It’s time to talk about birth control. With so many options, it can be daunting determining which method is best for you. There are numerous factors to consider when choosing the right form of contraceptive. Some considerations include convenience, chronic diseases, smoking status, personal beliefs, age, level of effectiveness, protection against sexually transmitted infections (STIs), and reversibility. All these factors are considered when determining an appropriate contraceptive method, which is overwhelming! First, let’s break down each method of non-permanent contraceptive therapy.
Hormonal implant: The hormonal implant is the most effective form of non-permanent contraceptive. The implant is 99.9% effective in the prevention of pregnancy. The hormonal implant uses progestin to stop ovulation and thicken cervical mucous. The procedure is done in the office, where a thin plastic rod 4 cm in length is placed beneath the skin in the arm. This form of birth control is effective for three years. This method is great for women who are looking for a contraceptive they do not have to remember to take daily. The implant is safe to use in women who are at risk for heart disease, stroke, those who experience migraine with aura, women who smoke tobacco over the age of 35, or in women who have hypertension or a history of blood clots.
Hormonal IUD: A close second in effectiveness is the hormonal IUD. Like the implant, the IUD uses progestin for prevention of pregnancy. It is a small, T-shaped plastic device that is inserted in the office setting. Depending on the IUD, these are approved for 3-5 years for contraception. This form of contraception is helpful to treat heavy periods. Similar to the hormonal implant, this form of birth control is safe in women with the risk factors listed above. The IUD is not appropriate for those with pelvic inflammatory disorder, undiagnosed vaginal bleeding, suspected pelvic malignancy, or those with distorted anatomy of the uterus.
Birth control shot: The birth control shot is an intramuscular injection using progestin medroxyprogesterone acetate for the prevention of pregnancy. This form of birth control is 99.7% effective. The shot is given every 12 weeks and must be administered in the office. The injection may be beneficial for those who experience pain with their periods. There is a warning against long term use of this contraceptive longer than 2 years as this medication has shown to possibly cause bone loss with extended use. This medication is avoided in teenagers or those at high risk for osteoporosis.
Combination pills: Birth control pills are 99% effective with perfect use, 91% effective in typical use. The pill is taken daily around the same time each day. The pill uses both estrogen and progestin to prevent ovulation and thicken the cervical mucous. There are many different formulations for this form of contraception, some allow for a period to occur monthly, while others allow for a period to occur every three months. The main benefit to this form of contraception is that it is not invasive and does not require frequent visits to your health care provider for management. The pill can be effective in the treatment of acne, PMS, iron deficiency anemia, PCOS, and prevent endometrial and ovarian cancers.
Progestin-only pill: The progestin only pill is 99% effective in perfect use, 91% effective in typical use. The pill must be taken at the same time each day to be effective. This form of birth control is appropriate for breastfeeding mothers and high-risk patients as have been listed out above. They are packaged for a 28-day cycle, without placebo pills.
Birth control patch: The birth control patch is 99% effective with perfect use and 91% effective with typical use. This form of birth control contains both estrogen and progestin. The patch is placed on the skin once a week, wearing the patch for 21 days. The patch is removed in the fourth week, allowing for a period to occur. The patch has similar benefits as the combination pill.
Contraceptive ring: The ring is 98% effective with perfect use, 91% effective with typical use. The ring is flexible, transparent, and plastic. It is inserted in the vagina and remains there for three weeks. The ring is removed on the fourth week to allow for a period. A new ring must be inserted on the same day every fourth week to be effective. The ring has similar benefits as the patch and combination pills and is not the birth control choice for those at-risk individuals listed previously.
Copper IUD: The copper IUD is a non-hormonal contraceptive option and is 99.2% effective in the prevention of pregnancy. The copper IUD causes an inflammatory reaction that makes for a toxic environment for sperm and eggs preventing fertilization from occurring. Similar to the hormonal IUD, this is placed in the office setting. This is an option for those who are sensitive to hormones, are in a high-risk category, or would prefer to avoid hormone containing methods. This form of birth control is effective for 10 years.
It is important to note that the above-mentioned forms of contraceptives do not provide protection from sexually transmitted infections. Condoms are the only form of contraceptive method that will provide protection from both sexually transmitted infections and unwanted pregnancy. It is important to have regular STI testing, pap smears, and annual visits with your health care provider.
There are other birth control options such as female condoms, male condoms, pull-out method, diaphragm, cervical cap, sponge, spermicide, and the fertility awareness method that are not depicted here. These options are shown to be somewhat less effective than the methods described above but may be an option that you opt for to fit your needs.
For more information on birth control options, please see the CDC website shown below: