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What are my birth control options?
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If you are thinking of starting a new form of birth control, unhappy with a current method, or reconsidering something you have used in the past, it is important to select a method of birth control that fits your personal lifestyle so you will use it correctly and consistently.
Nothing is perfect. You, with the help of your doctor, need to consider many important issues in choosing the right method of birth control for you, such as:
→how each method is used
→if you are likely to use it correctly
→your current health
→whether you smoke
→whether you have any children
→whether you desire to have more children
→the frequency of your sexual activity
→your partner’s feelings about birth control
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| The "pill" |
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| These are safe, effective, and reversible birth control. It is important to start these methods when you are sure that you are NOT pregnant, most commonly with your menstrual period.
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| The "shot" |
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| None of these methods cause infertility, but they can cause a delay in the return of your pre-existing fertility when you discontinue them. Sexually transmitted diseases, however, if not treated, can cause infertility. Hormonal methods do not protect you from sexually transmitted infection; if this is a concern, you must also use a condom.
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| The "implant" |
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| Each type of hormonal birth control also provides non-contraceptive health benefits. However, if you have certain medical problems you may not be a candidate for some or any of the hormonal methods. Hormonal forms of birth control include the pill, the shot, and the implant.
All of these methods require a doctor’s visit to obtain.
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The IUD is a small, plastic device inserted into and left inside the uterus. The IUD is most appropriate for a woman in a mutually faithful relationship (she and her partner have no other sexual partners) and has at least one child. Today’s IUDs are safe, convenient, and highly effective as well as reversible. You need to discuss with your doctor and be examined to determine if you are an appropriate candidate. There are 2 types of IUDs currently available.
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| Mirena IUD |
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The Mirena IUD is medicated with progesterone andproduces a local hormonal effect on the uterus. It is effective for 5 years. The copper IUD, also known as Paragard, is a device containing copper which prevents fertilization. It contains no hormones so does not produce any hormonal side effects, but most women will report heavier, more crampy periods. It is effective for 10 years.
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| Paragard IUD |
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| Barrier methods |
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BARRIER METHODS
These are some of the oldest and safest forms of birth control and can be used by most couples. They must be used every time you have sex. They produce no side effects except for an occasional allergy to the spermicide or to latex. They are easily available and inexpensive but may not be as effective as other methods. However, using 2 of these methods together (i.e. condom and diaphragm) makes it highly effective.
Barrier methods include condoms, spermicides, and the diaphragm and cervical cap. You will need to be fitted for a diaphragm during an office visit and you will need a prescription to obtain it. The other barrier methods are available over the counter.
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SURGICAL STERILIZATION
Surgical options for birth control are available for both men and women. It is the most commonly used method and is highly effective. However, these are permanent forms of birth control and should only be considered when your family is complete. If you are uncertain about future pregnancy it is best to use an alternative method.
You may undergo bilateral tubal ligation at the time of delivery of a baby or at anytime not related to pregnancy. It can be done as a laparoscopic procedure under general anesthesia and you would go home that day. There is also a procedure called Essure which is done through a hysteroscopic approach (without any abdominal incisions) and can be done with sedation rather than general anesthesia.
If you are considering permanent surgical sterilization, also discuss with your partner the option of vasectomy. This is performed by a urologist as a minor office procedure under local anesthesia with much less risk.
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Contraceptive method failure rates during the first year of continuous use in the US
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FIRST-YEAR CONTRACEPTIVE FAILURE RATES
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Percentage of women experiencing an unintended pregnancy
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Method
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Perfect use
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Typical use
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Pill (combined)
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0.3
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8.7
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Tubal sterilization
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0.5
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0.7
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Male condom
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2.0
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17.4
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Vasectomy
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0.1
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0.2
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Depo-provera (3-month injectable)
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0.3
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6.7
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Withdrawal
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4.0
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18.4
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Copper-T IUD
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0.6
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1.0
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Mirena IUD
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0.1
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0.1
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Periodic abstinence
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–
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25.3
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Calendar
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9.0
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–
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Implant
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0.05
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1.0
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Diaphragm
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6.0
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16.0
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Female condom
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5.0
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27.0
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Spermicides
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18.0
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29.0
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No method
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85.0
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85.0
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Sources: Perfect use—Hatcher RA et al., eds., Contraceptive Technology, 18th rev. ed., New York: Ardent Media, 2004, Table 9-2.
Typical Use—Ibid.; and Fu H et al., Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth, Family Planning Perspectives, 1999, 31(2):56–63; and Kost K, et al., Estimates of contraceptive failure from the 2002 National Survey of Family Growth, Contraception, 2007, 77(1):10-21.
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