Methods of Birth Control
Abstinence – is 100% effective in preventing pregnancy. However, not everyone who intends to be abstinent refrains from sexual activity.
Rhythm method – has a failure rate of 9-25% in the first year. This method makes assumptions about a woman’s fertile periods based on the length of her previous menstrual cycles, and has a woman avoid intercourse (or use barrier methods) during her most fertile days.
Withdrawal method – (coitus interruptus) has a failure rate of 4-27% in the first year. This method involves interrupting intercourse prior to ejaculation.
Condoms, male– have a failure rate of 2-15% in the first year. A protective sheath of (usually) latex is placed over the erect penis to physically block semen from entering the partner. Condoms may be combined with spermicides to increase effectiveness should they break or slip, and have the added benefits of being relatively inexpensive, as well as protecting from some sexually transmitted diseases.
Condoms, female – have a failure rate of 5-21% in the first year. A nitrile barrier is worn internally by the receptive partner and acts as a physical barrier against semen. This method also reduces the risk of transmission of sexually transmitted diseases.
Diaphragms – have a 6-16% failure rate for the first year. They consist of a silicone dome with spring molded into the rim, inserted correctly as a cervical barrier prior to intercourse along with spermicide. Diaphragms are fitted by a health care professional and require a prescription.
Contraceptive sponges – have a 20-32% failure rate for the first year, and are available over the counter without a prescription. The sponge is inserted into the vagina prior to intercourse, and contains spermicide.
Spermicides – have an 18-29% failure rate for the first year if used alone, and are typically combined with other methods to decrease the failure rate. This over-the-counter medication available in many forms can be inserted vaginally prior to intercourse in order to eradicate sperm.
Oral contraceptives – have a 0.05%-9% failure rate for the first year. They consist of estrogen/progestin combination or progestogen-only medications which are taken orally every day to suppress ovulation. Birth control pills must be prescribed by a physician and have some health risks, such as increased chance of blood clots forming within the body. They have the advantage of usually causing lighter and more predictable menstruation.
Contraceptive patch – has a 0.03-8% failure rate for the first year, and consists of combination estrogen/progestin medication delivered through the skin through an adhesive patch to inhibit ovulation, similar to oral contraceptives.
Contraceptive vaginal ring – has a 1-2% failure rate for the first year, and consists of a flexible plastic ring worn in the vagina that releases progestin and estrogen to inhibit ovulation, similar to oral contraceptives.
Depo-Provera – has a 0.3-3% failure rate for the first year. This progesterone hormone is injected every 3 months and suppresses ovulation. Menses tend to be irregular and decrease with length of use, but patients tend to experience some weight gain over time. Return to fertility may be delayed for several months.
Nexplanon implant – has a 0.05% failure rate for the first year. This is a 4cm long subdermal implant inserted just under the skin of a woman’s upper arm which releases a progestin over a 3-year period, inhibiting ovulation. Most women will experience light irregular uterine bleeding, although 20% will have no menses at all.
Copper IUD – has a 0.6-0.8% failure rate for the first year. An intrauterine device is a long-acting reversible contraceptive that can remain in the uterus to provide birth control for up to 10 years. Menstrual flow can be heavier with this IUD in place, IUD is inserted by a health care provider in the office, and risks include pelvic infection and uterine perforation which occur rarely.
Progesterone IUDs – has a 0.2% failure rate for the first year. This intrauterine device is inserted by a health care provider at an office visit, and can be effective up to 5 years. Menstrual flow is generally much lighter with the progesterone IUD in place. Risks are similar to the copper IUD.
Emergency contraception – refers to the use of hormones or the use of an IUD FOLLOWING intercourse to help prevent pregnancy. Use of emergency contraceptive pills reduces the risk of pregnancy from an unprotected act of intercourse by 75%, whereas using an IUD within 5 days after unprotected intercourse is as effective as normal IUD use. Post coital pills may be taken up to 72-120 hours after intercourse to be effective (the sooner, the better), and prevent pregnancy by delaying or inhibiting release of the egg from the ovary, and are not thought to harm established pregnancies. Some forms of emergency hormonal contraception are available over the counter.
Vasectomy – has a 0.15-1% failure rate in the first year. The male undergoes an office procedure under local anesthesia to prevent sperm from entering the ejaculate permanently.
Tubal ligation – has a 0.5% failure rate in the first year. This permanent form of birth control involves clamping/blocking/sealing a woman’s fallopian tubes to prevent fertilization. This procedure is commonly performed at the time of C-section, just after a vaginal delivery, or laparoscopically as an outpatient procedure. The Essure method of trans-cervical sterilization can be performed in a gynecologist’s office.
Please ask your physician to help you make informed decisions about the type of contraception you choose.