Birth Control

Choosing a Birth Control Method

With so many methods available and so many factors to consider, choosing birth control can be difficult. You may be able to decide on a method by asking yourself the following questions.

Might I want to have a biological child in the future?

One of your first considerations might be to determine whether you want permanent or temporary birth control. In other words, you should consider whether you want to conceive any (or more) children. This is a decision that will affect the rest of your life and can be made only after thinking it through carefully.

If you know that you will not ever want to conceive a pregnancy, tubal ligation or tubal implants for you or a vasectomy for your partner is a reasonable option to consider.

If you are not sure about the future even though you know how you feel now, a temporary method is a better choice. If you are young, have few or no children, are choosing sterilization because your partner wants it, or think it will solve money or relationship problems, you may regret your decision later.

How would an unplanned pregnancy affect my life?

If an unplanned pregnancy would seriously impact your plans for the future, choose a birth control method that is highly effective. Or, if you have a stable relationship and income and plan to have children in the future anyway, you may feel comfortable using a less reliable method.

How effective are different types of birth control?

See a table showing the birth control failure rates of each method.

Hormonal injections (Depo-Provera), implants (Implanon), and the hormonal and copper IUDs are highly effective methods of birth control (97%, 99.8%, and 99.9% effective). That means fewer than 1 to 3 out of 100 women using these methods will become pregnant in a year.⁶

Birth control pills (both combination and progestin-only) have a high success rate of 92%. That means that 8 out of every 100 women taking pills become pregnant in a year. If taken carefully every day or at the same time every day, birth control pills are over 99% effective.⁶ The hormonal skin patch and vaginal ring are thought to be about as effective as birth control pills.

Barrier methods , including the diaphragm, cervical cap, Lea's Shield, male condom, female condom, and spermicide, are moderately successful at preventing pregnancy. The diaphragm and cervical cap are 84% effective for women who have not had a vaginal childbirth. This means that of all such women using a diaphragm or cap, 16 out of every 100 get pregnant in a year.⁶ Women who have delivered a baby vaginally have lower rates of success with diaphragms and cervical caps.⁶ These methods are more effective when they are used every time you have sex and when they are fitted correctly. Some women find it hard to plan ahead or to interrupt an intimate moment before having sex to use a barrier method.

Condoms alone or spermicides alone are also moderately successful at preventing pregnancy.

• The male condom is 85% effective.⁶ This means that out of 100 couples who use only male condoms for birth control each time they have sex, 15 will become pregnant in a year.
• The female condom is 79% effective.⁶ This means that of all couples who use only female condoms, 21 out of 100 will become pregnant in a year.
• Spermicide is 71% effective.⁶ This means that of all couples who use only spermicide, 29 out of 100 will become pregnant in a year.

Consider carefully whether these higher risks of pregnancy are acceptable to you. Experts recommend that you use condoms along with another method or spermicide and condoms together to increase their effectiveness.

To be effective, a barrier method must be in place every time you have sex. When possible, put a diaphragm, cervical cap, sponge, or shield in place ahead of time. If not, it's necessary to interrupt the moment and put the barrier in place. Some people successfully use a condom or other barrier method as part of their lovemaking.

Consider how comfortable you feel about using a particular method of birth control. If you are not comfortable with or might not consistently use a birth control method for any reason, that method is not likely to be reliable for you in the long run. A reality check for birth control methods can help you determine which method is right for you.

How can I prevent sexually transmitted diseases?

Unless you know that your partner has no other sex partners and is free of sexually transmitted diseases (STDs), you are at risk for STD infection. If you are at risk, protect yourself from infection every time you have sex. Use a condom in addition to any other birth control method you choose.

You can choose between a male or female condom to reduce your risk for HIV (the virus that causes AIDS), gonorrhea, syphilis, chlamydia, genital warts, herpes, pelvic inflammatory disease (PID), and other infections.

What health factors could limit my choice of birth control?

If you have health problems or other risk factors, some birth control methods may not be right for you.

• Smoking. If you smoke more than 15 cigarettes a day and are 35 or older or have high blood pressure, a history of stroke, a history of blood clots, liver disease, or heart disease, you may not be able to use combined hormonal methods.
• Migraines. If you have migraine headaches, talk to your health professional about whether you can try combined hormonal contraception.
• Diabetes. If you have advanced or long-standing diabetes, discuss the risks of taking hormonal birth control methods with your health professional.
• Breast-feeding. If you are breast-feeding, the estrogen in combined hormonal birth control can lower your milk supply. Progestin-only pills, an implant (Implanon), both kinds of IUDs, or Depo-Provera injections do not affect your milk supply and are a good option for breast-feeding women.

Other health problems that might keep you from using a particular birth control method are relatively rare, especially in young women. However, before using any method, you should talk with your health professional to see if it is safe for you.

If you are at risk of sexually transmitted disease (STD) infection, consider the following:

• Spermicide. Most spermicides contain a chemical called nonoxynol-9 (N9). The U.S. Food and Drug Administration (FDA) warns that N9 in vaginal contraceptives and spermicides may irritate the lining of the vagina or rectum. This may increase the risk of getting HIV/AIDS from an infected partner.
• IUD. All women at risk for an STD should be screened before getting an intrauterine device (IUD).⁷ If a sexually transmitted disease is present at the time the IUD is inserted, the infection can be carried into the uterus. This can lead to pelvic inflammatory disease, which can cause infertility.⁴ If you are getting an IUD and have any risk of getting an STD, use condoms before and after the IUD is inserted.
• Depo-Provera. Use of Depo-Provera may increase the risk of chlamydia or gonorrhea infection among women who are exposed to these diseases.⁸ If you have any risk of getting an STD, use condoms.

Using Depo-Provera for 2 or more years can also cause bone loss, which may not be fully reversible after stopping the medication.⁹

A small study among teens showed that bone loss from Depo-Provera was reversed after they stopped getting the shots.¹⁰ Talk to your doctor about your risks if you have used Depo-Provera longer than 2 years.

What other factors might influence my decision?

Each method has benefits.

• Combination pills, which contain both estrogen and progestin, may reduce acne, pain during ovulation, premenstrual symptoms, and heavy menstrual bleeding and cramping.
• One type of birth control pill called YAZ or Yasmin reduces severe mood and physical symptoms that some women get before they start their monthly periods.¹¹ These symptoms are called premenstrual dysphoric disorder (PMDD). YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms.
• Seasonale or Seasonique is a combination pill you take for 84 days rather than the normal 21 days; then you take no pills for 7 days in order to have a period (menstruate). This decreases your menstrual periods to only 4 a year.
• Lybrel is a low-dose combination pill. You take a hormone pill every day of the month, and have no monthly periods. (But it is common to have unexpected spotting or bleeding, especially during the first year.)
• The progestin IUD (Mirena), the progestin-only injection (Depo-Provera), and the progestin-only implant (Implanon) can relieve cramping and menstrual bleeding, make periods less frequent, or even stop periods altogether.
• Unlike the combination pill, most women can take the progestin-only pill, including those who are breast-feeding (because estrogen lowers milk supply). However, you must take the progestin-only pill at the same time each day to prevent pregnancy.

The most common reasons women give for quitting hormonal contraception (combination pills, patches, or rings; progestin-only pills, implants, or injections; or the progestin IUD [Mirena]) include:¹²

• Irregular bleeding (12%).
• Nausea (7%).
• Mood changes (5%).
• Weight gain (5%, except for Mirena IUD).
• Breast tenderness (4%).
• Headache (4%).

Condoms and spermicides are available without a prescription. You can buy condoms and spermicides at most drugstores.

What are some other considerations in choosing a birth control method?

Other factors to consider when choosing a method of birth control include:

• Health benefits, such as decreased risk for sexually transmitted diseases with condoms and reduced risk of ovarian cancer and uterine cancer with use of birth control pills for one year or longer.
• Convenience and ease of use. Birth control forms such as patches, shots, implants, IUDs, and vaginal rings are convenient for women who have trouble remembering to take a daily pill or couples who know they won't use a barrier method every time they have sex.
• Cost. Over time, the higher one-time cost of IUD insertion or sterilization surgery may be less than the continued costs of buying pills or condoms and spermicide.

Birth control methods work the same for people of any age, although some methods are not recommended for sexually active teenagers or women over 35 who smoke. This can be because of health reasons or poor pregnancy prevention if the method is not used every time. It's important to understand:

• How pregnancy occurs.
• The myths about sex and pregnancy.

Once you have looked at the facts about the different methods and considered your own values and needs, you can choose the method that will work best for you. Using condoms with any method may increase its reliability and helps to protect you from sexually transmitted diseases (STDs). For more information, see:

Which birth control method should I use?

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Author:	Bets Davis, MFA	Last Updated: May 22, 2008
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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