What is birth control?

Birth control is a way for men and women to prevent pregnancy. There are many different methods of birth control. By learning more about the options, you can decide which method is right for you and your partner.

If you are sexually active and don't want a baby, don't wait to use birth control. An unintended pregnancy can happen any time you have unprotected sex.

What are the types of birth control?

The following information describes many different birth control methods. Before you choose a method, you should discuss birth control with your partner and your healthcare provider.

Birth control methods are only effective if used properly. Make sure that you understand how to correctly use the method you choose.

Abstinence

Abstinence is the only birth control that is 100 percent effective and is also the best way to protect you against STDs. You may not be ready to have sex. Don't let someone pressure you into having sex if you don't feel ready. It is an important decision with serious emotional and physical consequences.

Female sterilization – tubal ligation (surgical)

What is it? Tubal ligation is surgery to "tie the tubes" (fallopian tubes) of a woman. This causes permanent sterility by preventing transport of the egg (ovum) to the uterus. This also blocks the passage of sperm up the tube to the ovulating ovary where fertilization normally occurs.

How is it done? Tubal ligation is done in a hospital or outpatient surgical clinic while the patient is asleep (given anesthesia). One or two small incisions (cuts) are made in the abdomen at the navel, and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted. Using instruments that are inserted through the laparoscope, the fallopian tubes are burned or sealed shut. The skin incision is then stitched closed. Tubal ligation can be performed immediately after childbirth through a small incision near the navel or during a Cesarean section (C-section).

How is it available? Tubal ligation must be performed by a healthcare provider.

How effective is it? Except in rare cases, this procedure is almost 100 percent effective. Depending on the technique your doctor uses, tubal ligation has about three to 17 failures in 1,000 procedures.

You should know: Female sterilization is not reversible. Sterilization does not protect against STDs, including HIV (the virus that causes AIDS). The male condom provides the best protection against most STDs.

Male sterilization – Vasectomy

What is it? A vasectomy is a simple, permanent sterilization procedure for men. The operation, usually done in a physician's office, requires cutting and sealing the vas deferens, the tubes in the male reproductive system that carry sperm. A vasectomy prevents the transport of sperm out of the testes. This surgery does not affect the man's ability to achieve orgasm or ejaculate (potency). There will still be a fluid ejaculate, but there will be no sperm in this fluid. Studies have shown that vasectomy increases sexual satisfaction between couples.

How is it done? Vasectomy is usually done in the surgeon's office while the patient is awake but pain-free (using local anesthesia). A small incision is made in the upper part of the scrotum. The tubes (vas deferens) are tied off and cut apart. The skin incision is stitched closed. The patient is able to return home immediately. Vasectomy is a much simpler procedure than tubal ligation.

How is it available? Vasectomy must be performed by a healthcare provider.

How effective is it? Except in rare cases, this procedure is nearly 100 percent effective. Although vasectomy has a failure rate of less than 1 percent, failure, while rare, is possible.

You should know: Sterilization does not protect against STDs, including HIV (the virus that causes AIDS). The male condom provides the best protection against most STDs.

Progestin arm implant – Nexplanon®

What is it? Nexplanon® is a single rod of hormone (the size of a matchstick) that is placed directly under the skin of the upper arm by a physician. It delivers a progestin hormone (no estrogen), over a three-year period.

How can I get it? Nexplanon® is placed by a physician who is certified in this procedure.

How effective is it? Nexplanon® is almost 100 percent effective. It is the most effective form of reversible contraception, with less chance of failure than even female sterilization.

You should know: The side effects of Nexplanon® are similar to other progestin-only (no estrogen) methods. The most common side effect is irregular bleeding, though the bleeding tends to be light. This typically improves after six to 12 months, with many women having no further bleeding (which is safe). Nexplanon® will need to be removed via an office procedure after three years, but can removed at any time before that time if desired.

Intrauterine device (IUD)

What is it? An intrauterine device (IUD) is a small, flexible, T-shaped device that is placed into the uterus (womb). There two types of IUDs:

  • An IUD made of copper
  • An IUD made of plastic with very low doses of progestin (no estrogen)

The copper ParaGard T380A®, can be kept in place for 10 years. The copper stops the sperm from making it through the vagina and uterus to reach the egg, preventing fertilization.

The progestin IUDs include Mirena® (five years, highest progestin dose), Kyleena® (five years, medium dose), and Skyla® (three years, lowest progestin dose). The progestin dose of the IUDs are so low, that they have minimal absorption into the body. These IUDs work by causing the cervical mucus to become thicker so the sperm cannot reach the egg. The hormone also thins the lining of the uterus, so menstrual bleeding becomes lighter.

How is it used? Once the IUD has been inserted, the woman does not need to take any further steps to prevent pregnancy.

How is it available? After a pelvic exam, the IUD is placed into the uterus through the cervix by a trained healthcare provider.

How effective is it? The IUD is close to 100 percent effective. Progestin containing IUDs and the arm implant are the most effective contraceptive options.

You should know: Side effects are different for the different IUDs. Copper IUDs may cause more painful and heavy periods in some women. The advantage is that it can be used in women who can’t use any hormones (such as breast cancer survivors). The side effects of progestin containing IUDs are similar to other progestin-only (no estrogen) methods. The most common side effect is irregular bleeding, though the bleeding tends to be light. This typically improves after six to 12 months, with many women having no further bleeding (which is safe). IUDs will need to be removed via a simple office procedure at the expiration time, but can removed at any time before that time if desired. In the rare chance pregnancy occurs while having an IUD, there is greater risk of ectopic pregnancy (pregnancy outside the uterus).

Combined hormonal contraception

Includes estrogen containing birth control pills, the contraceptive vaginal ring (NuvaRing®), and patch (Xulane®)

What is it? The pill, patch and ring are medications that women take to prevent pregnancy. The pill is taken daily, the vaginal ring is used once a month, and the patch is changed weekly.

How is it used? A pill is taken at the same time every day. There are several different types of pills. Some are designed to allow the woman to have a period every month and others allow the women to have period every three months or not at all. All of these methods require that a woman use it regularly. If you forget to use the contraceptive, irregular menstrual cycles are common, and you can get pregnant.

How can I get it? In most states, the pill must be ordered for you by your healthcare provider. It is obtained by prescription. In a growing number of states it is available over-the-counter without a prescription, under the supervision of a pharmacist.

How effective is it? Combined hormonal contraceptives have the potential to be 99 percent effective if used correctly. However, in the real world with typical use, nine out of 100 women will get pregnant each year on the pill because they do not use it correctly. Some studies show that women who are overweight might be more likely to get pregnant while on the pill than normal weight women. However, the pill is much more effective than the barrier methods such as condoms, diaphragm, cervical cap, contraceptive foam, etc.

You should know: The pill can cause minor side effects in the first several months of use, including:

  • Breast tenderness/pain
  • Nausea
  • Headaches
  • Irregular menses

Typically these symptoms resolve. Estrogen containing contraceptives can increase the risk of blood clots. Estrogen containing contraceptives are not recommended for women who are over 35 years of age if they smoke, but can be used until menopause if you don't smoke cigarettes and are in good health. There are many health benefits to these contraceptives, including lighter, regular periods, as well as less menstrual cramping. Pill users also will notice improvement in acne, PMS, menstrual headaches, as well as a lower risk of uterine and ovarian cancer in pill users.

Progestin only pills (mini pills)

What is it? These are pills that contain only one hormone (progestin).

How do they work? Mini pills work by thickening the cervical mucus so the sperm cannot reach the egg. The hormone in the pills also thins the lining of the uterus, so menstrual bleeding is lightened. A pill is taken every day with no placebo (break).

How is it available? In most states, the pill must be ordered for you by your healthcare provider. It is obtained by prescription. In a growing number of states it is available over-the-counter without a prescription, under the supervision of a pharmacist.

How effective is it? With typical use, nine out of 100 women will get pregnant each year on the pill because they do not use it correctly. It is important to take it daily, at the same time each day. Some studies show that women who are overweight might be more likely to get pregnant while on the pill than thinner women. However, the pill is much more effective than the barrier methods such as condoms, diaphragm, cervical cap, contraceptive foam, etc.

You should know: The side effects of progestin only pills are similar to other progestin-only (no estrogen) methods. The most common side effect is irregular bleeding, though the bleeding tends to be light. This typically improves after six to 12 months, with many women having no further bleeding (which is safe). The mini pill is a good alternative for women who are breastfeeding or who cannot take estrogen in the traditional pill.

Depo-provera®

What is it? Depo-Provera® is a form of the hormone progestin.

How is it used? It is given as an injection into the woman's buttocks or arm. Each injection provides protection against pregnancy for 12 to 15 weeks.

How is it available? Depo-Provera® must be ordered by a healthcare provider. It is taken every three months, usually given at the doctor's office. There is a lower dose formulation that is available to be injected at home by the patient.

How effective is it? The Depo-Provera® shot has the potential to be 99 percent effective if used correctly. However, with typical use, six out of 100 women will get pregnant each year on the shot because they do not get the four injections per year on time.

You should know: Depo-Provera®’s bleeding profile is similar to other progestin-only (no estrogen) methods. Fifty percent of women who use Depo-Provera for more than a year stop getting their periods while on the medication. However, some irregular bleeding can occur, especially in the first year. In a small percentage of women, Depo-Provera can cause some weight gain. This is the only contraceptive that may do this. However, most women on Depo-Provera® do not gain any weight. A healthy lifestyle can prevent chance of weight gain.

Emergency contraception (or “morning after pill”)

What is it? Emergency contraception is a form of birth control that may be used by women within 120 hours (five days) of having unprotected sex. This may be necessary in the case of contraceptive failure (broken condom), rape, or any other situation where highly effective contraception was not available. It is most effective when taken soon after unprotected intercourse. A copper IUD is the most effective form of emergency contraception, and also provides ongoing birth control. There are two types of emergency contraceptive pills available. The more effective pill is called ulipristal (brand name: ella). It is only available by prescription. Several over-the-counter options are available and all contain levonorgestrel (many generic names including Plan B, Next Choice, etc).

How does it work? The pills prevent pregnancy by temporarily blocking eggs from being produced (delaying ovulation). The copper IUD makes it difficult for sperm to get to the egg.

How is it available? Over-the-counter levonorgestrel pills can be purchased at a pharmacy without a prescription by men and women of any age (including those under age 16). Ulipristal (ella) has to be prescribed by a provider. Because many pharmacies will need to order ella (delaying when you’ll receive it), consider asking your doctor for an advanced prescription to have on hand in case of emergency. An IUD requires an office visit for procedure within five days of intercourse.

How effective is it? Emergency contraceptive pills can be up to 90 percent effective when taken within 72 hours of unprotected intercourse. However, no pills will work if you have already ovulated. This is why it’s important to take it as soon as possible after intercourse. Ella is two times more effective than the over-the-counter pills. A copper IUD is almost 100 percent effective.

You should know: You do not need to take a pregnancy test before taking emergency contraception pills. Menstrual irregularities are common for the few weeks after the pills have been taken. However, if you do not get your menstrual cycle within a few weeks of taking emergency contraception, you should take a pregnancy test since these methods are not 100 percent effective. It is important to use condoms or abstain from intercourse for the next five days after taking emergency contraception, otherwise you can get pregnant. If you find yourself taking emergency contraceptive pills frequently, speak to your doctor about more effective ways to prevent pregnancy.

Male condoms

What is it? The male condom, or "rubber," is a thin covering made of latex, plastic or animal membrane that is rolled over an erect penis. The covering prevents semen, the fluid that contains sperm, from entering a woman's vagina. Latex condoms are best for most people. Use plastic condoms if you or your partner is allergic to latex. Condoms made from animal skins may not provide good protection from sexually transmitted diseases (STDs).

How is it used? The condom is rolled over the erect penis before sexual activity begins. If the condom does not have a built-in nipple, leave ¼-inch of the condom free at the tip of the penis so that semen has a place to collect. A new condom must be used each time you have sex. The condom must be in place before the penis gets near the vagina.

How can I get it? Condoms can be purchased at most drug stores. Condoms also are sold in vending machines in restrooms.

How effective is it? About 18 percent of women will get pregnant each year when condoms are used. However, condoms can be more effective when they are used exactly as intended.

You should know: Latex condoms provide protection—although not 100 percent protection—from STDs by preventing the infected area from coming into contact with the partner. Even though they do not provide 100 percent protection, they are one of the best options available. Use only water-based lubricants, such as K-Y Jelly® or Astroglide®. Oil-based lubricants (Vaseline®, baby oil) can cause condoms to leak or break. If a condom breaks, a woman is at increased risk of getting pregnant. She should consider emergency contraception.

Diaphragm

What is it? A diaphragm is a round piece of flexible rubber with a rigid rim. The woman places the diaphragm in her vagina and against her cervix. The diaphragm prevents semen from entering the womb. Spermicide must be used with a diaphragm.

How is it used? Spermicide is put in and around the rim of the diaphragm no more than two hours before intercourse. The diaphragm is then inserted into the vagina. More spermicide should be inserted into the vagina each time you have sex without removing the diaphragm.

How can I get it? You must visit your healthcare provider and get a pelvic exam so that you can be fitted for a diaphragm that is right for you. There is one diaphragm that is “one-size-fits-all,” called Caya, which can be purchased online.

How effective is it? About 12 percent of women get pregnant each year despite using a diaphragm, but it can be more effective when used exactly as instructed.

You should know: Do not remove the diaphragm for at least eight hours after intercourse. Using a diaphragm and spermicide may not protect against some STDs, including HIV (the virus that causes AIDS). The male condom provides the best protection against most STDs. If you gain or lose 10 to 15 pounds, you may have to be refitted for a new diaphragm.

Cervical cap

What is it? The cervical cap is a thimble-shaped cup made out of plastic or soft rubber that fits snugly over the cervix.

How is it used? It is used the same way as a diaphragm. The woman coats the cup with spermicide, and inserts the cap into her vagina and up to her cervix before sex. The cap blocks the cervix, and the spermicide paralyzes the sperm. More spermicide must be inserted into the vagina each time you have sex. (Do not remove the cap each time you have sex.)

How can I get it? You must visit your healthcare provider and get a pelvic exam so that you can be fitted for a cervical cap.

How effective is it? About 21 percent of women get pregnant each year despite using a cervical cap, but it can be more effective when used exactly as instructed.

You should know: Do not remove the cervical cap for at least eight hours after intercourse. The cap can be kept in place for up to 48 hours, but spermicide must be applied inside the vagina no more than two hours before sex. Using a cervical cap and spermicide may not protect against some STDs, including HIV (the virus that causes AIDS). The male condom provides the best protection against most STDs.

Female condom

What is it? The female condom is a lubricated polyurethane (plastic) tube that has a flexible ring at each end. One end of the tube is closed.

How is it used? Before sexual activity begins, the woman inserts the condom into her vagina so that the closed end of the tube covers the cervix, and the other end slightly covers the labia (lips on the outside of the vagina). The condom blocks sperm from entering the womb.

How can I get it? Like the male condom, the female condom is available at drug stores without a prescription.

How effective is it? About 21 percent of women get pregnant each year despite using a female condom, but the condom can be more effective when used exactly as instructed.

You should know: Female condoms provide some protection against STDs, but the male condom provides the best protection. Female condom can be used while menstruating. It needs to be removed immediately after sex.

Sponge

What is it? The sponge is a small, donut-shaped device that is coated with spermicide.

How does it work? The sponge is moistened with water and inserted into the vagina. It is made of polyurethane foam that feels like natural vaginal tissue. The sponge protects against pregnancy in three ways:

  • The sponge releases a spermicide to kill sperm cells.
  • The sponge is constructed to trap and absorb semen before the sperm have a chance to enter the cervix.
  • It acts as a barrier between the sperm and the cervix.

How is it available? The sponge is available without a prescription at most drug stores.

How effective is it? About 32 percent of women who have had babies in the past will get pregnant each year despite using the sponge, but they can be more effective when used exactly as instructed. In comparison, nine to 16 percent of women who have never had a child will get pregnant each year using the sponge, depending on how correctly it is used.

You should know: The sponge provides a continuous presence of spermicide throughout a 24-hour period, allowing for multiple acts of intercourse within that time without the need for additional spermicide. The sponge is associated with higher rates of vaginal infections, and is less effective than a diaphragm.

Withdrawal (pullout) method, spermicides (film, jelly, foam, etc.)

These are not effective methods of birth control when used on their own. Out of every five women using these methods to prevent pregnancy, one will get pregnant by the end of the year. Spermicides are used with other barrier methods such as diaphragms and cervical caps to help improve their effectiveness.

Rhythm

What is it? A woman practices rhythm, or natural family planning, by learning to recognize the days she is fertile, and then abstaining from sex before and during those days.

How is it done? Methods include keeping track of changes in body temperature and vaginal discharge (fluid from the vagina.)

How is it learned? Your healthcare provider can describe how to practice natural family planning.

How effective is it? Using the rhythm method, up to 25 percent of women get accidentally pregnant in one year (some studies quote failure rates as high as 50 percent). If done properly, it can be 90 percent effective.

You should know: Natural family planning also can be used to help a woman get pregnant by pinpointing her most fertile times. It also has no side effects and is inexpensive. The rhythm method does not work for all couples. Women who have regular menstrual cycles and who are very careful about when they have sex usually find it to be effective. Women who have irregular cycles and who are not so careful often end up becoming pregnant.

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