Contraception: What Are Your Options?

contraceptive options There are many types of birth control now available. Talk with your doctor to about which option may be best for you. Your plans about future pregnancy, lifestyle, and overall health can all play a role in your decision.

What Is the Best Birth Control Method for Me?

Your doctor can help narrow birth control options. Review information they provide to better understand benefits and problems with each type. Factors that may play a role include:

  • Your health
  • How often you have sex
  • Number of partners
  • Desire to have children in the future
  • Possible side effects
  • How comfortable you would be with the method

Note : Not having sex is the only 100% effective way to avoid pregnancy and sexually transmitted diseases (STDs), including HIV infection.

Long Lasting, Low Effort

This type of birth control lasts for a long time and does not need regular care from you. It is effective soon after implant, often within a week. They can also be reversed. This means the device can be removed if you wish to become pregnant. Low maintenance choices include:

Birth Control Implant is a small rod that is placed under the skin of upper arm. The rod releases the hormone progestin. Implants are 99% effective at preventing pregnancy. It may take up to a week after implant for it to be effective and then can last up to 5 years. The implant can cause some pain or discoloration in the arm for some. Progestin can also cause heavier or longer periods than your normal.

Intrauterine device (IUD) is a T-shaped device inserted through the vagina and into the uterus by a doctor. It prevents sperm from reaching the egg. IUDs may be Copper or hormonal. Copper IUDs can last up to 10 years. They can be a good choice for those who can't use hormones because of health issue like cancer. Hormonal IUDs release progestin and may last 3 to 6 years depending on the specific brand. They can be a good choice for those that can't take birth control with estrogen. IUDs are 99% effective at preventing pregnancy. They can cause some pain and cramping after implant but it usually passes in a few days.

The implant and hormonal IUD both release progestin. This hormone can cause changes to period and cramping. Some may be helpful changes, like less cramping or bleeding. Others may have heavier or longer periods. It may take a few cycles for the body to adjust. Neither implants nor IUDs protect against sexually transmitted infections.

Regular Doses

This method of birth control is short-term and will require frequent action. You may need to take action daily, weekly, or monthly. These methods of birth control are 99% effective when used as recommended. Human error may decrease effectiveness to 91% (94% for shots). Pregnancy is possible after stopping any of the birth control below. Choices include:

  • Birth control pill —must be taken every day. Other medicine or illnesses may also decrease the effectiveness. The pills may have a combination of estrogen and progestin or have progestin alone. Progestin only pills are also called mini pills.
  • Birth control patch —is replaced every week. It is important to replace it on the same day every week. The patch releases estrogen and progestin through the skin. It may be placed on arm, belly, back or buttocks. You can still shower, bathe, or swim with it on.
  • Birth control vaginal ring —you will need to place a flexible ring in your vagina every few weeks. You will need to follow the schedule recommended for your product. The ring releases estrogen and progestin.
  • Birth control shot —is taken every 3 months. You may need to go to a clinic or you may be able to give yourself the injections. The shot has progestin. Pregnancy can happen if you forget to get your shot on time. This can decrease effectiveness from 99% to 94%.

Hormone treatment can cause changes to period and cramping. Some may be helpful changes, like less cramping or bleeding. Others may have heavier or longer periods. It may take a few cycles for the body to adjust. These methods of birth control do not protect against sexually transmitted infections.

Used During Sexual Activity

These methods do not rely on hormones to prevent pregnancy. Instead, they work by blocking sperm from entering the vagina. They are temporary, placed before sex and removed after. They can be very effective when used properly. However, misuse or misplacement can increase the risk of pregnancy.

Condoms prevent sperm from getting into the vagina. They are 98% effective when they are used as they should. Human error reduces effectiveness to 85%. Latex or plastic condoms can also protect against STIs.

Internal condoms are inserted into the vagina. They can help to prevent pregnancy and STIs. They are 95% effective when they are used as they should. Human error reduces effectiveness to 79%.

Spermicide is a cream or gel that can kill sperm. It can be applied directly to the vagina. Spermicide alone is about 72% effective. It is more effective when used with other birth control such as diaphragm or sponge.

A diaphragm, sponge, and cap can be placed over the cervix to block sperm. They are most effective when used along with spermicide. These devices can prevent pregnancy but do not protect against STIs:

  • Diaphragm is a flexible cup that you insert into the vagina and remove after sex. They are 94% effective against pregnancy when they are used as they should. Human error reduces effectiveness to 88%.
  • A birth control sponge is inserted into the vagina before sex and removed after. They are 80% to 91% effective against pregnancy when they are used as they should. Human error reduces effectiveness to 76% to 88%.
  • Cervical cap is inserted into the vagina before sex and removed after. It is 71% to 86% effective against pregnancy.

Permanent Birth Control

These surgeries will prevent sperm or egg release. They are meant to be a permanent form of birth control. This means a pregnancy will not be possible after the procedure. The procedures are 99% effective. Surgical procedures include:

  • Tubal ligation —blocks fallopian tubes from releasing eggs.
  • Vasectomy —vas deferens tubes are blocked to prevent sperm release.

Natural Family Planning

Pregnancy may be prevented by:

  • Fertility Awareness Method —tracks ovulation and avoids sex or uses other birth control when fertility is high. You will need to track cycle for a few months to better understand when fertile period is. Can be 76%-88% effective.
  • Withdrawal Method —is pulling penis out of vagina before ejaculation. Human error can reduce effectiveness to about 78%.
  • Breastfeeding —during first 6 months after giving birth. Exclusive breastfeeding can stop the release of an egg but it requires a regular breastfeeding schedule. The use of formula to supplement feeding can allow enough of a break for pregnancy to happen. Its is 98% effective for 6 months after birth with exclusive breastfeeding.

Emergency Contraception

Sometimes birth control plans fail. Doses or steps may be missed, condoms can break, or rhythm may be off. Emergency contraception (EC) can help if your first plan fell through. Sperm can remain in the body for up to 6 days after sex. It can fertilize any egg that arrives in this time. EC works by keeping sperm away from egg. There are two methods:

  • Emergency contraceptive pill —there are 2 types. They stop the body from releasing an egg. The pills can be taken up to 5 days after sex. The pill may be over-the-counter or prescription only. Weight may also play a role in the choice of pill.
  • Copper IUD —may be inserted up to 5 days after unprotected sex. Sperm does not like copper. The IUD will keep sperm away from egg.

EC works best when taken as soon as possible. It is not effective if sperm already fertilized the egg, it does not cause an abortion. EC is not as effective as birth control options listed above. It should only be used as a back up when needed.

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org

WomensHealth.gov—US Department of Health and Human Services
http://www.womenshealth.gov

CANADIAN RESOURCES:

Sex Information and Education Council of Canada
http://www.sieccan.org

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

REFERENCES:

Adrenal incidentaloma. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/contraception-overview. Accessed April 13, 2021.

American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 186: Long-acting reversible contraception: Implants and intrauterine devices. Obstet Gynecol 2017 Nov;130(5):e251.

Berens P, Labbok. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeed Med . Jan-Feb 2015;10(1):3.

Birth control. Planned Parenthood website. Available at: https://www.plannedparenthood.org/learn/birth-control. Accessed April 13, 2021.

Birth control guide. United States Food and Drug Administration website. Available at: https://www.fda.gov/consumers/free-publications-women/birth-control. Accessed April 13, 2021.

Gompel A, Ramirez I, et al. Contraception in cancer survivors - an expert review Part I. Eur J Contracept Reprod Health Care . 2019 Jun;24(3):167.

Last reviewed April 2021 by EBSCO Medical Review Board  Last Updated: 4/13/2021