Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor’s recommendation.

Key points in making your decision

Birth control methods allow a woman or a couple to choose whether or when to have a child. Consider the following when making your decision:

• Permanence. If you are certain that you don’t want children (or more children), you might consider a permanent method of birth control, such as female tubal ligation or implants or male vasectomy.
• Effectiveness. Consider how important it is to you to avoid pregnancy, and then look at how well each method works. Hormonal implants and injections (Depo-Provera) and the hormonal and copper IUDs are the most effective. Birth control pills (both estrogen-progestin and progestin-only), patches, and rings are highly (but slightly less) effective. Barrier methods such as condoms, diaphragms, and spermicides are only moderately effective. See a reliability table for details on each method.
• Convenience. Some methods require more effort than others. Do a reality check by asking yourself how likely you are to use the method consistently. Answer whether you are willing to interrupt lovemaking, to abstain from sex during certain times of the month, or to remember to take a pill every day.
• Sexually transmitted disease protection. The most highly effective hormonal and IUD methods do not protect you from sexually transmitted diseases (STDs). Condoms are the only dependable protection you have from STDs. But condoms alone are not a highly effective birth control method. To avoid both STD infection and pregnancy, be sure to combine a condom with a more effective birth control method.
• Health risks. If you have health risks, some birth control methods may not be right for you. For example, combined (estrogen and progestin) birth control methods are not recommended for women older than 35 who smoke. Other conditions that may limit your choices of birth control include having migraines, heart disease, high blood pressure, blood clots, or diabetes.
• Return to fertility. If you plan to have children within the next year or two, you may want to avoid the Depo-Provera (progestin-only) shot, which can stop your monthly periods and delay your return to fertility.¹ Taking estrogen-progestin for a long time can also make your periods stop. You might not start periods again for several months after you stop taking hormones. But it isn’t permanent. You will start ovulating and having your periods, and your fertility should get back to normal.
• Other benefits. Some birth control methods have beneficial side effects. Combination hormonal methods (estrogen and progestin) can improve acne. Both combination and progestin-only methods reduce menstrual cramping and flow. In fact, with the Lybrel combination pill, the Depo-Provera shot, or the Mirena IUD, your period may stop altogether.

Medical Information

What are the different methods of birth control?

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 while you can try to reverse it with another surgery, reversal is not always successful. Methods include:

• Tubal ligation or implants. The fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked. A new type of procedure, using a device (called Essure) to block the fallopian tubes, is done without an incision and on an outpatient basis.
• Vasectomy. In this minor procedure, the vas deferens, the tube that carries sperm from the testicles to the seminal fluid (semen), from each testicle is cut and blocked so that sperm are no longer present in the semen.

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

• Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills, skin patches, and rings.
• Progestin-only hormonal methods include pills (also called the “mini-pill”) and injections (Depo-Provera). Progestin-only methods are an option for women who cannot take estrogen.

Compare the:

• Advantages and disadvantages of combination hormonal methods with progestin-only pills, patches, and rings.
• Advantages and disadvantages of the progestin-only (Depo-Provera) shot.

An intrauterine device (IUD) is a small device that is placed in your uterus to prevent pregnancy. IUDs usually contain copper (Copper T 380-A) or a hormone (the Mirena IUD, which releases a progestin called levonorgestrel). IUDs can provide birth control for 5 to 10 years.

Barrier methods include the diaphragm, cervical cap, Lea’s Shield, male condom, female condom, spermicidal foam, sponges, and film. Barrier methods 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. (A diaphragm, cap, or shield can be put in a few hours beforehand, if you can plan ahead.)

Fertility awareness, or natural family planning, requires that a couple chart the time during a woman’s menstrual cycle that she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a highly effective method of preventing pregnancy.

If you are at risk of getting or spreading a sexually transmitted disease (such as genital herpes, chlamydia, and AIDS), use a condom. To most effectively prevent pregnancy, combine a condom with a highly effective birth control method.

How effective are birth control methods?

Hormonal implants, injections (Depo-Provera), and the hormonal and copper IUDs are very highly successful methods of birth control. These methods are 97% to 99.9% effective. That means fewer than 1 to 3 women out of 100 women who are using these methods will become pregnant during the first year of use.

Birth control pills (both combination and progestin-only) have a high success rate of 92%. But if taken properly (every day or at the same time every day), birth control pills can be highly successful. The hormonal skin patch and vaginal ring are thought to be about as effective as birth control pills, but how well they actually work has not been well studied.

Barrier methods, such as the diaphragm or condom, are moderately successful at preventing pregnancy. The diaphragm and cervical cap are 84% effective for women who have not had children or who have had a cesarean section. Women who have delivered children vaginally have lower rates of success with diaphragms and cervical caps. They are more effective when used consistently and fitted correctly, although not all women are able to achieve this.

Doctors often recommend that you use spermicides and condoms together or along with another method to increase their effectiveness. The male condom is 85% effective. The female condom is 79% effective. Spermicide is 71% effective. In real numbers, this means that of women who use male condoms alone for birth control each time they have sex, 15 out of 100 will become pregnant in the first year of use. Consider carefully whether this risk is acceptable to you.

Using fertility awareness takes organization, good record keeping, close observation of your body changes, and cooperation from your partner. Even when practiced carefully and consistently, fertility awareness is not a reliable method of birth control. Of women who use fertility awareness for birth control, 20 to 25 out of 100 will become pregnant in the first year of use.

Consider how comfortable you feel about using a particular method of birth control. If you are not comfortable or will not consistently use a birth control method for any reason, that method may not be effective. A reality check for birth control methods can help you determine which method is right for you.

Patch warnings

• The patch delivers more estrogen than the low-dose birth control pills do. Some research has found that women using the patch are more likely to get dangerous blood clots in the legs and lungs. The risk may be higher if you smoke or have certain health problems. The U.S. Food and Drug Administration (FDA) suggests that you talk to your doctor about your risks before using the patch.
• Direct sunlight or high heat can increase, then lower, the amount of hormone released from a patch. This can give you a big dose at the time and leave less hormone for the patch to release later in the week. This increases your risk of pregnancy. Avoid direct sunlight on the hormone patch. Also avoid using a tanning bed, heating pad, electric blanket, hot tub, or sauna while you are using a hormone patch.

What are health risks that may affect my choices?

Some health conditions may limit your choice of birth control methods. Discuss appropriate methods of birth control with your health professional if you:

• Have a chronic illness, such as diabetes or heart disease.
• Have a history of cardiovascular problems, such as high blood pressure (hypertension), stroke, high cholesterol, or blood clots.
• Have a history of nervous system problems, such as seizures or headaches.
• Have a history of migraines.
• Smoke cigarettes.
• Have a history of cancer.
• Use prescription medications. Certain antibiotics, antiretrovirals, and anticonvulsants, as well as St. John’s wort, make certain hormonal birth control less effective.²
• Have low bone density (osteoporosis) in your personal or family history.
• Are overweight. The pill and the patch may not work as well if you are overweight (body mass index greater than 30).

Bone thinning. Using Depo-Provera for 2 or more years can cause bone loss, which may not be fully reversible after stopping the medication and can lead to osteoporosis in later life. This concern may be greatest during the teen years, when young women should be building bone mass. Depo-Provera use is not recommended to be used for longer than 2 years unless you are protecting your bones with daily calcium and regular weight-bearing exercise, such as walking or running. Talk to your doctor about your risks if you have been using Depo-Provera for longer than 2 years.

Sexually transmitted disease. If a sexually transmitted disease is present at the time an IUD is inserted, a woman is at increased risk for pelvic inflammatory disease (PID) in the 20 days after insertion. Pelvic inflammatory disease can lead to infertility.⁷ This is why a test for STDs is important before inserting an IUD.

Will some temporary birth control methods prevent me from having children when I want them?

Consider how soon, if ever, you would like to become pregnant. Except for sterilization methods, which permanently prevent pregnancy, all currently available birth control methods allow you to become pregnant again, although some may cause a delay.

Depo-Provera. For some women, it may take 3 to 18 months to get pregnant after the last Depo-Provera (a progestin-only hormonal method) shot.

The estrogen-progestin pill. If you take monthly cycles of birth control hormones for a long time, your periods might stop. You might not start periods again for several months after you stop taking hormones. But it isn’t permanent. You will start ovulating and having your periods, and your fertility should get back to normal. Since it is common to ovulate before your first period comes back, it is possible to get pregnant sooner than you expect. So if you aren’t in a rush to get pregnant, use some form of birth control after you stop birth control hormones.

What can I do if I have unprotected sex?

Emergency contraception is a backup method for unprotected intercourse. This would be when you have not used a birth control method or have reason to believe that your method has not protected you as it should. For example, you could use emergency contraception if the condom breaks during sex.

Your Information

One method may work better than others for a woman or for a couple. You may use more than one method at a time, especially if you need sexually transmitted disease protection and highly effective birth control. And birth control needs change over time. Consider the information below as you make your decision.