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:
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 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.1-3
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%.1-3
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.
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-to-body 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 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.
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
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
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
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.1-3
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.
NuvaRing, is a flexible plastic ring that is inserted and left in the vagina for 3 weeks out of each 4-week menstrual cycle.1-3 Estrogen and progestin are released into the vagina, providing effective birth control.2
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.2
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
A new study published in The Lancet Oncology claims the birth control pill offers long-term 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.
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?
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.
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.1-3
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
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.
On the next page we look at more birth control methods, their effectiveness and side effects.