Choosing the right birth control (contraceptive) method is a very personal decision. There are several options available and only you and your partner can decide which one is right for you. In fact, it’s not uncommon for a woman to change her birth control method several times throughout her reproductive years. The considerations to keep in mind when choosing a contraceptive method are:
- How effective the method is.
- How likely you are to use it, i.e. will you use it if you have to put it in place every time? Can you remember to take a pill every day?
- Protection against sexuality transmitted disease
Most contraceptive methods take commitment so make sure you understand the method you have chosen before you begin.
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Birth Control Pills
More than 60 million women take the pill worldwide and it is the most popular form of contraception in the United States. Most pills contain estrogen and progestin and work by preventing ovulation. Used correctly (taking it at about the same time every day), it is 99% effective. Pills available today are a much lower dose than the original birth control pill of the 1960’s and have fewer side effects.
There are some minor side effects associated with the birth control pill. These include: breakthrough bleeding (bleeding between periods), nausea, headaches, and breast tenderness. Many of these side effects decrease during the first three months of usage.
The advantages of the pill are that it does not interrupt sexual activity and allows for spontaneity. It offers protection against ovarian, endometrial, and colo-rectal cancers. The pill decreases menstrual bleeding and cramping. The pill also decreases the risk of PID (pelvic inflammatory disease) and can shrink some benign ovarian cysts. It is an easily reversible method.
The disadvantages are that it offers no protection against sexually transmitted diseases (STD’s). It can be expensive, it must be taken consistently every day and can cause mood changes. It can also cause rare, but dangerous complications.
Not all women are good candidates for the birth control pill. You should not take the pill if you are over 35 and smoke. You should not take the pill if you begin getting SEVERE migraine headaches after starting the birth control pill. Women who have a history of blood clots or stroke, have heart disease, or high blood pressure, have had breast cancer, have liver problems, have kidney problems or have active gallbladder disease should not take the pill.
A diaphragm is a flexible rubber cup-shaped device that you fill with contraceptive jelly and insert into your vagina up to six hours before sexual intercourse. The diaphragm, when properly inserted, covers the cervix (the opening of the uterus). The diaphragm itself acts as a physical barrier against sperm, while the contraceptive jelly kills any sperm that happens to get past the device. It must be left in place for six hours after intercourse.
The effectiveness of the diaphragm is 84-94% when used with spermicide. Using condoms along with the diaphragm increases the effectiveness to almost 99%. Inserting the diaphragm can be difficult and there is also an increased risk of urinary tract infections with its use. Once the diaphragm is inserted, more contraceptive jelly or cream must be inserted into the vagina with each additional act of intercourse.
The diaphragm must be fitted by your doctor or midwife and its size must be rechecked after the birth of each baby or if you have a significant weight loss or gain.
Intrauterine Device (IUD)
An IUD is a small, T-shaped piece of plastic that is inserted into the uterus by your doctor or midwife. The effectiveness is about 99%. Once the IUD is inserted, it offers protection for 5 to 10 years depending on the IUD used. A mirena IUD is a hormone containing IUD which has the added benefit of less menstrual flow and cramping.
The most common side effect of the IUD is heavier bleeding and cramping with your period unless a Mirena IUD is used. There are several serious complications that can arise from using the IUD’s such as infection, tubal pregnancy (pregnancy located in the fallopian tube), and perforation of the uterine wall.
Not everyone is a good candidate for the IUD. If you and your partner are not monogamous, the IUD is probably not for you. You should not use the IUD if you are having a problem with unexplained, abnormal uterine bleeding, have a history of endocarditis, are allergic to copper, or are anemic.
IUD’s are probably one of the easiest contraceptive methods to use. You don’t have to think about it every day. Once the IUD is in place, you only need to check the string once a month. In order to reverse the method, have the IUD removed by your health care provider.
Spermicides kill sperm, preventing the fertilization of an egg and can be purchased from a pharmacy without a prescription in cream, jelly, foam, or suppository form. However when used alone, they are only 79% effective. When used with condoms, the effectiveness increases to 99%. Spermicide has to be inserted in the vagina ½ hour or less before intercourse, and it must be reapplied with each additional act. They are convenient, portable, and relatively inexpensive to use.
A condom is a thin shield placed directly over the man’s erect penis. It catches the sperm released during ejaculation, thereby preventing the sperm from entering the woman’s vagina.
Most condoms are made from rubber (latex), but some are made from animal tissue. They may be lubricated or treated with a spermicide. Latex condoms, especially those treated with a spermicide, can protect both partners from most sexually transmitted diseases. They can be purchased without a prescription and are sold in a variety of places.
The condom is convenient, inexpensive, and easy to obtain. They are a good choice if either partner is not monogamous. They can increase the effectiveness of other forms of birth control and reduce the risk of STD’s. The disadvantages are a reduction in sexual spontaneity and sensation, along with the possibility of the condom breaking or leaking.
Depo-Provera injections are given every 90 days or four times a year and are 99% effective. The shots contain progestin, a hormone, which suppresses ovulation. The side effects include bleeding irregularities (although many women stop having periods after a few months), weight gain, headaches, decreased sex drive, and a delay in the return of fertility. Depo-provera injections do not offer protection against sexually transmitted diseases.
Many women prefer the injections because they only have to think about birth control 4 times a year. Women with menstrual cramps or heavy bleeding enjoy the amenorrhea (absence of periods) that often accompanies the injections.
The female condom is a lubricated, plastic sheath with rings on each end. One end is open and remains outside the vagina. The other end is closed and looks like a diaphragm. It is placed inside the vagina so that it covers the cervix, preventing sperm from entering the uterus and fertilizing an egg.
The female condom offers protection against most sexually transmitted diseases, but it is cumbersome to use, more visible, and less comfortable than a male condom. It is not available in all areas of the country.
Natural Family Planning
Natural family planning is based on fertilization occurring just before, during, and after ovulation. By monitoring yourself daily, you may be able to determine when you are ovulating. In practice, it is the most risky form of birth control and is only 30-70% effective. It is more effective for women with regular menstrual cycles who keep good daily records and are dedicated to the method. It is inexpensive and has no health risks involved. However, if you or your partner are not monogamous this method is probably not for you.
Voluntary sterilization is the most popular birth control method worldwide. Sterilization involves blocking or cutting the woman’s fallopian tubes so no eggs can travel to the uterus to be fertilized. It is generally an outpatient procedure and normal activities can be resumed within a few days. Sterilization, a permanent form of birth control, is 99.6% effective.
The risks with sterilization are the risks associated with any type of surgery. On rare occasions women may have complications from the anesthesia, internal bleeding, and injury to the surrounding internal structures, or infection. Because of its permanent nature women should consider this form of birth control when they no longer feel they want to have children or wish to think about birth control.