Birth control: What is the best option?
The decision to use birth control and the method of choice is a personal one. A healthcare provider or birth control clinic can guide the decision and advise which method may be best for each individual to safely and effectively prevent pregnancy.
While most methods of birth control are highly effective when used correctly, there is always a chance that any method will fail. Weighing the options with a doctor and partner is an important part of the decision-making process.
Some things to consider when choosing a birth control method are:
- The individual's health status.
- The 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.
There are several methods of birth control that require no device or medication, but they may be less reliable than other options.
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.
Not having any sexual intercourse including vaginal, anal, or oral, is referred to as continuous abstinence and is the only way to 100 percent avoid both pregnancy and contracting an STD.
Abstinence is both safe and effective and has many benefits; there are no side effects and it is free. However, there are times when abstinence is difficult to maintain.
The likelihood of conceiving before a baby is 6 months are lower if the mother is breast-feeding.
Breast-feeding is not considered a method of birth control beyond 6 months of age, but the chances of becoming pregnant before the baby is 6 months are lower when exclusively breast-feeding.
Exclusive breast-feeding means the baby is at the breast for all feedings, day and night. After delivery, exclusively breast-feeding mothers will not get their periods.
Once the baby gets anything other than breast-milk by mouth, even for one feeding, even with previously pumped breastmilk, the mother's body will ovulate and the menstrual cycles will continue.
What makes this method less than ideal is that the woman will ovulate first and then about 2 weeks later get her first period once the cycles have begun again. It is unlikely she will know she has ovulated and if she has unprotected intercourse, she will get pregnant and never get her first period.
Most doctors will recommend another birth control method in addition to breast-feeding. The benefits of this method of birth control are its safety, efficacy, convenience, and low cost (free). Breast-feeding itself has lifelong health benefits for both the mother and baby.
Some of its disadvantages include the need for exclusive breast-feeding and reduced vaginal lubrication. When used correctly, approximately 2 percent of women will experience an unintended pregnancy, but this method is less likely to be used correctly.
One definition of outercourse is no vaginal intercourse but the practice of other forms of sexual activity; the other definition is no oral, anal, or vaginal penetration.
Examples of outercourse include kissing, masturbation, manual stimulation, body-to-body rubbing, fantasy, sex toys, oral, and anal sex.
This method of birth control is a nearly 100 percent effective if carefully used, but it is seldom carefully used. Sometimes, semen or pre-ejaculate can come in contact with the vagina, making conception a risk.
Because sperm are mobile, they can find their way inside the vagina and up to the egg. Benefits of outercourse include its safety, lack of side effects, decreased risk of fluid exchange, and new relationship and sexual experiences.
The disadvantages include difficulty abstaining and the potential for vaginal contact with sperm. Outercourse does not protect from sexually transmitted diseases.
Hormonal contraception can be administered in a variety of ways, including pills, patches, injections, intrauterine devices, and vaginal rings.
These risks are higher in some women, including women who are:
- 35 or older
- have a history of certain inherited blood-clotting disorders
- high blood pressure
- high cholesterol
- on prolonged bed rest
Hormonal methods do not protect against sexually transmitted disease and a condom will need to be used as well if either partner has had intercourse before.
Contraceptive pills contain either a combination of the hormones estrogen and progestin or just progestin. Contraceptive pills are an extremely effective method of pregnancy prevention, however, as with all other methods, they must be used correctly.
With correct use, only 1 percent of women will experience an unintended pregnancy.
The pill works less well in women who are taking:
It can also work less well in women who are overweight or experiencing diarrhea and vomiting.
Common side effects include:
- bleeding between periods
- breast tenderness
- nausea or vomiting
- gut disturbances
- weight gain
- mood changes
- 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.
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 percent of women having an unintended pregnancy.
The patch is less effective in women who are overweight, or taking any of the medications mentioned in the contraceptive pill section above.
Common side effects experienced with patches include intermenstrual bleeding, breast tenderness, and nausea or vomiting.
Given every 3 months, DepoProvera is an injectable form of birth control that uses the hormone progestin to prevent pregnancy.
When used correctly, this is a highly effective method of birth control with less than 1 percent of women experiencing an unintended pregnancy.
Benefits of injectable birth control include its safety and convenience, uterine cancer prevention, safety with breastfeeding, and lack of estrogen.
Side effects can include:
- irregular bleeding
- heavy periods
- libido changes
- weight gain
- abnormal hair growth
- breast tenderness
Additionally, after stopping the injections, there is a delay before normal fertility returns.
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 percent of women experiencing an unintended pregnancy.
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 symptoms of PMS.
Side effects can include:
- bleeding between periods
- breast tenderness
- GI disturbances
- vaginal discharge
An intrauterine device is a highly effective method of birth control.
The intrauterine device (IUD) is a T-shaped device inserted into the uterus by a doctor.
Currently, there are three IUDs available in the United States, the hormonal Mirena and Skyla IUDs and the non-hormonal copper IUD, Paragard. Less than 1 percent of women experience an unintended pregnancy with IUDs.
The Mirena can be left in place for 5 years, Skyla for 3, and Paragard for 10-12 years. While generally safe, the IUD cannot be used by all women.
Because this is a foreign device inserted into the vagina, the incidence of infection increases; therefore, this method is recommended for women who are in a monogamous relationship. As with any medication or device, there are risks and side effects. Depending on the IUD used, it can fall out, or cause:
- uterine cramps
- heavy periods
- intermenstrual bleeding
- an infection called pelvic inflammatory disease (PID)
- uterine perforation
In addition, women who become pregnant are at a higher risk of having an ectopic pregnancy, pelvic infection, miscarriage, danger to the baby, and 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 Paragard does not have an effect on hormone levels.
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. However, not all women can use this type of device.
This is a safe and highly effective form of birth control with less than 1 percent of women experiencing an unintended pregnancy during use.
The benefits of this method of birth control are numerous and include easy fertility restoration following its removal, safe use during breastfeeding, it does not contain estrogen, it is long-lasting, and does not require daily medication.
Side effects can include:
- irregular menstrual bleeding
- heavy periods
- weight gain
- ovarian cysts
- mood changes/depression
- hair loss
- upset stomach or nausea
- breast soreness
- decreased sex drive
- insertion site pain
- skin scarring
Also, certain medications can make it less effective.
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 be achieved by 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 natural hormones. Its permanency and limited reversibility can also be seen as disadvantages if the individual changes their mind following sterilization.
Types of female sterilization include:
During a tubal ligation, the fallopian tubes are surgically severed. This can be achieved in a number of ways, including tying and cutting, sealing, clamping, or removing a portion of the tube itself.
Tubal ligation is highly effective with less than 1 percent of women experiencing an unintended pregnancy.
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 after insertion.
Less than 1 percent of women experience 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 fluid build-up in the blood.
Men can undergo permanent sterilization by having a vasectomy. During this procedure, a man's vas deferens, which transport sperm, are blocked or closed to prevent conception.
After 3 months, there should be no sperm in the fluid a man ejaculates during orgasm. He 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 percent success rate; less than 1 percent 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, and it does not affect erection or sex organs.
As with any procedure, there are some risks, including:
- tube re-connection (rare)
- decreased libido or inability to have an erection (rare)
At times, male sterilization can be reversed, however, there is no guarantee that there will be successful restoration of fertility.
Morning after pill
The morning after pill, pictured here, contains powerful hormones that can prevent and unintended pregnancy.
Levonorgestrel (e.g. Next Choice One Dose and Plan B) or ulipristal acetate (Ella) are forms of the morning after pill and should be taken as soon as possible following unprotected intercourse to prevent an unintended pregnancy.
Many single dose morning after pills are available over the counter, however, some pills, such as those with two doses, require a prescription in women under 16 depending on the state; Ella requires a prescription for any woman, regardless of age.
Talk to a pharmacist if you are wanting emergency contraception and need guidance.
When used within 72 hours after unprotected intercourse, the levonorgestrel containing pills are about 89 percent effective in preventing an unwanted pregnancy. Although they can be taken up to 120 hours following unprotected sex, the pills efficacy decreases.
Ella, on the other hand, is about 85 percent 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.
The Paragard IUD, not only provides long-term birth control as discussed above, but can also be inserted within 120 hours of unprotected intercourse to avoid pregnancy.
Barrier methods include the male condom, female condom, diaphragm, cervical cap, shield, and sponges.
Male condoms are a safe and effective method of birth control and sexually transmitted disease prevention; they are most effective when used in combination with spermicide. (Note: natural/lambskin condoms do not protect against STDs.)
Male condoms can be used for vaginal, anal, and oral sex.
When used correctly, only 2 percent of women will experience an unintended pregnancy.
The benefits of condom use include safety, low cost, protection from both pregnancy and STDs, and are widely available over the counter.
Some disadvantages to condom use include latex allergy and change in sexual sensation.
Diaphragms are shallow silicone cups used with spermicide that are inserted into the vagina to prevent pregnancy. Your doctor will fit you for the correct diaphragm and they can be reused. Spermicidal cream or foam must be used with the diaphragm.
When used correctly, 6 percent of women will experience an unintended pregnancy.
Benefits to diaphragm use include safety, efficacy, convenience, ability to be used when breast-feeding, and no effect on hormones.
Some disadvantages include insertion, timing of placement, potential for dislodging, and the need for re-fitting by a doctor.
Side effects include:
- potential for allergic reaction
- frequent urinary tract infections
- vaginal irritation and the potential for toxic shock syndrome
(Note: The diaphragm must remain in the vagina for 6-8 hours following sex and removed within 24 hours.)
Cervical cap, marketed in the United States as FemCap, is a silicone cup fitted by a doctor, which sits in the vagina and covers the cervix.
In women who have never had a vaginal birth or been pregnant, 14 percent will experience an unintended pregnancy, rising to 29 percent with a prior vaginal birth.
Benefits to cervical cap use include safety, convenience, use when breastfeeding, and that it does not effect hormones.
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.
Spermicide is needed when using the cap.
(Note: The cervical cap must remain in the vagina for 6-8 hours following sex and removed within 48 hours.)
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. (Note: The cervical shield must remain in the vagina for 6-8 hours following sex and removed within 48 hours.)
Contraceptive sponges are spermicide-containing, plastic foam disks that are inserted into the vagina; in the U.S., it is marketed under the name Today's Sponge.When used correctly, there is a 9 percent chance a woman who has never had a baby will experience an unintended pregnancy.
When used correctly in women who have given birth in the past, 20 percent of women will experience an unintended pregnancy.
Benefits of sponge use include safety and convenience, no hormones or need to be fitted, and the ability to use when breast-feeding.
- spermicide side effects
- insertion challenges
- potential to break
- vaginal irritation
- vaginal dryness
- risk of toxic shock syndrome
(Note: Today's Sponge must remain in the vagina for 6-8 hours following sex and is effective for 24 hours. After 24 hours, it should be removed and replaced following placement in the vagina.)
Spermicides are available in many formulations including foams, gels, creams, films, suppositories, and tablets. These products are intended to kill sperm.
While they can be used alone as birth control, they are best when used in combination with other barrier methods. Spermicide is used with diagrams and cervical caps and can be used with condoms to reduce the chance of pregnancy.
When used correctly, the rate of unintended pregnancy is about 15 percent of women.
Certain medications used to treat yeast infections can negatively impact how well spermicides work.
Benefits to using spermicide include its ease of use and convenience, wide availability, and safety during breast-feeding. 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, and solution may leak from the vagina.
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.
When used correctly, 4 percent of women will experience an unintended pregnancy.The major drawback is 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. If ejaculation occurs around the vulva, or sperm end up near the vagina because they are on a persons hands, for example, pregnancy can still occur because sperm are mobile.
Speak with your healthcare 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.