Sexual Health > Reproductive Health > Birth Control

The Facts About Birth Control

Contraceptives allow pregnancy prevention on your own terms.

Birth control pills on a purple background.

Weighing the pros and cons of different birth control options will help you select the best product for your current lifestyle. Here's a breakdown of the variety of choices available.

Overview of birth control options

The multiple birth control options available today extend far beyond condoms and the pill. There are several short-acting and long-acting types with different administration methods, such as patches, injections, rings, implants, gels, and more. When used as prescribed, most modern birth control is nearly 100 percent effective.

As an alternative to birth control (or in conjunction with barrier methods), some people prefer to use fertility-awareness-based methods, also known as the rhythm method. With proper knowledge and training, natural family planning effectively prevents pregnancy about 75 percent of the time. Talk to your doctor about how to track ovulation if you’d like to learn more about fertility-awareness pregnancy prevention.

If you're not ready to get pregnant, planning ahead to protect yourself will give you peace of mind and better control over your preferred timing. Factoring in your goals, lifestyle, health conditions and sexual habits can help you decide what contraception method is best for you. Here is a rundown of the different categories to consider.

Birth control pills and patches

Birth control pills lessen the likelihood of sperm fertilizing the egg by:

  • Preventing or slowing ovulation
  • Thickening the cervical mucus
  • Thinning the uterine lining (the endometrium)

The two main types of oral contraceptives are the combination pill and the mini pill. Combination pills contain two hormones—estrogen and progestin—while mini pills are just progestin. Conventional packs of these contraceptives contain four to seven pills that are inactive (either placebos or iron supplements), so you'll experience monthly menstrual bleeding.

To reduce the frequency of your period, your doctor may suggest extended-cycle or continuous dosing pills. One week of inactive pills allows for menstrual bleeding after a series of 84 active pills, so you’ll only get a period four times per year. You can avoid having a period altogether with packs that don't provide any breaks of inactive pills. It's okay to not have a period when you're on the pill, and for some people, this option is preferred.

All combination pills aren't the same. There's a monophasic type that maintains a consistent dosage of hormones each week and a multiphasic in which the hormone concentration varies during each week of your cycle.

If you're not ready to get pregnant, planning ahead to protect yourself will give you peace of mind and better control over your preferred timing.

If you have endometriosis or PCOS, your doctor may recommend oral birth control to improve your symptoms. Birth control can also lower your risk for certain cancers, reduce acne and help treat severe PMS.

Not everyone is a good candidate for oral birth control. If you smoke or have heart disease, breast cancer, liver disease or uncontrolled diabetes, your doctor may guide you toward another form of contraception. Fortunately, there are plenty of options to choose from.

Birth control patches are another type of short-acting hormonal contraceptive similar to the pill, but they have fallen out of favor with some practitioners concerned about blood clotting issues. If you'd rather wear a patch than swallow a pill, this option might appeal to you. You can place the patch on your buttocks, lower abdomen or upper body—but your breasts. Each week, you'll apply a new patch and take off the old one. After doing this for three weeks, you'll take one week off from the patch and have your period. When attached, the patch releases estrogen and progestin to prevent pregnancy.

Long-acting reversible contraceptive

Intrauterine devices (IUDs) and birth control implants are convenient ways to prevent pregnancy. IUDs are tiny, T-shaped devices inserted into the uterus. There are two types of IUDs: those that release progestin (hormonal IUDs) and those made of copper. Hormonal IUDs can remain in your body for three to six years, while copper IUDs last up to 10 years.

Similar to birth control pills, hormonal IUDs prevent fertilization by thickening the cervical mucus and thinning the endometrium. Copper IUDs affect sperm motility (movement), rendering them unable to enter the uterus.

Real-life statistics show the rate of pregnancy for people relying on male condoms is 18 percent, birth control pills 9 percent and less than 1 percent for long-acting reversible contraception.

If you decide you'd like to get pregnant, your doctor can remove your IUD at any time to discontinue the contraceptive effects. After you've given birth, an IUD can be placed before you leave the hospital, so you don't have to worry about an accidental pregnancy while tending to your newborn, or placed during your six-week postpartum visit.

Birth control implants are another low-hassle way to prevent pregnancy. For them, your doctor will implant a device in your upper arm after applying a local anesthetic. Once inserted, the implant can help prevent pregnancy for up to three years. If you decide you'd like to get pregnant, birth control implants can be removed anytime, and the effects will wear off shortly after. You can also have a new implant placed after three years for continued protection.

Vaginal rings and injections are also available and contain similar amounts of hormones as other methods. These options are between 91 and 99 percent effective. Unlike with an IUD, you can insert the vaginal ring yourself without the help of your doctor. This flexible ring—it contains the same hormones as the pill but uses a different delivery system—goes inside the vagina and releases pregnancy-blocking hormones for the first three weeks of your cycle. After three weeks, you can remove the ring to have your menstrual cycle. A new ring is reinserted after your period.

The birth control shot is given on a three-month basis. Your healthcare provider will inject a dose of hormones into your arm or backside. Half of women stop getting their period after one year of using the birth control shot, but this is not a cause for concern. The shot is very effective at preventing pregnancy, but if you stop getting the shot or don't get it on time, pregnancy protection isn't guaranteed.

Barrier methods

There are several barrier methods available for contraception, including some that help protect against sexually transmitted diseases. Popular barrier methods include:

  • Cervical cap: A plastic dome that covers the cervix for temporary birth control
  • Condom: Male or female condoms provide a lining between the penis and vagina
  • Diaphragm: A dome-shaped cup that covers the opening of the cervix to block sperm entry
  • Spermicide: A chemical sold as a cream, gel, suppository, film or tablet that inactivates sperm
  • Sponge: Placed in the cervix to prevent sperm from entering

Several varieties of these products are available, including lambskin or polyurethane condoms for people who are allergic to latex. Cervical caps can also be made from latex or silicone. A benefit of barrier methods is they don't interfere with your hormones. However, there is room for human error when not used correctly. Your doctor will give you a prescription for a cervical cap or diaphragm that fits properly and provide instructions for using spermicide.

Emergency contraception

Ideally, you'll want to prevent pregnancy before or during intercourse. If you had unprotected sex and need protection afterward, emergency contraception is available. Having your doctor insert a copper IUD is one option. There are also three types of emergency contraception pills: ulipristal, progestin-only pills and combination pills. These work by delaying or preventing ovulation and preventing the implantation of a fertilized egg.

Some pills are available over the counter, while others require a prescription. Call your OB-GYN or local pharmacist to find out about your options. You'll want to get emergency contraception as soon as possible because there's a limited window of time for effectiveness. Most can be taken up to five days after sex, but doing so sooner gives you a better chance of pregnancy prevention.

Permanent birth control

If you never plan to have children or don't want any more children, you can consider permanent birth control. Female sterilization is called tubal ligation. For this procedure, the fallopian tubes are surgically tied or closed off to prevent fertilization. Patients can go home the same day of the procedure, which can be performed in a hospital or an outpatient facility.

Male sterilization is done through a vasectomy, another same-day outpatient procedure. After a vasectomy, ejaculate no longer contains sperm. Unlike tubal ligation, which works immediately, vasectomies can take 12 weeks before reaching full effectiveness. Sperm count will be tested at the doctor's office to verify the operation has been successful.

How to know which method is right for you

There are lots of factors to keep in mind when deciding on the right form of birth control. Real-life statistics show the rate of pregnancy for people relying on male condoms is 18 percent, birth control pills 9 percent, and less than 1 percent for long-acting reversible contraception. Since long-acting reversible contraception doesn’t require patient compliance (once your doctor places the device, you don’t have to think about it), there's less chance of mistakes occurring.

If you choose other forms of birth control, it's crucial to follow your doctor's instructions to ensure maximum effectiveness. The pill is ideal for someone who might want to get pregnant in the near future since it stops working once you discontinue it. However, if you don’t want to have to remember to take a pill at the same time every day, or if you're concerned about STD protection, the pill may not be the best choice.

Condoms are the only method of birth control that protects against STDs. You can use condoms only, or together with natural family planning or birth control products. Talk to your OB-GYN to come up with a pregnancy prevention strategy that works for you.

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Birth control pills on a purple background.