by: Megan Blomeyer, MS-IV
With many different types of birth control, how do you chose the right contraception for you? From barrier devices and hormonal methods to intrauterine devices and surgical sterilization, choosing a birth control method is an important decision and can be overwhelming. This post is intended to give you information on the advantages, disadvantages and uses for the various types of birth control. Keep in mind that all contraceptive forms are not 100% effective. The only form of contraception without risks and 100% effectiveness is abstinence from sexual intercourse.
Before we begin the discussion about the different types of contraception, let’s talk about how one becomes pregnant so that you can better understand how the various contraceptive methods work. Each month an egg is released from the female ovary. This is known as ovulation. The egg travels from the ovary, down the fallopian tube and into the uterus. If the egg is met by a sperm as it moves down the fallopian tube, it can become fertilized. When fertilized, the sperm and egg combine to form an ovum, which can implant or attach to the inside of the uterus also called the womb. The uterine lining or endometrium must thicken and cervical mucus needs to be produced for proper implantation and development of the ovum into a baby. Contraceptive methods work at varying points in this process to prevent pregnancy.
Image courtesy of: Suararakyat. “Sexual and asexual reproduction.” 4 March 2009. Accessed 14 October 2013. <http://3t1sc09.blogspot.com/2009/03/analysing-fertilisation-and-pregnancy.html>
Image Courtesy of: Diabetes Mine. “Ask D’Mine: The Best Birth Control for FWDs is…” 22 September 2012. Accessed 14 October 2013.<http://www.diabetesmine.com/wp-content/uploads/2012/09/Birth-Control-Words.jpg>.
The first type of contraception we will discuss is barrier methods. Barrier methods such as condoms, diaphragms and spermicide prevent sperm from reaching the egg.
1. Condoms can be used as a contraceptive method, but also provide a reduction in the rate of sexually transmitted diseases. Using a male latex or female condom correctly and on a regular basis is about 80% effective in preventing unintended pregnancy. Other advantages include protection from tubal pregnancy and cervical cancer, usage in breastfeeding women and enhancement of other methods of contraception. Disadvantages include interference with maintenance of an erection or reduction in pleasurable sensation, breakage or slipping and irritation if a partner has a latex allergy.
2. Diaphragms or other cervical caps are placed inside the vagina to cover the cervix and block sperm entry. Effectivity of approximately 85-90% can be achieved with correct use of this method. Advantages and disadvantages are similar to those of condoms, but diaphragms do not prevent sexually transmitted diseases as condoms may.
3. Spermicides can be applied as a foam, gel, cream, suppository, tablet or film that are placed inside the vagina no more than one hour before intercourse and are left in place for at least six to eight hours after intercourse. Spermicides work by killing sperm and can be used in combination with male condoms, diaphragms or cervical caps. Typically, they are about 70% effective. Advantages are that it does not contain hormonal additives, can be used by breastfeeding women and can be used to enhance other forms of contraception especially when a condom breaks, an intrauterine device is expelled or an oral contraceptive pill is missed. Disadvantages are that it has a high failure rate when used as the sole method of contraception, must be reapplied each time you have sex and may be irritating to one or both partners.
Intrauterine Devices (IUD)
IUDs are used when patients want to achieve long term contraception up to 5-10 years. This type of birth control is reversible by removing the IUD. Insertion is particularly favorable immediately postpartum (after giving birth).
1. A copper IUD works by preventing sperm movement and slowing the travel speed of the ovum down the fallopian tube.The copper IUD may also work by damaging or destructing the ovum but the effects occur before
Image courtesy of: National Institute for Reproductive Health. “Maybe the IUD is Right For You.” Accessed 14 October 2013. <http://maybetheiud.org/basic/>.
implantation. The copper IUD can remain in the uterus for up to ten years and is >99% effective. The most common side effects are abnormal bleeding and pain.
2. A hormonal IUD ex. Mirena releases a small amount of a hormone called progestin. It works just like a copper IUD but also decreases the thickness of the endometrium and changes the amount and characteristics of the cervical mucus which are necessary for implantation. The hormonal IUD can remain in the uterus for up to five years and also has a greater than 99% effective rate. Common side effects include headaches, nausea, breast tenderness, depression and ovarian cyst formation.
Hormonal Methods are commonly used by women as their primary choice for birth control. These methods include both progesterone only forms (pills, implants and injections) and combined progesterone and estrogen pills and patches. Hormonal contraception may also help with menstrual cramps, reduce bleeding during menstruation, prevent uterine and ovarian cancer, treat acne and oily skin or hair. Additionally, hormonal
methods that include estrogen may keep bones stronger.
1. A progestin implant consisting of six rods is placed under the skin of the upper arm and releases progestin into the body over a three year period. Progestin suppresses ovulation, thickens cervical mucus and alters the lining of the uterus. This has a greater than 99% effective rate. Side effects include increased or decreased bleeding during the menstrual cycle, weight gain, headaches, stomach aches, vaginal infections and breast pain. Advantages include not having to take a pill everyday and the ability to be used in people who are unable to use combined oral contraceptive pills (see below).
2. Progestin injections are given to women once every three month. These shots are about 95% effective and work just like the progestin implant. Advantages are similar to progestin implants, but they also reduce the risk of endometrial and ovarian cancer, pelvic inflammatory disease and ectopic pregnancy. Disadvantages include headaches, alterations in mood, decreased bone density, weight gain and bleeding between periods.
Image courtesy of: The Telegraph. “The Pill: women’s best friend?” 16 May 2010. Accessed 14 October 2013. <http://www.telegraph.co.uk/health/women_shealth/7728971/The-Pill-womans-best-friend.html>.
3. Oral contraceptive pills
a. Combined estrogen and progesterone pills are prescribed by a physician and work by inhibiting ovulation and transport of the egg through the fallopian tube for fertilization. It also prevents development of the endometrium and cervical mucus production required for proper implantation. Advantages include better regulation of the menstrual cycle, decreased pain and bleeding during your period, reduction in acne, lower risk of ovarian and endometrial cancer, less benign breast disease and protection from osteoporosis. Disadvantages include headaches, mood changes, breast tenderness, nausea and irregular bleeding between periods. Serious, but very rare side effects include blood clots, benign liver masses and heart attack. Because of these side effects, women over 35 who smoke, have compromised liver function or a history of blood clots are encouraged not to take combined birth control pills. The efficacy is 99.9% when taken correctly and has a failure rate of about 3% per year.
b. Progestin only pills inhibit ovulation in about 60% of women. They suppress endometrial development and thickening of the cervical mucus. There are no restrictions with this medication as there are with combined pills so women over 35 who smoke and breastfeeding mothers can use this form of contraception. Side effects include bleeding between periods, lack of periods and headaches. A disadvantage of this form of contraception is that if one pill is forgotten or vomited, a back-up method of contraception such as condoms must be used for 48 hours.
4. The patch consists of both progesterone and estrogen. The patch works similarly to the combined pills, but the patch is placed on the skin for one week. Advantages and disadvantages are similar to the combined pills, but this does not have to taken on a daily basis which makes it appealing.
Fertility Awareness based methods
Fertility awareness or natural family planning methods involve abstaining from sexual intercourse when the female is experiencing her “fertile period” which is calculated by measuring basal body temperature, observing changes in vaginal mucus, confirming the presence of luteinizing hormone in the urine, using a calendar method or combining more than one of these methods. Advantages are that there are not any side effects because no medications are used and it enhances a woman’s awareness of her body. Major disadvantages are that is it only reliable in well instructed and motivated women, is not reliable in women with irregular menstrual cycles and requires abstinence from sex for more than one week each month. There is also a fairly high rate of failure if improperly used.
Surgical sterilization provides a permanent solution to prevent pregnancy and is suggested for patients who have decided they no longer want to conceive in their lifetime. These methods are generally >99% effective. In general, these procedures are not reversible and careful thought about future child bearing should be considered.
1. Female sterilization or a tubal ligation involves a women having her “tubes tied.” The fallopian tube is the most common place where the egg and the sperm meet. Closing these tubes off to sperm prevents fertilization. This method is effective immediately.
2. Transcervical sterilization is conducted by placing a device through the cervix into the fallopian tube. This device irritates the fallopian tube and creates a scar which “plugs” the tube to again prevent fertilization. The scar can take approximately three months to grow so another birth control method must be used during this time.
3. Male sterilization or vasectomy is an operation which closes the vas deferens to prevent sperm from entering the ejaculate. If there is no sperm in a man’s ejaculate, it is not transferred to the woman preventing fertilization of an egg. After the procedure, the sperm count in the ejaculate will slowly drop to zero in about twelve weeks; therefore, another form of contraception must be used during this time.
This presentation was intended to give you an overview of the various contraceptive methods. Ask you doctor for help in determining what method is right for you and to provide more information about the different forms of contraception.