Birth Control: Birth Control Methods

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Birth Control Methods

There are many methods of birth control. Learn about the different kinds of birth control to help you choose the best one for you. When making your choice, also consider that only a condom will help protect you from sexually transmitted diseases (STDs). To protect yourself and your partner against STDs, use a condom (along with your chosen birth control method) every time you have sex.

Hormonal methods

Hormonal methods are very reliable means of birth control. Hormonal methods use two basic formulas:

• Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills ("the Pill"), skin patches, and rings.
• Progestin-only hormonal methods include pills, also called "mini-pills"; injections (Depo-Provera); and implants (Implanon). If you cannot take estrogen, a progestin-only method may be an option for you. See information about the progestin-only Mirena intrauterine device (IUD) below under IUDs.

Combination and progestin-only methods are prescribed for women for different reasons. Compare the recommendations for and against combination and progestin-only hormonal birth control pills, patches, implants, and rings. Each type of method has its pros and cons.

• Combination pills may reduce acne, pain during ovulation, and premenstrual symptoms. Both types of pill reduce heavy bleeding and cramping. Unlike the combination pill, the progestin-only pill can be taken by almost all women, including those who are breast-feeding, although it must be taken at the same time each day to be effective. (Combination pills are also taken daily but without as much attention to the time of day.) When you first start taking either type of birth control pill, it is necessary to use a backup birth control method for the first week.
• Patches or vaginal rings are similar to combination pills, but they don't require taking a daily pill. The patch is changed weekly, and the ring is changed monthly (with 1 week off after 3 weeks of use).
• Some birth control pills reduce severe mood and physical symptoms that some women get before they start their monthly periods. These symptoms are called premenstrual dysphoric disorder (PMDD). There are birth control pills that are helpful for women who have migraines with their periods. There are also birth control pills for women who want fewer periods or who want to stop having periods.
• The progestin-only (Depo-Provera) shot does not require taking a daily pill. Instead, you see your health professional once every 3 months for the injection.
• The progestin-only hormone implant (Implanon) releases hormones that prevent pregnancy for about 3 years. It must be inserted and removed by a trained health professional. The actual implant is about the size of a matchstick and is inserted under the skin on the inside of the upper arm.

Intrauterine device (IUD)

An intrauterine device (IUD) is a small device that is placed in the uterus to prevent pregnancy. There are two main types of IUDs: copper IUDs (such as Paragard) and hormonal IUDs (such as Mirena). Once an IUD is in place, it can provide birth control for 5 to 10 years, depending on the type. Unlike IUDs that were used in the 1970s, present-day IUDs are small, safe, and highly effective.

If a sexually transmitted disease is present at the time the IUD is inserted, the infection can be carried into the uterus. This can lead to pelvic inflammatory disease (PID), which can lead to infertility.⁴

The hormonal IUD (Mirena) typically reduces menstrual flow and cramping over time. On the other hand, the copper IUD can cause longer and heavier periods. However, the progestin IUD can have other side effects, including spotting, mood swings, and breast tenderness. These side effects occur less frequently than with other progestin-only methods.

Barrier methods

Barrier methods (including the diaphragm; cervical cap; Lea's Shield; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) prevent sperm from entering the uterus and reaching the egg. Typically, barrier methods are not highly effective, but they generally have fewer side effects than hormonal methods or IUDs. Spermicides and condoms should be used together or along with another method to increase their effectiveness. Barrier methods can interrupt lovemaking because they must be used every time you have sex.

Condoms (male or female) should always be used if you are at risk of getting or spreading a sexually transmitted disease, such as genital herpes, chlamydia, or HIV.

Fertility awareness (periodic abstinence or natural family planning)

Fertility awareness requires that a couple chart the time during a woman's menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a good choice if you need a highly effective form of birth control.

Breast-feeding may work as a form of birth control in the first 6 months after giving birth if you follow specific guidelines. For this method to work, you must breast-feed your baby every time. You can't use formula or other supplements. This is called the lactational amenorrhea method (LAM). Although LAM has been shown to be 98.5% effective when these conditions are met, many doctors recommend that you use another birth control method.⁵

Permanent birth control (sterilization)

Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is one of the most effective forms of birth control. Sterilization is intended to be permanent, and although you can try to reverse it with another surgery, reversal is not always successful.

• Tubal ligation or implants. Tubal ligation is a surgical procedure where the fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked. A new nonsurgical sterilization technique uses a small metal coil, or tubal implant , inserted up into each fallopian tube. Over time, scar tissue grows around each tubal implant, permanently blocking the tubes. Most women are able to return home within a couple of hours after either procedure. You must use another form of birth control for 3 months after receiving tubal implants. At 3 months, you will need to have an X-ray taken to make sure that your tubes are closed.
• Vasectomy. In this minor surgery, the vas deferens, the tubes that carry sperm from the testicles to the seminal fluid (semen), are cut and blocked so that the semen no longer contains sperm . This does not interfere with a man's ability to have an erection or enjoy sex. Men must have a sperm count check after having a vasectomy before relying on this for birth control.

Female sterilization is more complicated, has higher risks of problems after surgery, and is more expensive than male sterilization.

Contraception following pregnancy

Birth control is an important consideration after you have had a child. Your ability to become pregnant again may return within 3 to 6 weeks after childbirth. Think about what type of birth control you will be using, and make a plan during your pregnancy. Start using birth control as soon as possible after childbirth. Most methods of birth control can be started soon after childbirth, although some may not be recommended if you are breast-feeding.

Understanding how pregnancy occurs

You can best evaluate the advantages and disadvantages of the different methods of birth control when you understand:

• How pregnancy occurs.
• How each method prevents pregnancy.

Last updated:	May 22, 2008
Author:	Bets Davis, MFA
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Maria G. Essig, MS, ELS, Pat Truman, MATC