CONTRACEPTION

Contraception, also known as birth control, is designed to prevent pregnancy. It also allows individuals to plan the timing of pregnancy.

Types of Contraception

Not all contraceptive methods are appropriate for all situations, and the most appropriate method of birth control depends on a woman's overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases.

Individuals should consult their health care providers to determine which method of birth control is best for them. Some types carry serious risks, although those risks are elevated with pregnancy and may be higher than the risks associated with the various methods.

General methods of contraception include:

1) Continuous abstinence

2) Natural family planning/rhythm method

3) Barrier methods

• Contraceptive sponge
• Diaphragm, cervical cap, and cervical shield
• Female condom
• Male condom

4) Hormonal methods

• Oral contraceptives — combined pill ("The pill")Oral contraceptives — progestin-only pill ("Mini-pill")
• The patch
• Shot/injection
• Vaginal ring

5) Implantable devices

• Implantable rods
• Intrauterine devices

6) Permanent birth control methods

• Sterilization implant
• Surgical sterilization

7) Emergency contraception

Individuals should consult their health care provider to determine which method of birth control is best for them. It is also important to discuss birth control methods with your sexual partner.

How effective is contraception?

Different methods of contraception have different rates of effectiveness in preventing pregnancy.

Contraception is most effective when used correctly and consistently. The failure rate increases if a method of contraception is used incorrectly.

Can contraception reduce the risk of getting a sexually transmitted disease (STD)?

Only male and female condoms are effective at reducing the spread of STDs.

The male latex condom is the best method for protecting against STDs, including HIV/AIDS. Polyurethane condoms are an effective alternative if either partner has a latex allergy.

Natural/lambskin condoms do not prevent the spread of STDs because of the presence of tiny pores (holes) that may allow viruses such as HIV, hepatitis B, and herpes to spread.

The female condom has properties similar to the male condom, but researchers have not studied its effectiveness in reducing the spread of STDs as much as they have studied the male condom.

The most common STD is the human papilloma virus, or HPV. No method of contraception can fully prevent the transmission of HPV, because it can infect areas not covered by a condom.

However, using a condom with every sex act can lower the risk of transmission.

If you have questions about birth control and STDS, talk to your health care provider.

If you think you may have an STD, you should see your health care provider.

What are the health risks and side effects associated with contraception?

Different forms of contraception carry different health risks and side effects, and some of them are serious. It is important to talk to a health care provider to determine your specific health risks and which method of contraception is right for you.

Combined hormonal birth control methods can increase the risk of heart disease, high blood pressure, and blood clots. The risk of these conditions is higher in pregnancy than with any currently marketed birth control methods, so women need to weigh the benefit of protection from pregnancy with the risk of any specific birth control method. Women are at higher risk for these outcomes if they are more than 35 years old and smoke tobacco or if they have histories of blood clots or breast or endometrial cancer. They may be advised not to use combined hormonal methods of birth control.

It is important to monitor any side effects and consult your health care provider if you experience discomfort.

What are the health benefits associated with contraception?

Contraception is most often used to help prevent pregnancy. It can be helpful for women who do not wish to become pregnant and who are at higher risk for health problems associated with pregnancy. These can include an increased risk for high blood pressure, blood clots, gestational diabetes, heart disease, and stroke.

The risks of these conditions are higher in women who are obese, are older than 35, or who smoke tobacco. For women with high risk factors who need to avoid pregnancy, IUDs and implants may be the most effective methods.

Progestin-releasing IUDs may also reduce or prevent bleeding problems. Other health benefits for certain methods include reducing acne, treating anemia associated with excessive bleeding, and reducing the risk of endometrial, ovarian, or colon cancer. It is important to discuss the risks and benefits of the methods as well as the risk associated with pregnancy with your health care provider.

How well do different kinds of birth control work? Do they have side effects?

All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don't explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don't feel embarrassed about talking to him or her.

Some birth control methods can take time and practice to learn. For example, some people don't know you can put on a male condom "inside out." Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.

Here is a list of some birth control methods with their failure rates and possible side effects.

Method	Failure rate (the number of pregnancies expected per 100 women)	Some side effects and risks
Sterilization surgery for women	Less than 1 pregnancy	Pain Bleeding Complications from surgery Ectopic (tubal) pregnancy
Sterilization implant for women (Essure®)	Less than 1 pregnancy	Pain Ectopic (tubal) pregnancy
Sterilization surgery for men (vasectomy)	Less than 1 pregnancy	Pain Bleeding Complications from surgery
Implantable rod (Implanon®)	Less than 1 pregnancy Might not work as well for women who are overweight or obese.	Acne Weight gain Ovarian cysts Mood changes Depression Hair loss Headache Upset stomach Dizziness Sore breasts Changes in period Lower interest in sex
Intrauterine device (ParaGard®, Mirena®)	Less than 1 pregnancy	Cramps Bleeding between periods Pelvic inflammatory disease Infertility Tear or hole in the uterus
Shot/injection (Depo-Provera)	Less than 1 pregnancy	Bleeding between periods Weight gain Sore breasts Headaches Bone loss with long-term use
Oral contraceptives (combination pill, or "the pill")	5 pregnancies Being overweight may increase the chance of getting pregnant while using the pill.	Dizziness Upset stomach Changes in your period Changes in mood Weight gain High blood pressure Blood clots Heart attack Stroke New vision problems
Oral contraceptives (continuous/extended use, or "no-period pill")	5 pregnancies Being overweight may increase the chance of getting pregnant while using the pill.	Same as combination pill Spotting or bleeding between periods Hard to know if pregnant
Oral contraceptives (progestin-only pill, or "mini-pill")	5 pregnancies Being overweight may increase the chance of getting pregnant while using the pill.	Spotting or bleeding between periods Weight gain Sore breasts
Skin patch (Ortho Evra®)	5 pregnancies May not work as well in women weighing more than 198 pounds.	Similar to side effects for the combination pill Greater exposure to estrogen than with other methods
Vaginal ring (NuvaRing®)	5 pregnancies	Similar to side effects for the combination pill Swelling of the vagina Irritation Vaginal discharge
Male condom	11-16 pregnancies	Allergic reactions
Diaphragm with spermicide	15 pregnancies	Irritation Allergic reactions Urinary tract infection Toxic shock if left in too long
Sponge with spermicide (Today® Sponge)	16-32 pregnancies	Irritation Allergic reactions Hard time taking it out Toxic shock if left in too long
Cervical cap with spermicide	17-23 pregnancies	Irritation Allergic reactions Abnormal Pap smear Toxic shock if left in too long
Female condom	20 pregnancies	Irritation Allergic reactions
Natural family planning (rhythm method)	25 pregnancies	None
Spermicide alone	30 pregnancies It works best if used along with a barrier method, such as a condom.	Irritation Allergic reactions Urinary tract infection
Emergency contraception ("morning-after pill," "Plan B® One-Step," "Next Choice®")	1 pregnancy It must be used within 72 hours of having unprotected sex. Should not be used as regular birth control; only in emergencies.	Upset stomach Vomiting Lower stomach pain Fatigue Headache and dizziness Irregular bleeding Breast tenderness

What should I do if I want to become pregnant?

If you want to become pregnant, talk to your health care provider about stopping your birth control.

When taking oral contraceptives, ovulation can be restarted by stopping taking the pill. It is possible to become pregnant during the next menstrual cycle after stopping the pill, but it may take 1 or 2 months before you return to the previous timing of your cycle.  If you are using a contraceptive patch or vaginal ring, removing the device stops the delivery of hormones, and the results are similar to stopping oral contraception. Recovery of fertility after injections of Depo-Provera® may take longer, up to 10 months in some cases.

IUDs must be removed by a health care professional. After removal, pregnancy is possible at any time.

An implanted rod must also be removed by a health care provider. The implant is removed through a small cut in your arm, and pregnancy is possible any time after the implant is removed.

Is contraception used for things other than preventing pregnancy?

Yes. Use of oral contraceptives can also reduce severe menstrual cramps, make menstrual bleeding lighter, and clear up acne. There is also evidence that use of the pill can reduce the risk of endometrial,ovarian, and colon cancer, reduce the occurrence of cysts in the breasts and ovaries, protect against iron deficiency anemia, and improve bone density. The hormonal IUD can also reduce severe menstrual cramps and make menstrual bleeding lighter.

Oral contraception can also be used treat other gynecological disorders, such as uterine fibroids, endometriosis, and polycystic ovary syndrome. The pill may also offer some protection against pelvic inflammatory disease, which can lead to infertility if left untreated.

What is the best method of birth control (or contraception)?

There is no “best” method of birth control. Each method has pros and cons.

All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn’t easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.

Before choosing a birth control method, think about:

• Your overall health
• How often you have sex
• The number of sex partners you have
• If you want to have children someday
• How well each method works to prevent pregnancy
• Possible side effects
• Your comfort level with using the method

Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have sex.

Can all types of birth control prevent sexually transmitted infections (STIs)?

No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

Where can I get birth control? Do I need to visit a doctor?

Where you get birth control depends on what method you choose.

You can buy these forms over the counter:

• Male condoms
• Female condoms
• Sponges
• Spermicides
• Emergency contraception pills (girls younger than 17 need a prescription)

You need a prescription for these forms:

• Oral contraceptives: the pill, the mini-pill
• Skin patch
• Vaginal ring
• Diaphragm (your doctor needs to fit one to your shape)
• Cervical cap
• Cervical shield
• Shot/injection (you get the shot at your doctor’s office)
• IUD (inserted by a doctor)
• Implantable rod (inserted by a doctor)

You will need surgery or a medical procedure for:

• Sterilization, female and male

Are there any foams or gels I can use to keep from getting pregnant?

You can buy spermicides over the counter. They work by killing sperm. They come in many forms:

• Foam
• Gel
• Cream
• Film
• Suppository
• Tablet

Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.

Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.

All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.

How effective is withdrawal as a birth control method?

Not very! Withdrawal is when a man takes his penis out of a woman’s vagina (or “pulls out”) before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. “Pulling out” can be hard for a man to do. It takes a lot of self-control.

Even if you use withdrawal, sperm can be released before the man pulls out. When a man’s penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.

Withdrawal does not protect you from STIs or HIV.

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