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Birth Control Contraception

Contraception, or birth control, is intended to prevent pregnancy. Contraception allows women to be sexually active while choosing whether or not they become pregnant.

Types of Birth Control Contraception

Birth Control ContraceptionThere are many different methods of birth control.  Some require a prescription or medical procedure but others are available over-the-counter.  Most contraception methods are temporary and will need to be used every time a sexual encounter occurs or must be used or taken on a daily basis.  Other forms of birth control may last months or even years without intervention.   Still, other methods are considered permanent.

While no form of contraception other than abstinence is 100% effective, user failure is a major reason for unintended pregnancy while using birth control.  Without birth control, the likelihood of pregnancy in a fertile couple who are regularly sexually active is about 85% within one year.  With the consistent and correct use of birth control, that rate may be decreased to less than one percent.

Permanent Birth Control

Aside from abstinence, sterilization is the only birth control method that is considered permanent.  Sterilization is performed when a woman has decided that she does not wish to have any children in the future.  Sterilization is performed by a healthcare practitioner and in most cases, cannot be reversed.

Tubal ligation

Tubal ligation is also known as having ones “tubes tied”.  It is a surgical procedure that can be done vaginally (through the vagina) or through an abdominal incision.  The woman’s fallopian tubes are severed or closed, through a combination of being cut, cauterized with electric current, tied with a medical ligature, sutures or clip, or having a portion removed, to prevent egg travel.  Tubal ligation is considered irreversible.

Essure

Essure is a non-surgical method of permanent birth control that has been highly controversial.  Essure is an implant which consists of wire coils and plastic which is inserted into the fallopian tubes.  The coils cause the formation of scar tissue which will close off the fallopian tubes, making egg travel impossible.  Essure was introduced in 2002 but has resulted in thousands of serious adverse events and Essure lawsuits being filed against its manufacturer, Bayer.  After several warnings by the FDA due to the risk of complications, Bayer has announced that it will no longer sell the device after December 2018.

Vasectomy

A vasectomy is a sterilization procedure which is performed on men, rather than women.  Vasectomy is a procedure in which the vas deferens or tube that carries sperm from the testes to the urethra is cut and/or cauterized shut.  Vasectomy is done in a physician’s office, under local anesthesia and requires only a tiny incision and virtually no recovery time.  In most cases, vasectomy is considered irreversible.

Reversible Birth Control Devices

Reversible birth control device are long-lasting contraceptives which are removable.  In most cases, fertility will return shortly after the device is removed.  Reversible birth control devices are generally considered to be more than 99% effective.

Intrauterine device

An intrauterine device (IUD) is a long-lasting contraception method.  An IUD is a device that is inserted into the uterus through the cervix and left in the place where it prevents implantation of a fertilized egg.  IUDs can be left in place for a number of years before needing to be removed and/or replaced.  There are two types of IUD:

  • Copper IUD – A T-shaped device which can be used for up to 10 years. Currently, in the U.S., the only copper IUD is sold under the brand name Paragard.
  • Hormonal IUD – A T-shaped device made of a polymer that releases a synthetic form of progesterone. Hormonal IUDs sold in the U.S. contain the hormone levonorgestrel and are sometimes called LNG IUDs.  Some brands of hormonal IUDs last for up to five years, while others are effective for only three years.

The most well-known form of hormonal IUD is the Mirena IUD which has been the subject of thousands of adverse event reports and lawsuits being filed against its manufacturer, Bayer.  Other hormonal IUDs are sold under the brand names Skyla, Liletta, and Kyleena and contain the same hormone but at lower amounts.

Birth Control Implant

A birth control implant is a device which is implanted under the skin of the upper arm.  It is constructed of a small plastic rod, about the same size as a matchstick, that releases a synthetic progesterone hormone over a period of years.  Contraceptive implants can be inserted in a physician’s office, under local anesthesia through a tiny incision.

Nexplanon is the only brand of birth control implant currently available in the U.S.  It contains the hormone etonogestrel and lasts for three years before needing replacement.  Nexplanon was introduced in 2010 to replace Implanon which was discontinued.  The first implantable birth control device, Norplant, was discontinued in 2002 after thousands of serious adverse events resulted in thousands of lawsuits filed against its manufacturer.

Temporary Birth Control

Temporary hormonal birth control is the most common type of contraception used in the U.S.  About 16% of women of reproductive age (15 to 44) in the U.S. use birth control pills, but forgetting to take a daily pill can reduce its effectiveness.  Other hormonal methods are good for one to three months but still need regular dosing.

Birth Control Pill

When taken as directed, birth control pills are about 97-99% effective but in practical use, fall to about 91% effectiveness.  This occurs because women forget to take their pill on a daily basis or other reasons which reduce effectiveness such as illness (vomiting or diarrhea) or drug interactions.

Birth control pills are also taken for hormone control purposes, to regulate menstrual periods, reduce menstrual pain and for severe acne.  There are two main types of oral contraceptives:

  • Combined oral contraceptive (COC) pills contain a combination of synthetic estrogen and synthetic progesterone (progestin).
  • Progestin-only pills (POP) only contain a synthetic progesterone and are sometimes called “mini-pill”. POPs are sometimes given to women who cannot take estrogen.

Birth Control Shot

A birth control shot is a ‘depo” injection containing a form of progesterone that is injected into the muscle of the buttock or arm every three months.  Over that period, the hormone is released from the muscle, providing birth control for 12 to 14 weeks.  A new injection must be given every 12 weeks to ensure protection.  Depo-Provera, containing medroxyprogesterone, is the only birth control shot currently on the U.S. market and with perfect use has about 99% effectiveness rate which may fall to 94% with typical use.

Birth Control Patch

A birth control patch is a thin sheet of adhesive plastic which slowly releases hormones through the skin.  Each patch has enough hormones to last for one week.  Patches are replaced weekly for three weeks, followed by a fourth week with no patch to allow for menstruation. Three brands of the birth control patch are currently available in the U.S., Evra, OrthoEvra, and Xulane.  All three patches contain ethinylestradiol (an estrogen) and norelgestromin (a progesterone). When used exactly as prescribed, the birth control patch is about 99% effective but in practical use is about 91% effective.

Vaginal Ring

The vaginal ring is a thin, plastic ring that contains synthetic progesterone and estrogen.  It is inserted into the vagina to be placed at the cervix where it releases hormone over 3 weeks.  At the end of the three weeks, the ring is removed for one week to allow for a menstrual period and then a new ring is placed.  The vaginal ring is available in the U.S. under the brand name, NuvaRing and contains Ethinyl estradiol (an estrogen) and etonogestrel (a progesterone).  When used as directed, Nuvaring is about 99% effective but may fall to 91% effectiveness in practical use.

Over-the-Counter Birth Control

Condoms

Condoms are the most common type of over-the-counter birth control.  They are also the only method of contraception that helps to prevent sexually transmitted infection or disease (STI or STD).

There are two types of condoms, male and female.  Male condoms are the most widely know and are generally made of a thin layer of latex (rubber) or polyurethane (plastic) which is worn over the penis.  Female condoms are thin polyurethane pouches that cover the inside of the vagina.  Though condom use is highly effective with perfect use, a high user failure rate brings the effectiveness down to about 88%.  Female condoms generally have an effectiveness rate of about 79%.

To increase the effectiveness of condoms for both pregnancy and disease prevention, the Centers for Disease Control recommends:

  • A condom should only be used one time. A new condom should be used for every sexual encounter and used condoms should be disposed of immediately.
  • Condoms have an expiration date that can be found on packaging. Expired condoms should not be used.
  • A condom should be put on before any sexual contact is made. Viable sperm can leak from the penis before ejaculation and result in pregnancy.
  • A condom should only be used if it is the correct size. A loose condom may slip off and a condom that is too small or tight may tear or break.
  • If a condom breaks or tears, it should be replaced immediately. If it tears during intercourse, an emergency contraceptive should be taken as soon as possible.
  • Lubrication use can reduce the risk of condom rupture or tear. Many condoms are pre-lubricated but water-based lubricants can be used separately.  Oil-based lubricants can weaken a latex condom and should not be used.
  • Some condoms also contain spermicide, making them more effective.

Spermicide

Spermicide is a chemical that works to prevent pregnancy by killing sperm cells.  Spermicide is available over the counter in different forms including foam, jelly, cream, and suppository.  It must be inserted into the vagina no more than 30 minutes before sexual intercourse and should remain in the body for six to eight hours.

The most common spermicidal ingredient is nonoxynol-9.  Some people are allergic or sensitive to spermicide and it should not be used.  When used alone, spermicide is only about 72% effective and should ideally be combined with another method such as condom or diaphragm.  Many condoms already contain spermicide and spermicide is nearly always recommended with diaphragm use.

Birth Control Sponge

The birth control sponge is a soft, donut-shaped sponge which contains spermicide.  The sponges are inserted into the vagina several hours or just before sex and should be left in place for at least six hours but not more than 30 hours.  Sponges should only be used one time and should not be used during menstruation.  There are now several brands of contraceptive sponges and all contain nonoxynol-9 as the spermicide.  For women who have not had children, the effectiveness rate is about 88% but falls for women who have previously given birth to about 76%.

Diaphragm

A diaphragm is a thin latex sheet surrounded by a flexible ring which is placed inside of the vagina to cover the cervix. It is usually used in combination with spermicide to provide a double protection.  Diaphragms must be fitted by a health care provider to ensure the right size, but spermicide may usually be purchased over the counter.  The device should be replaced every two years or sooner if a tear is noted.  When used correctly, diaphragms are about 88% effective at preventing pregnancy.

Natural Birth Control Strategies

Some couples use natural methods to prevent pregnancy.  These methods include the “rhythm method” which avoids sex on days the woman is likely to be fertile and the “withdrawal method” in which the man withdraws his penis from the vagina before ejaculating.  When used alone, a withdrawal will result in pregnancy in about 22% of women within a year and fertility awareness, about 24%.

Emergency Contraception

Emergency contraception is not a form of birth control that should be used regularly.  It should only be used when a condom has broken during intercourse or to prevent pregnancy after unprotected sex.  Emergency contraceptive pills (ECP), also called “the morning after pill” is usually several tablets that are similar to a birth control pill that is taken 12 hours apart.  They should be taken as soon as possible, or within 5 days after unprotected.  In some areas, ECPs are available over-the-counter but may require a prescription in other regions.  After taking ECP, a menstrual period will begin.

A copper IUD can also be used as emergency protection if a woman was intending to obtain one anyway.  If inserted within 5 days of having sexual intercourse, copper IUD is 99% effective in preventing pregnancy.

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