Birth Control

It is estimated by the American College of Obstetricians and Gynecologists (ACOG) that about half of all pregnancies are unplanned. Birth control, used properly, allows most pregnancies to be planned. A planned pregnancy, in turn, allows a couple to be proactive with their health prior to the pregnancy. It also makes early prenatal care more likely. (Read about "Healthy Pregnancy") In addition, certain methods of birth control also provide potential protection from some sexually transmitted diseases (STD's) or sexually transmitted infections (STI's) such as HIV, herpes, HPV and others. (Read about "STD's" "HIV / AIDS")

The Food and Drug Administration (FDA) and ACOG list five basic methods of birth control. They are:

• hormonal
• intrauterine devices (IUD)
• barriers
• sterilization
• natural

ACOG says that each method of birth control has pluses and minuses and it's important to discuss the issues with your health care provider (HCP). The following is a short discussion on the various methods. All of the statistics on the effectiveness of each method comes from the FDA.

Hormonal

All of the hormonal methods use hormones to keep the body from releasing an egg, the event known as ovulation. Without releasing an egg, there is no chance of pregnancy. They also create an unfriendly environment for fertilization and implantation. All hormonal birth control methods require a prescription.

• Oral Contraceptives - Perhaps the best known hormonal birth control method is "The Pill" or oral contraceptives. Birth control pills are considered highly effective, up to 95 percent, if taken correctly. There are two types of pills. One uses estrogen and progestin, the other just progestin. Oral contraceptives provide no protection from STD's. They must be taken on a schedule, no matter the frequency of intercourse, to be effective. If a woman misses a day when she's supposed to be taking a pill or is using certain antibiotics (Read about "Antibiotics") or medicines, the effectiveness may be compromised and she should use an additional form of birth control as a precaution against getting pregnant. The risks of using oral contraceptives, according to FDA include an increased risk of blood clots, heart attack, and stroke. (Read about "Heart Attack" "Stroke") In addition, cigarette smoking increases the risk of serious cardiovascular side effects from use of combination hormonal contraceptives.
• Skin patch - As an alternative to pills, the FDA in late 2001 approved a skin patch as a birth control method. The hormones are embedded in the adhesive layer and are slowly released when the patch is applied to the skin. Women who choose to use the product apply it to the lower abdomen, buttocks or upper body but not to the breasts. Each patch should be worn continuously for one week and is then replaced with a new patch on the same day of the week for a total of three weeks of patch wear. The fourth week, which is patch-free, allows a woman to have her menstrual period - similar to the regimen for birth control pills. The risks of using the patch, according to FDA, are similar to the risks of using birth control pills. However, FDA warns that women using the patch have a higher risk of developing serious blood clots, referred to as venous thromboembolism (Read about "Deep Vein Thrombosis" "Pulmonary Embolism"), than women using birth control pills. In clinical trials, the product appeared to be less effective in women weighing more than 198 pounds. About five percent of women had at least one patch that did not stay attached to their skin. About two percent of women in the studies withdrew from the clinical trial due to skin irritation from the patch. Again, the patch does not provide STD protection.
• Implants are usually placed in the arm and provide up to five years of birth control. They can be taken out at any time and can be replaced after the five years. They are considered 99 percent effective. They provide no protection from STD's.
• Contraceptive injections are given by healthcare providers on a regular schedule. That schedule varies depending on the exact product used. The injection functions in the same manner as the patch or oral contraceptives. Injections are considered up to 99 percent effective, but offer no protection from STD's.
• Emergency contraception (ECP) also falls under the hormonal list according to ACOG. It can be used if a woman has sex without using birth control or if a condom slips or breaks. ACOG says high doses of certain birth control pills, under the direction of a doctor, taken within 3 days can cause changes in the uterus that prevents pregnancy. The effectiveness rate is 75 percent, according to FDA. There is also a product called Plan B (progestin-only) made for use as emergency contraception. The two pills can be taken in two doses (one pill right away, and the next pill 12 hours later), or both pills can be taken at the same time. Some women feel sick and throw up after taking ECPs. Taking both pills at the same time will not increase your chances of having these side effects. If you throw up after taking ECPs, call your doctor or pharmacist. Plan B (progestin-only) has been approved to be sold over-the-counter to women who are 18 years of age or older. Women under the age of 18 will need a prescription. Women will have to show proof of age to buy Plan B. Plan B is considered 89 percent effective, according to the National Women's Health Information Center. Emergency contraception provides no protection from STD's.
• Vaginal contraceptive rings consist of a flexible, transparent, colorless ring about 2.1 inches in diameter containing the hormones etonogestrel and ethinyl estradiol, which are similar to the active ingredients in some oral contraceptives. After the ring is inserted, it releases a continuous low dose of the hormones. A new ring is used each month for continuous contraception. It provides no STD protection. If the ring has been out of the vagina for more than three hours, an additional method of contraception (male condom or spermicide) must be used until the ring has been back in place for seven days. It may also interfere with the correct placement and position of a diaphragm, according to the FDA. It is considered 98 to 99 percent effective.

As mentioned earlier all of these methods require a doctor's prescription. There have also been studies linking some forms of hormonal birth control with an increased risk of various health risks, especially in smokers. In addition, as women get older, the risks associated with different hormonal therapies can change. Some methods may also have some health benefits, such as decreasing the risk of ovarian cancer. (Read about ovarian cancer in "The Ovaries") Because of all this, the choices should be carefully discussed with your medical professional before settling on a method.

None of the hormonal methods provides any type of protection from STD's. As a result, women who use them should also consider the use of some sort of barrier method, such as a latex condom, to give them some protection from STI's.

Intrauterine Devices (IUD)

An IUD is a small plastic device that is inserted in the uterus and is left there. It contains either copper or hormones. It works by preventing fertilization and by stopping the egg from attaching to the uterine walls. ACOG says hormonal IUDs need to be replaced every 1 to 5 years depending on the IUD, copper containing ones can remain in up to 12 years. An IUD provides no STD protection and in fact can make them worse if you get an infection. ACOG says they are best suited for women who have had at least one child. They are considered 98 to 99 percent effective.

Barriers

Barrier methods keep the sperm and the egg from getting to each other. Without that, there is no fertilization or pregnancy. Some barrier methods, such as the cervical cap and a diaphragm, require a prescription but some are available over the counter at the drug store.

• Male condoms are readily available over the counter. A condom is a sheath placed over the erect penis before penetration, preventing pregnancy by blocking the passage of sperm. Each condom can be used only once. Many condoms are made of latex. For those who might be allergic to latex there are other types of condoms. (Read about "Latex Allergy") Some condoms are prelubricated. These lubricants do not increase birth control or STD protection. FDA says non-oil-based lubricants, such as water or K-Y jelly, can be used with latex or lambskin condoms, but oil-based lubricants, such as petroleum jelly, lotions, or baby oil, should not be used because they can weaken the condom and cause it to break. Used correctly, condoms are considered 86 percent effective as a method of birth control. Contraceptive form can be used with condoms to increase effectiveness. Latex condoms are considered the best barrier-type protection from STD's. However, some skin contact infections - such as herpes, HPV or syphilis - can still be transmitted because the condom only covers the shaft of the penis.
• Female condoms may offer some STD protection says FDA. They are used once and thrown away. The female condom is considered 79 percent effective as a birth control method.
• A diaphragm is a dome-shaped rubber disk with a flexible rim, and is designed to fit inside a woman's vagina. It requires a prescription. A diaphragm covers the cervix making it hard for sperm to reach the uterus, while a spermicide cream or jelly applied to the diaphragm before insertion kills sperm. Used correctly in combination with spermicide, it is considered 80 percent effective as a form of birth control.
• Cervical caps are small rubber cups that fit over the cervix. They require a prescription and do not provide any known protection from STD's. Used with spermicides they are considered an 80 percent effective birth-control option for women who have never given birth but FDA says that rate drops to 60 percent for women who have already had a baby. The cap may not fit properly if a woman has had surgery on her cervix.
• Sponges are placed in the vagina to cover the cervix. Used with spermicides they are considered up to 80 percent effective as a form of birth control. They are available in some areas and provide no known STD protection.
• Spermicides alone are designed to kill sperm. They are available over the counter. They are not considered very effective birth control unless combined with condoms. Spermicides themselves provide no protection from STD's.

All of these methods, even the ones that do not require a prescription, are best discussed with your healthcare provider. Side effects can include irritations, allergic reactions, urinary tract infections and even abnormal pap tests. (Read about "Allergies" "Allergies" "Urinary Tract Infections" "Cervical Cancer")

Sterilization

Sterilization works by blocking the egg or the sperm, so that they can't travel.

In women, the fallopian tubes can be blocked off by surgery. They can be cut and tied off or sealed by various methods. As a result, the egg can't travel to the uterus. The procedure is called tubal ligation and it is done under general anesthesia, regional anesthesia and sometimes sedation. (Read about "Anesthesia") FDA says complications can include infection, ectopic pregnancy, hemorrhage, and problems related to the use of general anesthesia.

In a newer procedure, a small metallic implant is placed into the fallopian tubes, inducing scar tissue to form over the implant, blocking the fallopian tube and preventing fertilization of the egg by the sperm. This procedure does not require an incision or general anesthesia. It is performed by inserting a small telescope with the implant through the cervix. Once the implant is in place, the telescope is withdrawn. This can be done under sedation or local anesthesia in a physician's office.

There may be other complications, and FDA says women should also know that while sterilization is considered permanent, pregnancies following sterilization can occur. This can happen, even many years after the procedure. If this does happen, such pregnancies are at increased risk to be ectopic, a life-threatening condition. Women who have undergone sterilization should contact their healthcare provider for a pregnancy test if they have an alteration in their menstrual cycle.

In men, vasectomy is the term given to the cutting of the tubes known as the vas deferens that carry the sperm from the testes to the penis. As a result, the man's ejaculate will no longer contain sperm, and he will not be able to make a woman pregnant. A vasectomy is usually done under local anesthesia, sometimes in a doctor's office. According to the National Institutes of Health (NIH), most men will feel sore for a few days after the procedure, and recover fully within a week. It's important that a couple continue to use protection until tests show that the man's ejaculate is totally free of sperm. NIH says approximately half a million vasectomies are performed in the United States each year.

Sterilization is considered permanent with an over 99 percent effective rate. In both tubal ligation and vasectomy, the hormones produced in the ovaries and the testes continue to be produced and move into the blood stream. There is no protection from STD's because of sterilization.

Natural

There are two forms of natural birth control. The first is withdrawal where the male withdraws before ejaculation. This is also called coitus interruptus. To be effective the male must withdraw every time. ACOG says a drawback of this method is that sperm may be present in the fluid before ejaculation. Withdrawal is considered effective about 80 percent of the time.

The second method is called natural family planning or the rhythm method. It uses biological changes in the female to time sexual activity. One method uses the calendar and the menstrual cycle of the female to avoid sex at suspected times of high fertility. This method is endorsed by some religious groups. The other method measures other body changes, such as cervical mucus and body temperature, in the same way to avoid pregnancy. These methods can also be used by couples to get pregnant. FDA considers natural family planning about 75 percent effective. This method is most effective for women who have regular, predictable menstrual cycles.

Neither of the natural methods provides any STD protection.

Related Information:

    Infertility

    Genital Health - Male

    Genital Health - Female