Birth control has come a long way since 1960 when the Food and Drug Administration (FDA approved “the pill” to provide a more practical and effective alternative to the contraceptives used at the time. Since that time, birth control has branched out into many different forms. Learn the pros and cons of each method to make the most educated decision for your health.
As one of the oldest forms of contraception, condoms date back as far as prehistoric times. Condoms come in a variety of shapes, sizes and materials and are among the most popular forms of contraception, used by about 5.5 million Americans every month.
Condoms provide great protection from both pregnancy and sexually transmitted diseases (STDs) when used correctly, which happens around 82 percent of the time. They are one of the most cost-effective and easiest contraceptives to obtain, and lack any side effects (unless you’re allergic to latex). They also don’t require a prescription. The best way to make sure condoms are the most effective is by using them the correct way each and every time.
Birth Control Pill
As the most popular form of contraception (9.5 million Americans) since 1982, the birth control pill is made up of one hormone (progestin) or two hormones (progestin and estrogen) that you take every day to prevent pregnancy. These hormones work together to stop ovulation. No ovulation means an egg is not released into the uterus, so pregnancy cannot happen. In addition, the pill’s hormones also thicken cervical mucus, making it hard for sperm to make their way to an egg if one is released after forgetting a dose.
The birth control pill is a safe, simple and convenient way to prevent pregnancy, and even comes with a few health benefits, such as reducing menstrual cramps, lighten periods and lower your risk of ectopic pregnancy. Like most medications, the pill does have a few side effects, but many usually go away after your body gets adjusted, around two to three months.
Forgetting pills, losing the pack and not refilling your prescription on time are a few of the main reasons why women who take the pill get pregnant, which is why it has a 91 percent efficacy rate. The pill also does not protect you from STDs, so it should be used in tandem with a barrier method.
Intrauterine devices (IUDs) have been in the news a lot over the last few years due to their efficacy (99 percent!), lifespan, ease of use and ability to be reversed (unlike tubal ligation). According to The American College of Obstetricians and Gynecologists, IUDS are 20 times more effective than birth control pills, the patch or the vaginal ring. These perks make the IUD one of the most popular birth control methods, with about 4.5 million users.
An IUD is a tiny T-shaped device that is inserted into your uterus by your doctor. There are two types: copper and hormonal. Copper IUDs create a chemical reaction that is toxic to sperm, are non-hormonal and last up to 12 years. Hormonal (progestin) IUDs act similar to the birth control pill in that they release a constant stream of hormones to prevent pregnancy, but do not require taking a pill every day. Hormonal IUDs can last anywhere from three to seven years.
IUDs are convenient and can be removed at any time before they medically need to be, making it easy to start planning your family once you are ready. IUDs won’t affect your fertility or make it harder to get pregnant, and it is possible to get pregnant as soon as you have your IUD removed.
That being said, you shouldn’t entirely take an “out of sight, out of mind” mentality with your IUD. The IUD comes with a pair of strings that hang from the device about two to three centimeters into your uterus. These strings make it easier for your doctor to remove the device when needed. The IUD does come with known side effects, such as pain when the IUD is put in, nausea, irregular periods, cramps, etc.
The Depo-Provera shot is a progestin-only injection you get four times a year in the arm or buttocks. It’s convenient and private, which may be why it’s one of the most popular forms of birth control, with close to 1.5 million users. There is a downside to the shot, though. While you don’t have to take it every day, if you get the shot more than two weeks late, it may stop working, which brings its efficacy rate down to 94 percent. You should consider this if you live far from your physician or have such a busy schedule that you cannot guarantee staying on top of your follow-up shots.
Unlike barrier methods, the shot does not protect against STDs and side effects can include loss of bone density, dizziness or depression. On the other hand, many women report lighter periods while using the shot, and the shot has been correlated to a risk reduction for uterine and ovarian cancers and ectopic pregnancies. Just like the pill or IUD, you can get pregnant after discontinuing use, but there tends to be about a nine to 10-month delay.
The birth control implant (Nexplanon or Implanon) is a small, thin and flexible rod about the size of a matchstick. Similar to the IUD, the implant releases progestin into your body to prevent pregnancy for up to five years.
After numbing your arm, the implant is inserted through a small incision and placed just under your skin a few inches above your elbow on the inside of your arm. Insertion may cause soreness and even bruising, and general side effects can include irregular bleeding, headaches and acne, but these should subside after six months. The implant also does not protect against STDs, so it should be used with a barrier method as well.
The implant is 99 percent effective, convenient and private, and is currently used by a little over 960,000 Americans. Like other methods, the implant is not permanent, meaning you can get pregnant after removing it, and most women will experience a reduction in period cramps and menstruation.
Unlike an IUD or the implant, the small, flexible birth control ring (NuvaRing) is inserted by yourself every month and releases estrogen and progestin.
The ring can be up to 91 percent effective, but you have to use it correctly every time. Side effects are similar to the birth control pill but also come with discharge or irritation. The ring is popular for women who experience irregular periods because it tends to make periods easier to predict. The hormones in the ring can also help to reduce period cramps and make your period lighter. Like other methods, you can get pregnant after using the ring, and the ring does not protect against STDs.
Fertility awareness methods (FAMs), also known as “natural family planning” or “the rhythm method,” use ovulation predictors, such as your body temperature or vaginal discharge, to tell you when you’re the most fertile. In order to use FAMs, you have to learn about your menstrual cycle and predictors of ovulation and fertility, and you must follow your chart and what your symptoms are telling you in order to not get pregnant.
The first FDA-approved app, Natural Cycles, was approved in August 2018 and it relies on readings you take with a Bluetooth-enabled thermometer. The app claims 93 percent effectiveness, while more traditional methods clock in around 76 percent efficacy.
Diaphragm or Cervical Cap
Diaphragms and cervical caps are barrier methods. A diaphragm is a bendable cup, shaped a bit like a saucer and a cervical cap is a small cup made from soft silicone and is shaped similarly to a sailor’s hat. Both are placed inside your vagina to cover your cervix and need to be custom-sized by a physician, but they must be used with spermicide, a cream gel that kills sperm, to be the most effective, which ranges anywhere between 71 and 88 percent.
In order for both to work best, they have to be used correctly every time. This is something to consider if you’re unsure (after some practice) that you can place either correctly each time you have sex. Both can also move out of place during sex. They also do not protect against STDs. Some people also experience irritation from the chemicals in spermicide, increasing the risk of getting STDs. If you commonly get urinary tract infections (UTIs) diaphragms and caps may not be the best option for you.
The water-resistant patch is loaded with estrogen and progestin, similar to the pill without the need to take it every day. Just place the small (two-inch by two-inch) patch on your upper-arm, back, buttocks or stomach once a week for three weeks every month and remove in order to get your period. If you prefer to skip your period, you can skip this step and place a new patch in a different area of your body immediately after removing the previous patch.
The patch boasts a 91 percent efficacy rate, and is convenient and discreet. Unlike the pill, you only have to think about changing your patch once a week. The patch can also cause bleeding between periods, tender breasts, headaches or nausea, which usually subsides after two or three months. After discontinuing use of the patch, it usually takes one or two months for your period to return to the cycle you had previously, but you can get pregnant right away.
The most permanent method on this list, tubal ligation typically involves an outpatient laparoscopic surgery, during which a doctor ties, cuts or seals your fallopian tubes. You still have your period after tubal ligation; you just cannot get pregnant. Tubal Ligation may not be a good choice for you if you think there may be a chance you’ll want to get pregnant in the future.
Tubal Ligation is non-hormonal and doesn’t require a device or medication to use, so it can be a great option for women who prefer not to use hormones. Much like most of the options in this article, it does have a few risks. All medical procedures carry some amount of risk, such as pain and discomfort during and after the procedure, and in very rare cases accidental injury to the bowel, bladder or arteries may happen.
There are many reasons why women choose birth control beyond its original intent and it’s a highly personal decision you should make for yourself and no one else. Having a discussion with a parent, nurse, doctor or pharmacist can help narrow down the many options available today to help you find the right method for you, your needs and your lifestyle. If you’re unhappy with the method you are currently on or you’re experiencing negative side effects, talk to a nurse or doctor about finding another birth control that will work better for you, and don’t be discouraged if it requires a bit of trial and error. Your health and happiness are important!