Birth Control

Birth Control: Comparing the Choices

Using effective birth control helps people stay in control of their lives

Today, many birth control methods are available for women and men. This guide describes and compares seven reversible (non-permanent) birth control methods: four recently-approved and five already-available methods. This information can help you work with your clinician to choose a method that is right for you.

Some of the abbreviations used in this guide:

  • FDA – U.S. Food and Drug Administration
  • IUD – intrauterine device
  • IUS – intrauterine system
  • STIs – sexually transmitted infections. STIs are diseases, infections, or illnesses that can spread from one person to another through sexual contact. Some examples of STIs are chlamydia, herpes, HIV, gonorrhea, and syphilis.

The male and female condoms are the ONLY methods of contraception that can help protect you from STIs (see abbreviations). If you are at risk of getting STIs, for example, you have more than one sexual partner or the person you are having sex with may have more than one sexual partner, please use a male or female condom, in addition to whatever other contraceptive you may choose.

Newly Approved Birth Control Methods

Vaginal Ring

The Food and Drug Administration (FDA) approved the vaginal ring in October 2001. The flexible, doughnut-shaped ring is a system of delivering birth control drugs. Each ring is made of a type of vinyl and should be worn for three weeks out of the month. It’s folded and inserted high into the vagina, where it slowly releases estrogen and progestin hormones. These hormones are absorbed into the bloodstream. The ring is about 2″ in diameter and one size fits all women.

What You Need To Do:
Insert one ring in the vagina and keep it in place for three weeks in a row. Remove it for a one-week break and then insert a new ring.

Pros:

  • Better than 99% effective at preventing pregnancy
  • You do not have to do anything before, during, or after sex
  • The exact positioning of the ring within the vagina is not critical for it to work because it is not a barrier method

Cons:

  • If the ring is removed (or in the very unlikely event—less than 3%—the ring comes out) for more than three hours, however, the woman must use additional birth control until the ring has been reinserted for seven days, giving the medications time to rise to protective levels again.
  • Side effects may include vaginal discharge, infection, and irritation in small numbers of women

Making a Decision About the Vaginal Ring

How does the vaginal ring work?
The ring prevents pregnancy the same way as birth control pills. It works primarily by preventing ovulation, which means that the ovary does not release an egg to be fertilized. It also makes changes to the mucus on your cervix, making it more difficult for sperm to enter your womb.

Can the ring slip out of place?
Rarely (less than. It can slip out of the vagina if it has not been put in correctly, or while pulling out a tampon, or having a bowel movement, or with severe constipation

Does the ring protect me from sexually transmitted diseases?
The ring does not protect women against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Will I still get my period regularly?
Yes. The ring does change your regular period.

How soon can I become pregnant after I stop using the ring?
Most women can become pregnant again about two to three months after they stop using the ring.

Transdermal Contraceptive Patch

The Food and Drug Administration (FDA) approved the transdermal contraceptive patch (brand name Ortho Evra®) in November 2001. The patch is a highly effective, weekly hormonal birth control patch that is worn on the skin to prevent pregnancy. It is worn for one week and replaced on the same day of the week for three consecutive weeks, with the fourth week “patch-free.” The patch is a very thin, beige, smooth patch that measures 1 3/4 inches on each of its four sides. It can be worn on the upper outer arm, buttocks, abdomen, or upper torso. It uses a combination of the hormones estrogen and progestin to prevent pregnancy – much like most birth control pills. Studies have shown the patch remains attached and effective when you bathe, swim, exercise, or wear it in humid weather.

What You Need To Do:
Remember to apply a new patch on the same day of the week for three consecutive weeks, for a total of 21 days. No patch is needed during the fourth week.

Pros:

  • 99% effective at preventing pregnancy if used exactly according to the directions. Because this method is not yet available in the U.S., we do not know the the effectiveness percentage for “typical” users–including women who may not always use a method exactly how and when they are supposed to use it.
  • You do not have to do anything before, during, or after sex
  • The patch can be worn on the upper outer arm, buttocks, abdomen, or upper torso

Cons:

  • A small percentage of women have experienced skin irritation while using the patch

Making a Decision About the Transdermal Contraceptive Patch

How does the patch work?
The patch prevents pregnancy the same way as birth control pills. It works primarily by preventing ovulation, which means that the ovary does not release an egg to be fertilized. It also makes changes to the mucus on your cervix, making it more difficult for sperm to enter your womb.

Will the patch fall off easily?
Studies have shown the patch remains attached and effective when you bathe, swim, exercise, or wear it in humid weather.

Does the patch protect me from sexually transmitted diseases?
The patch does not protect women against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a latex condom.

Will I still get my period regularly?
Yes. The patch does not change your regular period

How soon can I become pregnant after I stop using the patch?
Most women can become pregnant again about two to three months after they stop using the ring.

Intrauterine System

The FDA approved the levonorgestrel intrauterine system (LNG IUS, brand name Mirena®) in December 2000, although it has been used in Europe for over a decade. The T-shaped system, which is placed in your uterus, contains a five-year supply of a hormone that prevents pregnancy. The system releases a low dose of the hormone each day. It works nearly as well as having your tubes tied, but unlike sterilization, it is quickly reversible.

What You Need To Do:
Visit your clinician to have the system put in place.

Pros:

  • 97 – 99% effective at preventing pregnancy
  • Lowers the risk of a pregnancy in your fallopian tubes
  • You don’t have to do anything once it’s in place, and it lasts for five years.
  • Makes your monthly period lighter and less painful – and can reduce the anemia (low blood count) that heavy bleeding can cause

Cons:

  • Many women have irregular bleeding or spotting in the first few months. But it almost always goes away after three to six months – and then bleeding is light.
  • This method should not be used while breast-feeding and is best for women who have one (faithful) partner.
  • Some women may have side effects including mood changes, acne, headache, breast tenderness, and nausea.

Making a Decision About the Intrauterine System

How does the intrauterine system work?
The intrauterine system probably prevents pregnancy in several ways. First, the hormone in the intrauterine system keeps sperm out of your womb. Second, the intrauterine system may cause other changes in your body that stop sperm or make them less active. Also, some women may not produce an egg on a monthly basis.

How often will I need to see the clinician once my IUS is in place?
You will need an exam about three months after the clinician inserts the system. Then, there’s no need to see the clinician about the IUS until it’s time to remove it. Of course, you should contact the clinician if any problems or concerns arise.

Will I still get my period regularly?
Although irregular bleeding and spotting can occur during the first few months of use, after that most women get their period on a regular schedule. But the IUS does make periods lighter, shorter, and less painful.

About one woman in five stops having her period a few months after an IUS is put in place. This is safe, and many women welcome it. If you want to know how and why it happens, ask your clinician.

How soon can I become pregnant after the health care provider removes the system?
About eight out of ten women trying to get pregnant will in the first year after the IUS is removed.

Does the IUS protect me from sexually transmitted infections?
The IUS does not protect against sexually transmitted diseases (STIs) such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Is it painful to have the system put in place?
Most women report having very little or no pain. But about one woman in five has moderate or severe pain.

Does the IUS affect my risk for pelvic diseases?
Your risk of pelvic infection from using the IUS is very low. The only major reason for concern is if you or your partner has sex with more than one person.

Birth Control Injections: Monthly

Women receive injections each month in the arm, buttock, or thigh. The monthly injection (brand name Lunelle®) contains a combination of two hormones. The hormones help prevent pregnancy and keep your monthly periods more regular.

What You Need To Do:
Get your injection on time to keep your birth control working.

Pros:

  • Better than 99% effective at preventing pregnancy
  • no need for action before, during, or after sex
  • May have the same health benefits as birth control pills, but more study is needed to confirm this

Cons:

  • Not always convenient to get an injection on time each month.
  • May stop the flow of breast milk – women who want to breast feed should begin receiving injections only after breast milk is not the baby’s only food source.
  • Side effects may include weight gain, infection, headache, breast pain, and acne.

Making a Decision About Monthly Birth Control Injections

How does the monthly injection work?
The hormones in the injection stop the ovaries from releasing eggs, and they also work by keeping sperm out of your womb.

How often will I need to see my clinician?
You will need to see your clinician each month on about the same day to get your injection.

Does the injection protect me from sexually transmitted diseases?
Birth control injections do not protect women against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Will I still get my period regularly?
During the first few months, you may have breakthrough bleeding and spotting. After that, most women go back to a more regular monthly pattern.

How soon can I become pregnant after I stop getting the injections?
Most women can become pregnant about two to three months after the last injection.

Other Available Birth Control Methods

Barrier Methods

Barrier methods include over-the-counter methods and prescription methods. Male and female condoms, sponges, and spermicides can be bought over-the-counter; your clinician must prescribe the diaphragm and cervical cap. Barrier methods are placed either in the woman’s vagina or over a man’s erect penis (condoms) before a couple has sex.

What You Need To Do:
Use them correctly every single time you have sex.

Pros:

  • Easy to get, some sold widely without a prescription.
  • Full personal control over use: no need for special medical procedures or examinations.
  • Side effects are uncommon. Almost anyone can use them (except those sensitive to their ingredients).
  • A useful short-term option if you don’t have sex often.

Cons:

  • Of all contraceptives, barrier methods are the most subject to human error—which can lead to unplanned pregnancies.
  • Condoms sometimes break
  • Couples need to plan ahead and have the products available whenever they have sex.

Making a decision about barrier methods:

How do barrier methods work?
They prevent pregnancy by stopping sperm from reaching the womb.

Do barrier methods protect me from sexually transmitted diseases?
Male latex condoms help protect against sexually transmitted diseases, including HIV/AIDS.

The female condom may give limited protection against STIs, but it is not as effective as the male latex condom.

Is it painful to put barrier methods in place?
No. But some men feel that condoms lessen their pleasure during sex.

Birth Control Pills

Birth control pills contain hormones that prevent pregnancy. Today’s pills are safe and effective for most women if taken as prescribed.

What You Need To Do:
Take a pill at the same time every day. Refill your prescription on time.

Pros:

  • Studied for more than 40 years; long-term safety well known
  • Helps protect against cancer of the ovaries and uterus.
  • Protects against infections of the tubes and ovaries.
  • Nothing to do before, during, or after sex.
  • Makes monthly periods lighter and lessens cramps.

Cons:

  • Can be hard to remember daily pill and timely refills.
  • Side effects may include nausea, breast tenderness, spotting, weight gain, mood changes, and headaches.
  • Some women cannot use (e.g., those with medical conditions such as high blood pressure, or those over age 35 years who smoke).

Making a Decision About Birth Control Pills

How does the pill work?
There are two basic types of pills: those with a combination of hormones and those that contain only one hormone. Birth control pills prevent pregnancy because their hormones stop the ovaries from releasing eggs. They also thicken the mucus on your cervix, making it more difficult for sperm to enter your womb.

Does the pill protect me from sexually transmitted diseases?
Birth control pills do not protect against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Do I need to “take a break” from the pill?
There is no medical reason to take a break from your pills. Plus, they prevent pregnancy best if you take them at about the same time every day.

Will I still get my period regularly?
Yes. In fact, birth control pills make monthly periods more regular.

How soon can I become pregnant after I stop taking my pills?
Most women can become pregnant in about one to three months after they stop taking the pill.

Birth Control Injections: 3-Month

Women receive an injection in the buttocks or arm every three months. This injection (brand name Depo-Provera™) contains a single hormone that prevents pregnancy.

What You Need To Do:
Get your injection on time to maintain birth control protection.

Pros:

  • Convenient – injection is needed only 4 times a year
  • Safe, highly effective, long lasting; no need for action before, during, or after sex..
  • Can be used safely right after childbirth and while breastfeeding.
  • Helps protect women from cancer of the lining of the womb.
  • Reduces monthly bleeding and anemia (low blood count).

Cons:

  • Long acting; not a good method for women who want less than a year of birth control.
  • Side effects may include bloating/weight gain, headaches, depression, loss of interest in sex, or hair loss.
  • Side effects can go on for eight months after you stop having injections.

Making a Decision About 3-Month Birth Control Injections

How do the injections work?
The hormone in the injection stops the ovaries from releasing eggs, and it keeps sperm out of your womb.

How often will I need to see my clinician?
You will need to see your clinician every 12 weeks to get your injection.

Does the three-month injection protect me from sexually transmitted diseases?
Birth control injections do not protect women against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Will I still get my period regularly?
Irregular monthly periods and spotting may occur at first. Then, after a year or so, most women stop having periods. This is safe, and many women welcome it. If you want to know how and why it happens, ask your clinician.

How soon can I become pregnant after I stop getting the injections?
For many women, it takes a year or more after they stop getting the injections to be able to become pregnant.

Implants (5-Year)

Implants (brand name Norplant®) are match-sized sticks placed under the skin on the inside of a woman’s upper arm. They contain a hormone that prevents pregnancy for up to five years. However, implants can be removed at any time and you then can become pregnant.

What You Need To Do:
Have the implants been removed after five years? Have new implants put in if you still want birth control?

Pros:

  • Convenient-lasts for five years.
  • Safe, highly effective; no user action needed before, during, or after sex.
  • Helps protect women from cancer of the lining of the womb.

Cons:

  • Putting implants in or taking them out requires a small cut in the skin, and scarring may occur.
  • If implants fail, there is a greater chance of a pregnancy in your fallopian tubes.
  • Side effects may include acne, headaches, weight gain, and hair loss.

Making a Decision About Implants

How do implants work?
Implants work both by stopping egg release from a woman’s ovaries and by keeping sperm out of your womb.

Is it painful to have them inserted?
The clinician will numb your arm before the 10-minute insertion process. It is painless except for when your arm is numbed with an injection. Some women say their arm is a little sore or bruised for a few days.

How often will I need to see my clinician?
You will need to see the clinician three months after you receive the implants.

Do implants protect me from sexually transmitted diseases? Implants do not protect women against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Will I still get my period regularly?
Your periods will not stop while using implants, but they may be less regular; spotting may occur.

How soon can I become pregnant after my clinician removes the implants?
Your protection from pregnancy ends a few hours after you have the implants taken out.

Intrauterine Devices

Intrauterine devices (IUD, brand name Copper-T®) are a small, T-shaped piece of plastic, which contains either copper or a hormone that prevents pregnancy. The clinician puts it in the womb, where it can remain for one to ten years.

What You Need To Do:
Learn how to check the IUD string and do so after each monthly period. Tell your clinician if you can’t find it. Don’t pull on the string.

Pros:

  • Convenient and very effective.
  • Longest lasting of any method (copper IUD lasts up to ten years)
  • No user action needed before, during, or after sex.

Cons:

  • The copper IUD may increase cramps and bleeding during monthly periods.
  • Best for women who have one (faithful) partner.
  • IUDs that release hormones can have the same side effects as birth control pills, injections, and implants.

Making a Decision About IUDs

How do IUDs work?
All IUDs cause changes in your body that kill sperm or make them less active. In IUDs that release hormones, the hormone creates a barrier around the womb that keeps sperm out.

Is it painful to have an IUD inserted?
Few women find it painful to have an IUD put in or taken out. Some women may experience cramping for a short while after insertion.

How often will I need to see the clinician once it is inserted?
Unless you are having a problem or cannot find the IUD string, there is no need to see the clinician about the device until you want it taken out.

Do IUDs protect me from sexually transmitted diseases?
The IUD does not protect against STIs, such as HIV/AIDS. If you have more than one sex partner (or he does), have him use a condom.

Will I still get my period?
Yes. IUDs do not change the timing of or stop your regular period, although bleeding is likely to be heavier.

How soon can I become pregnant after the clinician removes my IUD?
You can become pregnant within about a month of having an IUD taken out.