Methods of Birth Control

There are many methods of birth control. Each method has good points as well as side effects. Birth control allows a woman to plan her family--both the number and spacing of children. All of these methods are safe when used appropriately.

Certain types of birth control offer added health benefits. Discuss the pros and cons of each method with your doctor so you can choose the best method for you.

The birth control pill, injections, vaginal ring, skin patch, intrauterine device (IUD), diaphragm, and cervical cap require a prescription. Condoms and spermicides do not.

More than one method may be used at the same time. For instance, a barrier method may be used with any other method. Using a barrier method with another method increases the effectiveness. It also may help protect against STDs.

Barrier Methods

Barrier methods include spermicides, condoms (male and female), the diaphragm, the cervical cap, and Lea's Shield:

Spermicides are chemicals that kill sperm. They are placed in the vagina close to the cervix. They include tablets, foam, cream, jelly, and film (thin sheets that contain spermicide).

The male condom is a thin sheath made of latex (rubber), polyurethane (plastic), or animal membrane. It is worn by the man over his erect penis.

The female condom is a thin plastic pouch that lines the vagina. It is held in place by a closed inner ring at the cervix and an outer ring at the opening of the vagina.

The diaphragm is a small, round rubber dome that fits inside the woman's vagina and covers her cervix.

The cervical cap is a small, thin rubber or plastic dome shaped like a thimble. It fits tightly over the cervix and stays in place by suction.

The Lea's Shield is a dome-shaped silicone device with a loop for removal that fits inside the woman's vagina and covers her cervix.

Spermicides are chemical barriers. The other methods are physical barriers. They keep the sperm from getting to the egg. Combining spermicides with physical barrier methods provides more protection. Some barrier methods--such as the diaphragm, cervical cap, and Lea's Shield--rely on spermicides for their full effectiveness and should be used with each act of sex.

Some people may be allergic to latex. These people might consider using condoms made from plastic or animal membrane. Keep in mind, however, that condoms made from animal skin do not provide the same protection against STDs.

Barrier methods are effective when used the correct way every time you have sex. Even one act of sex without birth control can result in pregnancy.

Intrauterine Device

The IUD is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy. Although there have been several types of IUDs, currently only two are available in the United States: the hormonal IUD and the copper IUD.

Both types of IUDs are T-shaped, but they work in different ways. The hormonal IUD releases a small amount of progestin into the uterus. This thickens the cervical mucus, which blocks the sperm from entering the cervix. It also thins the endometrium. This keeps a fertilized egg from attaching and makes menstrual periods light.

The copper IUD releases a small amount of copper into the uterus. A copper IUD does not affect ovulation or the menstrual cycle. It causes a reaction inside the uterus and fallopian tubes. This can prevent the egg from being fertilized or attaching to the wall of the uterus. It also reduces the sperm's ability to fertilize an egg.

A doctor must insert and remove the IUD. The hormonal IUD must be replaced every 5 years. The copper IUD can remain in your body for as long as 10 years.

The IUD does not protect against STDs. It may make them worse if you do get an infection.

Hormonal Contraception

With hormonal birth control, a woman takes hormones similar to those her body makes naturally. These hormones prevent ovulation. When there is no egg to be fertilized, pregnancy cannot occur. The hormones also cause changes in the cervical mucus and uterus that help prevent pregnancy. Hormonal pills, injections, rings, and patches are all very effective. For most women, the risk of serious complications is small. However, women older than 35 years who smoke should not use most types of hormonal methods because it increases their risk of heart attack and stroke.

Birth Control Pills. One of the most popular methods of hormonal birth control is the birth control pill (oral contraceptive). Most birth control pills are combination pills. They contain the hormones estrogen and progestin. There are many different brands of pills with different doses of hormones. This variety allows a woman to find a pill that is right for her. Some pills contain only progestin.

Birth control pills help protect against certain types of cancer, such as cancer of the ovary and endometrium. Most experts agree that women who have no other risk factors do not have an increased risk of getting breast cancer. These women can take the pill.

The pill also helps to keep your periods regular, lighter, and shorter. This makes women less likely to have anemia (low blood iron). The pill also reduces menstrual cramps. It lowers your risk of ectopic pregnancy. Some types of birth control pills also can help treat acne.

Injections. One type of injection of hormonal birth control, called depot-medroxyprogesterone acetate (DMPA), provides protection against pregnancy for 3 months. This means a woman needs only four injections each year. During the time that the injection is effective, you don't have to do anything else to prevent pregnancy. Another type of injection is given every month and contains estrogen as well as a progestin. Injections may be good for people who find daily birth control methods inconvenient. Women who take DMPA injections tend to have irregular bleeding.

Vaginal Ring. The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. The ring releases both estrogen and progestin continuously to prevent pregnancy. It is worn for 21 days, removed for 7 days, and then a new ring is inserted. During the week it is out, a menstrual period occurs. This is a lot like the way combination birth control pills work. A woman does not need to visit her doctor for insertion or removal of the ring. The ring may have benefits and risks like those of the birth control pill.

Skin Patch. The contraceptive skin patch is a small (1.75 square inch) adhesive patch that is worn on the skin to prevent pregnancy. It is a weekly method of hormonal birth control. The patch contains both estrogen and progestin and releases these hormones through the skin. A patch is worn for 1 week and then replaced with a new one on the same day of the week for 3 weeks in a row. During the fourth week, a patch is not worn, and a menstrual period occurs. This is another method that works a lot like combination birth control pills. A woman does not need to visit her doctor to apply or remove the patch. The patch may have benefits and risks like those of the birth control pill.

Natural Family Planning

Natural family planning used to be called the rhythm method or "safe period." It also is called periodic abstinence or, more recently, fertility awareness. It isn't a single method but a variety of methods. Natural family planning does not require drugs or devices. The success of these methods depends on you knowing when you ovulate and not having sex during the fertile period or using another method, such as condoms, during that time.

Types of natural family planning include:

Basal body temperature method--Taking your temperature every day to detect the slight increase just after ovulation

Ovulation/cervical mucus method--Noting changes in your cervical mucus

Symptothermal method--Combining the basal body temperature and ovulation methods, as well as checking for other signs of ovulation

Calendar method--Keep a menstrual calendar for 6 months to figure out your fertile period (also called the rhythm method)

Lactational amenorrhea--Ovulation and menstruation usually are postponed in breastfeeding women. If a woman does not ovulate, she cannot become pregnant.

These methods often are combined to prevent pregnancy. You need to know your body well and you and your partner must be willing to follow the method. This method can only work when you follow it correctly at all times.

Withdrawal

The withdrawal method prevents pregnancy by not allowing sperm to be released in the woman's vagina. This requires the man to take his penis out of the woman before he ejaculates. For this method to work, he must withdraw every time the couple has sex. Drawbacks are that sperm can be present in the fluid produced by the penis before ejaculation and some men fail to withdraw completely or in time.

Sterilization

New Option for Sterilization

Women who want a permanent method of birth control now have an option that does not involve surgery. With this method, a tiny springlike device is inserted through the vagina into each fallopian tube. This device causes scar tissue to build up in the tubes. This build-up blocks the fallopian tubes and prevents the sperm from reaching the egg. It takes 3 months for the scar tissue to grow, so women should use another method of birth control during this period. This device can be inserted in a doctor's office. See no incision tubal ligation for more information.

Sterilization for women and men works by permanently blocking the pathways of egg and sperm. This can be done by surgery. The sterilization procedure for women is called tubal sterilization. The procedure for men is called vasectomy. There also is a nonsurgical method for women.

Tubal sterilization is done by laparoscopy and minilaparotomy. The fallopian tubes are closed by tying, banding, clipping, blocking, or cutting them, or by sealing them with electric current. The surgery often is performed under general anesthesia. Sometimes women have sterilization right after the birth of a child. This is called postpartum sterilization.

Vasectomy involves cutting a man's vas deferens so that sperm cannot mix with semen. The tubes that carry sperm to the penis are clamped, cut, or sealed so that the ends do not join again. The man is given local anesthesia. Surgery is done in the doctor's office or a clinic.

Sterilization is meant to be a permanent form of birth control. If there is a chance you may want to have a baby later, you should not choose this method. Attempts to reverse it may not work. Re- versal procedures require major surgery, are expensive, and are rarely covered by insurance.

© 2007 Women Partners in OB-GYN