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Birth Control: How to Decide
Choosing what type of birth control to use can be confusing. It helps to start by answering a few basic questions. Consider the following:
- The importance of protection against STDs
- The level of effectiveness you desire
- Are convenience and cost are important for your decision?
While abstinence is the only 100% effective birth control method, other methods can be very nearly as effective when used properly.
Fertility awareness is also referred to as natural family planning. This method involves timing sexual activity to avoid a woman's most fertile periods. Measuring basal body temperature and monitoring cervical mucus are ways to determine when a woman is fertile. Your health care professional can train you in the safest way to use this method correctly.
Pros: It's inexpensive and does not involve drugs or medical procedures.
Cons: Spontaneity is limited, and it is only effective about 75% of the time (meaning you have a 1 in 4 chance of getting pregnant).
Spermicides are chemicals that kill sperm and prevent them from fertilizing the egg. They are available in different forms such as foams, creams, jellies, or films. Spermicides must be inserted into the vagina before sexual activity and are most commonly used with other birth control methods rather than alone. Some women may have tissue irritation if spermicides are used frequently.
Pros: Low cost and easy to use.
Cons: No protection against STDs, and may in fact increase the risk of transmission; effectiveness is limited (about 29% of users get pregnant).
Barrier methods involve prevention of contact between sperm and egg. The latex male condom is the classic method of barrier contraception. It protects against both pregnancy and most STDs. Couples who use male condoms experience about a 15% yearly pregnancy rate.
Pros: Easy to obtain, inexpensive, protects against most STDs.
Cons: Must be used correctly with each instance of sexual activity.
The female condom is a newer birth control option that is a plastic, pouch-like device put inside the vagina before sex. It can be inserted up to 8 hours prior to sexual activity. The female condom is slightly less effective than the male condom in preventing pregnancy. It should not be used together with a male condom due to the risk of breakage.
Pros: Offers some protection against STDs.
Cons: May be noisy, 21% of users become pregnant.
The diaphragm is another method of barrier contraception. It is a rubber dome that is inserted into the vagina and placed over the cervix before sexual activity. A diaphragm is typically used together with a spermicide. Its effectiveness is comparable to that of the male condom. It should not be used during a woman’s menstrual period due to an increased risk of toxic shock syndrome.
Pros: Low cost (the diaphragm costs $15-$75 and lasts two years).
Cons: No protection against STDs, must be fitted by a physician, cannot use during menstruation.
The cervical cap is another barrier method of contraception. It is smaller than the diaphragm and fits over the cervix. Like the diaphragm, the cervical cap is used with spermicide. About 15% of women who have never had children will become pregnant using this method; the risk increases to 30% for those who have had children.
Pros: Low cost, can remain in place up to 48 hours.
Cons: Requires a doctor visit for fitting, can't be used during the menstrual period, does not protect against STDs.
Birth Control Sponge
The Today Sponge is a foam sponge saturated with spermicide. It is inserted into the vagina and placed against the cervix. It can be inserted up to 24 hours prior to sexual activity. Its effectiveness is comparable to that of the cervical cap; failure rates are 16% for women who have not had children and 32% of women who have given birth.
Pros: Immediate effectiveness, prescription and doctor visit not required.
Cons: Can be hard to use correctly, cannot be used during the menstrual period, does not protect against STDs.
Birth Control Pill
Most oral contraceptive (or birth control) pills use a combination of estrogen and progestin hormones. The pill is the most common type of hormonal contraceptive and is highly effective. A prescription is required, and side effects may occur. Light spotting between periods and breast tenderness are common side effects. More serious side effects can include raised blood pressure and blood clots. The pill is not appropriate for all women.
Pros: Very effective, may reduce menstrual cramping and lead to lighter periods.
Cons: Cost is $15 to $50/month, no protection against STDs, side effects.
Birth Control Patch
The birth control patch is another type of hormonal contraceptive. The patch is applied to the skin and left in place for a week. It is changed weekly for 3 weeks, then for the fourth week no patch is worn. The patch contains the same types of hormones as the pill, and its effectiveness is comparable to that of the pill.
Pros: Lighter periods with less cramping, no need for a daily pill.
Cons: Same cost as birth control pills, no STD protection, may cause skin irritation.
The vaginal ring contains the same hormones as the pill and patch. It is worn inside the vagina and is replaced once a month. It may cause irritation of the vaginal wall along with the same side effects as the pill or patch.
Pros: Lighter and regular periods.
Cons: Cost is $30 to $50/month, side effects, no protection against STDs.
Birth Control Shot
A hormonal injection called Depo-Provera can protect against pregnancy for three months. It is more effective than the birth control pill; only 3% of women using this method will get pregnant in one year. It may cause spotting or other side effects.
Pros: Very effective, only injected 4 times/year.
Cons: Costly ($240/year), no protection against STDs, side effects.
Birth Control Implant
The same hormone in the birth control shot can be delivered in an implant. The implant is a small, matchstick-sized device implanted beneath the skin of the upper arm. Its effect lasts 3 years, and it has a failure rate of less than 1%. Like other hormonal methods, it can cause side effects including spotting or irregular bleeding.
Pros: Long-lasting, very effective.
Cons: Very expensive (exam, implant, and insertion cost up to $800), side effects, no STD protection.
The IUD, or intrauterine device, is a small, T-shaped device inserted by a doctor into the uterus. It prevents pregnancy for a number of years. ParaGard is the name for an IUD that contains copper and can be effective for up to 12 years. Another type of IUD known as Mirena contains hormones and is effective for 5 years. Both types of IUDs are highly effective.
Pros: Long-lasting effect.
Cons: May cause irregular or heavy periods, expensive, side effects, may slip out of place.
Permanent birth control is an option for women who are certain they do not want to have children in the future. Tubal ligation, or having one's "tubes tied" is a surgical procedure that closes off the Fallopian tubes so that eggs do not travel into an area where contact with sperm is possible. Surgical sterilization is nearly 100% effective.
Pros: Highly effective, permanent.
Cons: Surgery required, may not be reversible, costly, no protection against STDs.
Tubal implants are placed inside the Fallopian tubes to block them and prevent pregnancy, in a procedure that does not require surgery. The implants are made of metal or silicone and cause scar tissue to form and block the Fallopian tubes. It takes a few months for the scar tissue to form.
Pros: Permanent, surgery not required, very effective.
Cons: Delay of a few months until effective, irreversible, costly, may increase risk of infection.
Vasectomy is a permanent birth control option for men. Vasectomy is the surgical closure of the vas deferens, the tubes that transport sperm from the testes. This prevents sperm from being released, but ejaculation is still possible. It is almost 100% effective.
Pros: Effective, permanent.
Cons: Surgery required, may not be reversible, not immediately effective.
Emergency contraception is hormonal contraception used after sexual activity to protect against pregnancy if no birth control was used. Examples of emergency contraceptives include Plan B, Plan B One-Step, and Next Choice. All of these contain a high dose of a hormone used in birth control pills, and they must be taken within 72 hours of sexual activity. Ella is a type of emergency contraception that uses a non-hormonal drug and can be used up to 5 days after sexual activity.
Options for Older Women
Lifestyle factors and age are important in choosing a birth control option. Hormonal methods like the pill, patch, or implant are not recommended for women over age 35, who smoke, or are obese, due to the risk of serious complications. Women approaching menopause may have an extra benefit from the birth control shot, since it can help relieve symptoms of perimenopause.
The withdrawal method or "pulling out," involves the man withdrawing his penis prior to ejaculation. When done correctly every time, only about 4% of couples will get pregnant in a year, but this can be difficult. More typical results show that about 18% of users become pregnant within a year.
Pros: Free, no hormones or surgery required.
Cons: No protection against STDs, difficult to do correctly.
Least Effective Methods
Without birth control, about 85% of couples will become pregnant in a year. Even birth control methods with low effectiveness will reduce that number.
Most Effective Methods
While abstinence is the only birth control method that is 100% effective, hormonal contraceptives, IUDs, and permanent birth control methods are also highly effective. Barrier methods are moderately effective for typical users.
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