Birth Control Methods

What is contraception?

Birth control and contraception are terms used to refer to ways to prevent pregnancy. There are many ways to prevent pregnancy when you are having sexual intercourse. They include the use of hormone medicines, contraceptive devices (barriers and IUDs), periods of avoiding sex, spermicides, withdrawal, and devices and surgery for sterilization. Some birth control methods work better than others. What follows is basic information on these different methods. This will help you decide which method may be right for you and your lifestyle.

Remember that you need to consider whether the method you choose will also protect you from getting sexually transmitted diseases (STDs). Sometimes you may need to use more than one method to prevent pregnancy AND infection. The latex or polyurethane male condom and the female condom are the best protection currently available against STDs. They are the only birth control methods that will reduce your risk of being infected with HIV, the virus that causes AIDS. Hormones, natural family planning, and withdrawal do not give any protection against infection.

What are the different methods of contraception?

Hormone Medicines

Birth control pills (also called oral contraceptives), shots, vaginal rings, skin patches, and implants contain manufactured forms of the hormones estrogen and/or progesterone. The hormones stop a woman's ovaries from releasing an egg each month. They also have some effects on the uterus and cervix that make it harder for sperm to enter the uterus or for a fertilized egg to stay in the uterus.

• A woman takes birth control pills according to a daily schedule prescribed by her healthcare provider.
• The Depo-Provera shot, which contains progesterone, may be given every 3 months to prevent pregnancy during that time.
• Vaginal rings are flexible rings that are inserted into the vagina for 3 weeks. They are then removed for 1 week, and then replaced with a new ring for another 3 weeks. The rings release hormones into your body.
• Patches containing hormones may be put on the skin. Each patch is worn for 1 week then thrown away. This is repeated 2 more times with 2 more patches. Then no patch is worn for 1 week.
• The implant (Implanon) is a single small, thin capsule containing progesterone that is placed under the skin of a woman's arm. The implant prevents pregnancy for up to 3 years, the length of time recommended for leaving the implant in place.

You will need to see your healthcare provider to get any of these hormonal forms of birth control.

Contraceptive Devices

Most contraceptive devices form physical or chemical barriers that stop sperm from entering the uterus.

The male condom is a tube of thin material (latex rubber or polyurethane is best). It is rolled over the erect penis just before any contact of the penis with a woman's genitals. The male condom provides the best protection against STDs, including HIV and hepatitis B.

The female condom is a 7-inch-long pouch of polyurethane with two flexible rings. It is inserted into the vagina before sex. It covers the cervix, vagina, and area around the vagina. The female condom also provides protection against some STDs, including HIV and hepatitis B.

Spermicides are sperm-killing chemicals. They are available as foam, jelly, foaming tablets, vaginal suppositories, or cream. They are inserted into the vagina no longer than 30 minutes before sex. Spermicides should NOT be used alone. They should be used with another form of birth control, such as a condom, diaphragm, or cervical cap for increased effectiveness. Spermicides do not protect against STDs.

The sponge is a round, soft sponge of polyurethane foam. It is soaked with a spermicide. No more than 24 hours before intercourse, the sponge is dampened and then inserted into the vagina against the cervix.

You can buy condoms, spermicides, and sponges at drug and grocery stores without a prescription.

The diaphragm is a soft rubber dome stretched over a flexible ring. No more than 6 hours before sex, you fill the diaphragm with a spermicidal jelly or cream and insert it into the vagina.

The cervical cap is made of latex rubber or plastic and is shaped like a cup. It is smaller and more rigid than a diaphragm. No more than 24 hours before sex, the cap is filled with a spermicidal jelly or cream and inserted into the vagina and over the cervix.

The intrauterine device (IUD) is a small plastic device containing copper or hormones. Instead of stopping sperm from entering the uterus, the IUD changes the physical environment of the reproductive tract. This change prevents the egg from being fertilized or implanting and growing in the uterus. An IUD is inserted into the uterus by your healthcare provider. Depending on the type, it may be kept in the uterus 5 to 10 years before it must be replaced.

Both the diaphragm and cervical cap require a fitting by your healthcare provider. If you choose to use an IUD, you will need to see your provider for insertion and removal of the IUD.

Natural Family Planning (Periodic Abstinence) and the Withdrawal Method

The natural family planning methods of birth control do not depend on any devices or drugs. To prevent pregnancy you cannot have sex for a short period of time during each menstrual cycle. To know when it is safest to have sex, a woman must record her body temperature and changes in cervical mucus every day (the symptothermal method). For most people, other methods of birth control are more reliable.

The withdrawal method involves removing the penis from the vagina just before semen starts coming out (ejaculation). Often sperm get into the vagina before or during withdrawal, making this method unreliable and pregnancy after it common.

Sterilization

Sterilization is the closing of the tubes that normally carry the sperm or eggs with surgery or special devices. A woman or man who has these procedures will no longer be able to conceive children.

When a woman is sterilized, her fallopian tubes, which carry the eggs from the ovaries to the uterus, are sealed off. The surgical procedure for this is called a tubal ligation. A procedure that uses hysteroscopy (a lighted instrument placed into the uterus through the vagina) rather than surgery is a new alternative to ligation. It involves blocking the tubes by placing tiny devices that look like coiled springs into the tubes. (Other methods of birth control must be used for 3 months after the devices are placed in the tubes.)

In a vasectomy a surgeon cuts and seals off the tubes that carry sperm in a man.

These procedures are usually permanent methods of birth control. They can sometimes be reversed to restore the ability to conceive, but the reversal procedures are costly and not always successful. In women, the risk of ectopic (tubal) pregnancy is increased.

Hysterectomy is another permanent method of sterilization procedure in which the uterus is removed. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus. Other female organs, such as the ovaries and fallopian tubes may also be removed when the uterus is removed. Hysterectomy is usually only done if there are other problems with the female organs, such as fibroids or abnormal menstrual bleeding.

Emergency Contraception (Plan B)

For women who have had unprotected intercourse and are at risk for pregnancy, a type of oral contraceptive pill that contains the progestin hormone levonorgestrel can be taken to prevent pregnancy. It is highly effective at preventing pregnancy (98%) if taken within 12 hours after intercourse. However, the longer the delay in taking the pills, the lower the success rate. For example, the chance of preventing pregnancy is only 50% if the pills are not started until 120 hours (5 days) after intercourse. In many areas, the pills are available without a prescription at pharmacies.

How well do the various methods prevent pregnancy?

The following chart shows the typical failure rates of birth control methods discussed in this handout. The failure rate is the number of pregnancies expected per 100 women during 1 year of using each method. The rates vary, depending on how correctly and consistently each method is followed. If a method is used perfectly, the failure rate is lower than the typical rate shown here. Use of more than one method (for example, birth control pills and condoms) can decrease the chances of failure.

 
                                Percentage of Women Experiencing 
 Birth Control                 an Unintended Pregnancy within the 
    Method                            First Year of Use 
----------------------------------------------------------------------
                                 Typical Use    Perfect Use 
----------------------------------------------------------------------
Spermicides                          20%          6%
Natural Family Planning
  (Periodic Abstinence)              25%          9%
  Symptothermal method               25%          2%
Withdrawal                           27%          4%
Cervical Cap with Spermicide
  Women who have given birth         32%         26%
  Women who have not given birth     16%          9%
Diaphragm with Spermicide            16%          6%
Condom
  Female                             21%          5%
  Male                               15%          2%
Sponge
  Women who have given birth         32%         20%
  Women who have not given birth     16%          9%
Pill                                  8%          0.3%
IUD
  with copper                         0.8%        0.6%
  with hormones             less than 1%   less than 1%
Shot (Depo-Provera)                   0.3%        0.3%
Implant                               0.05%       0.05%
Patch (Ortho Evra)                    8%          0.3%
Vaginal ring (NuvaRing)               8%          0.3%
Female Sterilization                  0.5%        0.5%
Male Sterilization                    0.15%       0.1%
No Method                            85%         85%
-------------------------------------------------------------
Note: These failure rates are modified from the Guttmacher 
Institute. Facts on contraceptive use. Available at: 
http://www.guttmacher.org/pubs/fb_contr_use.html. "Typical 
use" refers to a method's reliability in real life, when 
people do not always use a method properly.

As you can see, other than sterilization, the IUD and hormone medicines such as birth control pills, an implant, patch, shot, or vaginal ring are the most effective methods of birth control. However, the diaphragm and condom can be nearly as reliable if they are used properly.