Pinky Ronen, M.D.
It can be difficult to decide which birth control method is best because of the wide variety of options available. The best method is one that you will use consistently, is acceptable to you and your partner, and does not cause bothersome side effects. Other factors to consider include:
No method of birth control is perfect. You must balance the advantages and disadvantages of each method and then choose the method that you will be able to use consistently and correctly.
Emergency contraception, sometimes called the morning after pill, refers to the use of medication to prevent pregnancy. You can use the morning after pill if you forget to take your birth control pill, if a condom breaks during sex, or if you have unprotected sex for other reasons (including victims of sexual assault). Morning after pills may be hormonal (eg, PlanB Obe-Step®) or nonhormonal (eg, Ella®). An IUD can also be inserted for use as emergency contraception, and is more effective at preventing a pregnancy than pills. Detailed information on emergency contraception is available separately.
Most birth control pills, also referred to as "the pill," contain a combination of two female hormones.
How well do they work? When taken properly, birth control pills are very effective. In general, if you miss one pill, you should take it as soon as possible, If you miss two or more pills, continue to take one pill per day and use a back-up method of birth control (eg, a condom) for seven days. If you miss two or more pills, you should also consider taking the morning after (emergency contraception) pill.
Side effects — Side effects of the pill include:
Nausea, breast tenderness, bloating, and mood changes, which typically improve after two to three months.
Irregular vaginal spotting or bleeding. This is particularly common during the first few months. Forgetting a pill can also cause irregular bleeding.
Progestin-only pills — Unlike traditional birth control pills, the progestin-only pill, also called the mini pill, does not contain estrogen. It does contain progestin, a hormone that is similar to the female hormone, progesterone. This type of pill is useful for women who cannot or should not take estrogen.
Progestin-only pills are as effective as combination pills if they are taken at the same time every day. However, progestin only pills have a slightly higher failure rate if you are more than three hours late in taking it.
The only injectable method of birth control currently available in the United States is medroxyprogesterone acetate or DMPA (Depo-Provera®). This is a progestin hormone, which is long-lasting. DMPA is injected deep into a muscle, such as the buttock or upper arm, once every three months. A version that is given under the skin is also available.
DMPA is very effective, with a failure (pregnancy) rate of less than one percent.
Side effects — The most common side effects of DMPA are irregular or prolonged vaginal bleeding and spotting, particularly during the first three to six months. Up to 50 percent of women completely stop having menstrual periods after using DMPA for one year. Menstrual periods generally return within six months of the last DMPA injection.
Birth control skin patches contain two hormones, estrogen and progestin, similar to birth control pills. The patch is as effective as birth control pills, and may be preferred by some women because you do not have to take it every day.
Ortho Evra is the only skin patch birth control available in the United States. You wear the patch for one week on the upper arm, shoulder, upper back, or hip. After one week, you remove the old patch and apply a new patch; you repeat this for three weeks. During the fourth week, you do not wear a patch and your menstrual period occurs during this week.
The risks and side effects of the patch are similar to those of a birth control pill, although there may be a slightly higher risk of developing a blood clot.
A flexible plastic vaginal ring (Nuvaring®) contains estrogen and a progestin. You wear the ring in the vagina, where there hormones are slowly absorbed into the body. This prevents pregnancy, similar to a birth control pill. You wear the ring inside the vagina for three weeks, followed by one week when you do not wear the ring; your menstrual period occurs during the fourth week. The ring is not noticeable, and it is easy for most women to insert and remove. You may take the ring out of the vagina for up to three hours if desired, such as during intercourse. Risks and side effects of the vaginal ring are similar to those of birth control pills.
A single-rod progestin implant, Implanon®, is available in the US and elsewhere. It is inserted by a healthcare provider into your arm. It prevents pregnancy for up to 3 years as the hormone is slowly absorbed into the body. It is effective within 24 hours of insertion. Irregular bleeding is the most bothersome side effect. Most women can become pregnant quickly after the rod is removed.
Barrier contraceptives prevent sperm from entering the uterus. Barrier contraceptives include the condom, diaphragm, and cervical cap. A full discussion of barrier methods of birth control is available separately.
IUDs are placed by a healthcare provider through the vagina and cervix, into the uterus. The currently available IUDs are safe and effective. These devices include:
Sterilization is a procedure that permanently prevents you from becoming pregnant or having children. Tubal ligation (for women) and vasectomy (for men) are the two most common sterilization procedures. Sterilization is permanent, and should only be considered after you discuss all available options with a healthcare provider.
Some women and their partners cannot or choose not to use the birth control methods mentioned above due to religious or cultural reasons. Fertility-awareness based methods for preventing pregnancy are based upon the physiological changes during the menstrual cycle. These methods, also called "natural family planning," involve identifying the fertile days of the menstrual cycle using a combination of cycle length and physical manifestations of ovulation (change in cervical secretions, basal body temperature) and then avoiding sexual intercourse or using barrier methods on those days.