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Birth control and family planning
Which form of birth control you choose depends on a number of different factors, including your health, how often you have sex, and whether or not you want children.
Contraception; Family planning and contraception
Here are some factors to consider when selecting a birth control method:
- Effectiveness -- How well does the method prevent pregnancy? Look at the number of pregnancies in 100 women using that method over a period of 1 year. If an unplanned pregnancy would be viewed as potentially devastating to the individual or couple, a highly effective method should be chosen. In contrast, if a couple is simply trying to postpone pregnancy, but feels that a pregnancy could be welcomed if it occurred earlier than planned, a less effective method may be a reasonable choice.
- Cost -- is the method affordable?
- Health risk -- What are the potential health risks? For example, birth control pills are usually not recommended for women over age 35 who also smoke.
- Partner involvement -- The willingness of a partner to accept and support a given method may affect your choice of birth control. However, you also may want to reconsider a sexual relationship with a partner unwilling to take an active and supportive role.
- Permanence -- Do you want a temporary (and generally less effective) method, or a long-term or even permanent (and more effective) method?
- Preventing HIV and sexually transmitted infections (STIs) -- Many methods offer no protection against STIs. In general, condoms are the best choice for preventing STIs, especially when combined with spermicides.
- Availability -- Can the method be used without a prescription, provider visit, or, in the case of minors, parental consent?
- A condom is a thin latex or polyurethane sheath. The male condom is placed around the erect penis. The female condom is placed inside the vagina before intercourse.
- A condom must be worn at all times during intercourse to prevent pregnancy.
- Condoms are available in most drug and grocery stores. Some family planning clinics offer free condoms. You do not need a prescription to get condoms.
Diaphragm and cervical cap
- A diaphragm is a flexible rubber cup that is filled with spermicidal cream or jelly.
- It is placed into the vagina over the cervix before intercourse, to prevent sperm from reaching the uterus.
- It should be left in place for 6 to 8 hours after intercourse.
- Diaphragms must be prescribed by a woman's health care provider, who determines the correct type and size of diaphragm for the woman.
- About 5-20 pregnancies occur over 1 year in 100 women using this method, depending on proper use.
- A similar, smaller device is called a cervical cap.
- Risks include irritation and allergic reactions to the diaphragm or spermicide, and increased frequency of urinary tract infection. In rare cases, toxic shock syndrome may develop in women who leave the diaphragm in too long. A cervical cap may cause an abnormal Pap test.
- Vaginal contraceptive sponges are soft synthetic sponges saturated with a spermicide. Prior to intercourse, the sponge is moistened, inserted into the vagina, and placed over the cervix.
- See: Over-the-counter birth control for more information
Birth control methods that use hormones will have either both an estrogen and a progestin, or a progestin alone.
- Both hormones prevent a woman's ovary from releasing an egg during her menstrual cycle (called ovulation). They do this by affecting the levels of other hormones the body makes.
- Progestins help prevent sperm from entering the uterus by making mucus around a woman's cervix thick and sticky.
Types of hormonal birth control methods include:
- Combination birth control pills, which combine the hormones estrogen and progestin to prevent ovulation.
- Progestin only birth control pills, also called the "mini-pill."
- Implants -- small rods implanted surgically beneath the skin, which release a continuous dose of progestin to prevent ovulation.
- Progestin injections, such as Depo-Provera, are given into the muscles of the upper arm or buttocks once every 3 months. This injection prevents ovulation.
- The skin patch (Ortho Evra) is placed on your shoulder, buttocks, or other convenient location. It continually releases progestin and estrogen. Like other hormone methods, a prescription is required.
- The vaginal ring (NuvaRing) is a flexible ring about 2 inches wide that is placed into the vagina. It releases the hormones progestin and estrogen.
- Emergency (or "morning after") contraception. See: Emergency contraception
- The IUD is a small plastic or copper device placed inside the woman's uterus by her health care provider. Some IUDs release small amounts of progestin. IUDs may be left in place for 5 - 10 years, depending on the device used.
- IUDs can be placed at almost any time.
- IUDs are safe and work well. Fewer than 1 out of 100 women per year will get pregnant using an IUD.
- Risks and complications include cramps, bleeding (sometimes severe), and perforation of the uterus.
- The progestin IUD often causes irregular spotting for the first several months. In about 50% of women, the periods may stop completely by the end of the first year. This effect goes away when the device is removed.
PERMANENT METHODS OF CONTRACEPTION
These methods are best for men, women, and couples who believe they never wish to have children in the future. While viewed as a permanent method, these operations can sometimes be reversed if a man or woman later chooses to become pregnant.
- Coitus interruptus is the withdrawal of the penis from the vagina before ejaculation. Some semen frequently escapes before full withdrawal and before ejaculation, which is enough to cause a pregnancy.
- Douching shortly after sex is ineffective because sperm can make their way past the cervix within 90 seconds after ejaculation.
- Breastfeeding. Despite the myths, women who are breastfeeding can become pregnant.
CALL YOUR HEALTH CARE PROVIDER IF:
- You would like further information about birth control options
- You want to start using a specific method of birth control that requires a prescription or needs to be inserted by a health care provider
- You have had unprotected intercourse or method failure (for example, a broken condom) within the past 72 hours, and you do not want to become pregnant
MacIsaac L.Intrauterine contraception: the pendulum swings back. Obstet Gynecol Clin North Am. 2007 March;34(1):91-111, ix.
Mishell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 14.
Spencer Al, Bonnema R, McNamara MC. Helping women choose appropriate hormonal contraception: update on risks, benefits, and indications. Am J Med. 2009;122:497-506.
Amy JJ, Tripathi V. Contraception for women: an evidence-based review. BMJ. 2009;339:b2895. doi:10.1136/bmj.b2895.
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.