Birth Control Overview

There are many different contraceptive choices available. There is no perfect birth control; each has its advantages and disadvantages. This is a “big picture” discussion of birth control discussing the highlights of various methods. Please see the links to each individual method for a more in depth discussion.

The birth control pill, the patch, and the ring are all combination hormonal contraceptives. This means that they contain both estrogen and progesterone. They all will make the periods predictable and lighter with less cramps. The birth control pill needs to be taken at the same time every day. If pills are missed then there is risk of pregnancy. Pills have a very low failure rate when they are taken every day. If pills are missed there is a significant risk of pregnancy as well as abnormal bleeding.

The patch, Ortho Evra, is placed on the skin each week, for three weeks. This is followed by one week without the patch. The advantage of the patch is that they only need to be remembered each week. The disadvantage is that you have to wear a patch on your skin.

The ring , NuvaRing, is placed in the vagina and left for three weeks. It is then removed and a new one is placed one week later. The advantage is that it only needs to be remembered every three weeks. The disadvantage is you have to have a ring in the vagina most of the month. You also need to be comfortable putting the ring in your vagina and using your finger to remove it from the vagina each month.

The shot, Depo Provera, is given every 3 months. It is a progesterone only method, there is no estrogen. This eliminates the estrogen related side effects. This has a very small failure rate as long as it is given every 12 weeks. The shot will make the periods irregular and unpredictable. Most women, with time, will have very little or no bleeding with the shot. The shot can cause headache and in some women significant weight gain. It also suppresses estrogen levels and there is a theoretical risk of losing bone mineral density while on the shot.

The implant is another progesterone only contraceptive. It is a single plastic rod the size of a matchstick that is placed in the inner part of the upper arm. It last for 3 years. This has the lowest failure rate of any birth control apart from abstinence. It will make the periods irregular and unpredictable but most women will have fewer bleeding days and lighter bleeding. Most women experience less bleeding over time as well. This does not have as much hormone as the shot so you don’t get weight gain like you do from the shot.

The IUD (also called IUS) is a device that goes inside the uterus. In the US there are 2 types available, one lasts 5 years and one lasts 10 years. The 10 year one has no hormone but tends to make the periods heavier and more crampy. The 5 year one has progesterone and makes the periods lighter and less crampy. Many women will stop having periods at all with the 5 year IUD. The IUD is painful going in especially in women who have not had children. The IUD can fall out or be expelled. If this is not noticed you are at risk of pregnancy. Removal does not hurt but occasionally there can be difficulties if the strings are not visible. An STD with the IUD can be a disaster. I have taken care of patients that needed to be in the intensive care unit for STDs with an IUD.

Condoms, diaphrams, and the sponge are examples of barrier methods. They need to be used each time you have intercourse. They tend to have a much higher failure rate than the other methods because people often do not use them every time. Condoms can decrease the risk of some STDs.

The “pull-out” method, where the man removes the penis from the vagina prior to ejaculation does not work well to prevent pregnancy. Sperm does come out of the penis prior to ejaculation and this puts the woman at risk for pregnancy.

The “rhythm” has a very high failure rate. Sex even 5 days prior to ovulation can result in pregnancy. It is only possible to accurately predict ovulation 48-72 hours in advance. Unless abstinence is done the entire first half of the cycle the rhythm method is destined for failure. Even if sex is only during the second half of the cycle pregnancy is possible as methods to predict ovulation can be wrong.

The bilateral tubal ligation, the Essure tubal occlusion, and the vasectomy are types of sterilization procedures. These procedures are considered permanent and irreversible. They should only be performed if the patient is absolutely positive that they never want children after the procedure. These procedures are all more than 99% effective and do not change the hormones of the patient.