Contraception

What is the effectiveness of different forms of contraception?

• Most effective (99%): Intrauterine contraception (IUD), contraceptive implants, and sterilization are associated with a low pregnancy rate in all users.
• More effective (98%): Injectable contraceptives, the birth control pill, the vaginal ring and birth control patch are also associated with a very low pregnancy rate if they are taken consistently and correctly, but actual pregnancy rates are substantially higher because of inconsistent/incorrect use.
• Less effective (94-95%): Condoms are 95% effective, diaphragm and spermicide are 94%, and spermicide alone is 91% effective.
• Least effective (85%): Withdrawal, and rhythm or timed coitus are associated with higher rates of pregnancy

Intrauterine Device (IUD)

An IUD is a small, T-shaped device that is inserted and left inside your uterus to prevent pregnancy. An IUD must be inserted (and removed) by your doctor in her office.

INTRAUTERINE DEVICES DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — 1 woman out of 100 will become pregnant within the first year of using an IUD, with typical use.

Risks — Most common: bleeding.
Less common: infection inside the uterus and fallopian tubes, an IUD can come out of the uterus and move into the vagina, or poke into the uterine wall or poke through the uterus requiring removal or surgery.
Although rare, if pregnancy occurs, you are more likely to have a pregnancy in the fallopian tubes (ectopic pregnancy).

Benefits — highly effective, private, long-acting, reversible form of contraception. An IUD doesn’t interrupt the spontaneity of sex and you don’t have to take a daily pill or insert a monthly ring. Your baseline fertility returns immediately after your IUD is removed, so you can try to get pregnant right away. It is safe for most women, including teens, women who have not had children and breastfeeding mothers. A progesterone IUD may decrease the risk of endometrial cancer.

• ParaGard — No hormones, copper IUD that is effective for up to 10 years. Women retain regularity of periods, can be inserted as emergency contraception after unprotected sex. Menses may be heavier, longer, or more uncomfortable, particularly in the first several periods after insertion.
• Mirena/Liletta — Progesterone only, effective for up to 5-7 years. Women often have lighter periods or no periods, decreases menstrual cramping, may decrease pain from endometriosis, may decrease the chance of getting a uterine cancer. Common to have spotting daily after initial insertion, missed periods, irregular spotting or bleeding. Hormonal side effects like headaches, nausea, breast tenderness, mood changes, acne, hair loss, or mood changes are less commonly seen.
• Kyleena — Progesterone only (less than Mirena/Liletta), effective for up to 5 years. Women often have lighter or no periods, lasts up to 5 years. Side effects include irregular spotting or bleeding, headaches, nausea, breast tenderness, mood changes, acne or hair loss.
• Skyla — Progesterone only (less than Mirena/Lilleta/Kyleena), effective for up to 3 years. Women often have lighter periods, lasts up to 3 years. Side effects include irregular spotting or bleeding, headaches, nausea, breast tenderness, mood changes, acne or hair loss.

Proper Use: an IUD must be inserted and removed by your doctor in her office. You should check to feel your IUD strings about once a month.

Implants (Nexplanon)

Nexplanon is a single rod, progesterone containing implant (about the size of a matchstick) that is injected under the skin of the upper, inner arm and remains in place for up to three years. Nexplanon must be inserted and removed by your doctor in her office.

CONTRACEPTIVE IMPLANTS DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — With typical use, less than 1 woman out of 100 will become pregnant within the first year of using the implant.

Risks — Although rare, if pregnancy occurs, you are more likely to have a pregnancy in the fallopian tubes (ectopic pregnancy).

Benefits — Highly effective, private, long-acting, reversible form of contraception. Nexplanon doesn’t interrupt the spontaneity of sex and you don’t have to take a daily pill or insert a monthly ring. Your baseline fertility returns immediately after the contraceptive implant is removed, so you can try to get pregnant right away. It is safe for most women, including teens, women who have not had children and breastfeeding mothers.

Side Effects — Commonly causes irregular spotting or bleeding, prolonged bleeding, heavier periods. Other side effects may include headache, weight gain, acne, breast tenderness, mood changes or depression.

Proper Use — A contraceptive implant must be inserted and removed by your doctor in her office.

For more information about Nexplanon, click here (For information from the manufacturer, click here).

Permanent Sterilization

There are several methods of safe and permanent sterilization, including Laparoscopic tubal ligation, Essure, and for men, vasectomy. Talk to your doctor if you are interested in these methods.

The Birth Control Pill

The birth control pill must be taken every day and most contain a combination of estrogen and progestrone that prevents pregnancy. There are many types of birth control pills. You and your doctor can choose one that is right for you.

BIRTH CONTROL PILLS DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — 9 women out of 100 will become pregnant during the first year of using birth control pills with typical use.

Risks — There is a very small risk of developing high blood pressure, having a stroke or getting a blood clot in your legs or lungs. People with high blood pressure, smokers over the age of 35, and migraines with aura have a higher risk of blood clot or stroke. Talk to your doctor about what your risks might be. The pill is not associated with an overall increased risk of cancer.

Benefits — Major benefits include a regular, shorter, lighter, less painful period, as well as fewer premenstrual symptoms. Other benefits include decrease in acne, decrease in unsightly hair growth and prevention of menstrual migraines and ovarian cysts. Women who use the pill are less likely to get colon, uterine or ovarian cancer. The risk of developing breast cancer is not increased if you use the birth control pill.

Side Effects — Spotting or bleeding between periods, missed periods, bloating, nausea, breast tenderness, headaches, mood changes, decreased interest in sex. These side effects are often bothersome enough to stop the pill, but they usually go away after about three months of taking the pill. The birth control pill does not cause weight gain as a side effect. If you are having side effects from the pill, call your doctor and she can help you find another birth control pill or other form of contraception.

Proper Use — Birth control pills need to be taken every day about the same time of day. Skipping pills or taking the pill late can increase the chance of getting pregnant. Birth control pill packets usually include 4 to 7 days of hormone-free pills at the end of the pack each month. It is during these hormone-free days that women get their period. If you miss a pill, take it as soon as you remember. If you miss 2 pills, call the office for advice on how to proceed. Women who prefer not to get a period can skip the hormone-free pills and take a hormone pill every day instead. After the hormone pills in the pack are consumed, the new pill pack must be started immediately. The progesterone only pill pack does not have any hormone-free pills — all pills should be taken.

NuvaRing

The NuvaRing is a flexible, plastic ring that you insert into the vagina on a monthly basis. It releases estrogen and progesterone which is absorbed through the vagina. You insert the ring on your own and it is left inside the vagina for 3-4 weeks, once removed, you get a period.

NUVARINGS DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — With typical use, 9 women out of 100 will become pregnant during the first year of using the NuvaRing or birth control patch.

Risks — Similar to the birth control pill, there is a very small risk of developing high blood pressure, having a stroke or getting a blood clot in your legs or lungs. Talk to your doctor about whether these risks are too high for you. The pill is not associated with an overall increased risk of cancer.

Benefits — Once per month dosing, no need to take a pill daily, major benefits include a regular, shorter, lighter, less painful period, as well as fewer premenstrual symptoms. Other likely benefits include decrease in acne, decrease excess hair growth and prevention of menstrual migraines and ovarian cysts.

Side Effects — An increase in vaginal discharge, spotting or bleeding between periods, missed periods, bloating, nausea, breast tenderness, headaches, mood changes, decreased interest in sex. These side effects are often bothersome enough to stop the ring, but they usually go away after about three months of taking the pill. The birth control ring does not cause weight gain as a side effect.

Proper Use — The ring is worn for 21-28 days, removed for 4-7 days, and then a new ring is inserted. During the week it is out, bleeding occurs. The ring also can be used as a continuous-dose form of birth control. To use it this way, remove the old ring after 28 days and insert a new ring immediately with no ring-free week in between.

The Patch

The birth control patch, Ortho Evra, is a small, adhesive patch, like a large band-aid, that releases estrogen and progesterone which is absorbed through the skin to prevent pregnancy. Each patch lasts one week, then must be removed and replaced for three weeks in a row.

THE PATCH DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — With typical use, 9 women out of 100 will become pregnant during the first year of using the birth control patch.

Risks — Similar to the birth control pill, there is a very small risk of getting high blood pressure, having a stroke or getting a blood clot in your legs or lungs. The risk of blood clot or stroke is slightly higher than that of most birth control pills. Talk to your doctor about whether these risks are too high for you. The pill is not associated with an overall increased risk of cancer.

Benefits — Once per week dosing compared to daily (birth control pill). Major benefits include a regular, shorter, lighter, less painful period, as well as fewer premenstrual symptoms. Other likely benefits include decrease in acne, decrease excess hair growth and prevention of menstrual migraines and ovarian cysts.

Side Effects — Skin rash or irritation at patch site, “band-aid” stickiness at the patch site, spotting or bleeding between periods, missed periods, bloating, nausea, breast tenderness, headaches, mood changes, decreased interest in sex.

Proper Use — The patch replaced weekly for 3-4 weeks and then removed for 7 days. During the week without the patch, bleeding usually occurs. The patch also can be used as a continuous-dose form of birth control. To use it this way, replace with a new patch every week.

Injection

(Depot medroxyprogesterone acetate, commonly called Depo-Provera)

Depo-Provera is a progesterone injection that prevents pregnancy for 3 months.

DEPO-PROVERA DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — With typical use, 6 women out of 100 will become pregnant within the first year of using the injection.

Risks — Depo-Provera may cause a decrease in bone density. This bone loss usually resolves once the injections are stopped. Some women may be at increased risk of heart disease, particularly those that smoke, are diabetic, have high blood pressure or a history of stroke or vascular disease.

Benefits — Reversible form of contraception that does not contain estrogen. The Depo-provera injection doesn’t interrupt the spontaneity of sex and you don’t have to take a daily pill or insert a monthly ring.

Side Effects — Many women have irregular bleeding during the first 6–9 months of use, which may be heaver, lighter, or unpredictable. Many women stop having periods while using the birth control injection. Other side effects include weight gain (4 pounds per year), headaches, mood changes, nervousness, dizziness, weakness, fatigue.

Proper Use — You must return to see your doctor every three months to receive the birth control injection.

Barrier Methods

Condoms

Condoms can be make of latex, polyurethane or natural lambskin. Spermicidal condoms are no more effective than other lubricated condoms.

CONDOMS DO HELP PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectivess — 18 out of 100 women will become pregnant with typical use during the first year.

Risks — None.

Benefits — Protects against sexually transmitted infections, inexpensive, no prescription needed, can be used with breastfeeding and is hormone free.

Side Effects — Allergic reactions.

Proper Use — Before any penetration, place the rolled-up condom over the tip of the erect penis. Hold the end of the condom to allow a little extra space at the tip. Then unroll the condom over the penis. Right after ejaculation, grasp the condom around the base of the penis as it is withdrawn. Throw the condom away. Do not reuse a condom.

Spermicide

Spermicide is a foam, cream, jelly, suppository or film that is inserted into the vagina to try to kill sperm. It can be used with all other barrier methods except the sponge, which already contains a spermicide.

If used without a condom, SPERMICIDES DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — 28 out of 100 women will become pregnant with typical use during the first year.

Risks — None.

Benefits — Inexpensive, no prescription needed, can be used with breastfeeding, hormone free.

Side Effects — Allergic reactions, vaginal itching or burning.

Proper Use — When used alone, a spermicide should be inserted into the vagina close to the cervix no more than 30 minutes before intercourse and should remain in place for 6–8 hours after sex. A spermicide should be reapplied with each act of sex.

Diaphragm

A diaphragm is a small dome-shaped device made of latex or silicone that fits inside the vagina and covers the cervix. It must be used with spermicide. They require a prescription and your must be fitted by your doctor.

A DIAPHRAGM DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — 12-13 out of 100 women will become pregnant with typical use during the first year.

Risks — None.

Benefits — Inexpensive.

Side Effects — Allergic reaction.

Proper Use — Before intercourse, apply spermicide around the rim and inside the dome of the diaphragm. Squeeze the rim between your fingers and insert it into your vagina. The front part of the rim should be felt behind the pubic bone. Check to see if your cervix is completely covered by the diaphragm. Insert additional spermicide if sexually active within 6 hours. A diaphragm must remain in place for 6 hours after sex but no more than 24 hours.

To remove the diaphragm, pull gently on the front rim. To wash the diaphragm, use mild soap and water. Rinse the soap off well (soap can damage the rubber), dry it, and put it back in its case.

Female Condom

A FEMALE CONDOM DOES HELP PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — 21 out of 100 women will become pregnant with typical use during the first year.

Risks — None.

Benefits — Inexpensive, no prescription needed, can be used with breastfeeding, hormone free, can be inserted up to 8 hours prior to intercourse.

Side Effects — Vaginal discomfort, allergic reaction.

Proper Use — Squeeze the inner ring between your fingers and insert it into the vagina as far as possible. Push the inner ring up until it is just behind the pubic bone. About an inch of the open end should be outside your body. Right after ejaculation, twist the outer ring closed, and pull the pouch out gently. Throw the condom away. Do not reuse it. Do not use a male and female condom together.

Contraceptive Sponge (Today Sponge)

A Today Sponge is a doughnut-shaped sponge made of soft foam coated with spermicide that is inserted into the vagina.

A CONTRACEPTIVE SPONGE DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS

Effectiveness — 12 out of 100 women who have never been pregnant will become pregnant with typical use during the first year. The sponge is less effective in women who have given birth: 24 women out of 100 who have given birth will become pregnant within the first year of typical use.

Risks — Toxic shock syndrome.

Benefits — Inexpensive, no prescription needed, can be used with breastfeeding, hormone free, can be inserted up to 24 hours prior to intercourse.

Side Effects — Vaginal irritation and allergic reactions to polyurethane, spermicides, or sulfites (all of which are found in the sponge).

Proper Use — Wet the sponge completely and squeeze it gently. Squeeze the sides of the sponge upward and away from the loop and insert the sponge as far back into your vagina as you can. Check its position with your finger. You should be able to feel the loop. It can be worn for up to 30 hours total and can be inserted up to 24 hours before sex and should be left in place for at least 6-24 hours after sex. To remove the sponge, grasp the loop and slowly pull the sponge out.