and the ability to use when breastfeeding.
Disadvantages include spermicide side effects, insertion challenges, potential to break,
vaginal irritation, vaginal dryness or a mess from the required liquid and risk of toxic shock
syndrome.1,2 (Note: Today's sponge must remain in the vagina for 6 hours following
pregnancy and is effective for 24 hours; it should be removed within 30 hours following
placement in the vagina.)1
Recent developments on barrier methods from MNT news
Condom use higher in young HIV-positive women with gender-equal views, study finds
Perceiving men and women as equals may encourage the practice of safer sex among
young women with HIV, a new study finds.
Diaphragm birth control: how safe and effective is it?
A diaphragm is a shallow, dome-shaped rimmed cup that is placed in the vagina to cover
the cervix, which blocks the uterine opening to prevent pregnancy.
Spermicide
Spermicides are available in many formulations including foams, gels, creams, films,
suppositories and tablets.
Withdrawal is also called coitus interruptus or the "pull out method." A man who uses
withdrawal will pull his penis out of the vagina before ejaculation.
While they can be used alone as birth control, their efficacy is increased when used in
combination with other barrier methods (discussed above).
When used correctly, the rate of unintended pregnancy is about 15% of women; this
rises to 28-29% failure when used incorrectly or inconsistently.
Certain medications used to treat yeast infections can negatively impact the efficacy of
spermicide.
To ensure proper use, read the package insert carefully for instructions. Due to its
potentially irritative properties leading to skin breakdown, the spermicide, Nonocynol-9,
can increase some people's risk of contracting an STD if used several times per day, by
those with an increased risk of contracting HIV and when used for anal sex.2
Benefits to using spermicide include its ease of use and convenience, wide availability,
over-the-counter and safety during breastfeeding. Additionally, it does not cause
hormonal alterations, as with hormonal preparations of birth control.
Some disadvantages to spermicide use include potential for an allergic reaction or
irritation, solution may leak from the vagina, and decreased efficacy if used incorrectly.
Withdrawal method
Withdrawal or the "pull out" method is when a man withdraws the penis from the vagina
prior to ejaculation. While this method of birth control can be effective, its efficacy is
lessened if pre-ejaculate is released into the vagina prior to withdrawing or on the vulva.1,2
When used correctly, 4% of women will experience an unintended pregnancy; this
rises to 27% failure when used incorrectly.2
The benefits of using the withdrawal method include safety, free cost and prescription
free.2
The major drawback includes the need for self-control; men with a history of premature
ejaculation, teens and the sexually inexperienced should not use this method of birth
control.
Speak with your health care provider to see what method of birth control is best for
you, for detailed instructions on how to use each method or with any questions you
may have on pregnancy and STD prevention.
Not all methods prevent STD transmission, so if STD and pregnancy prevention are
desired, using one or more methods of birth control may be recommended.
Written by Lori Smith BSN MSN CRNP