Birth control and family planning
Definition
Which form of birth control you
choose depends on a number of different factors, including
your health, how often you have sex, and whether or
not you want children.
Alternative Names
Contraception; Family planning
and contraception
Information
Here are some factors to consider
when selecting a birth control method:
- Effectiveness
-- How well does the method prevent pregnancy? Look at the number
of pregnancies in 100 women using that method over a period of one
year. If an unplanned pregnancy would be viewed as potentially
devastating to the individual or couple, a highly effective method
should be chosen. In contrast, if a couple is simply trying to
postpone pregnancy, but feels that a pregnancy could be welcomed if
it occurred earlier than planned, a less effective method may be a
reasonable choice.
- Cost -- is the
method affordable?
- Health risk --
What are the potential health risks? For example, birth control
pills are usually not recommended for women over age 35 who also
smoke.
- Partner
involvement -- The willingness of a partner to accept and
support a given method may affect your choice of birth control.
However, you also may want to re-consider a sexual relationship
with a partner unwilling to take an active and supportive
role.
- Permanence --
Do you want a temporary (and generally less effective) method, or a
long-term or even permanent (and more effective)
method?
- Preventing HIV and
sexually transmitted diseases (STDs) -- Many methods offer
no protection against STDs. In general, condoms are the best choice
for preventing STDs, especially when combined with
spermicides.
- Availability --
Can the method be used without a prescription, provider visit, or,
in the case of minors, parental consent?
CONDOMS
- A condom is a thin latex or
polyurethane sheath. The male condom is placed around the erect
penis. The female condom is placed
inside the vagina before intercourse. Semen collects inside the
condom, which must be carefully removed after
intercourse.
- A condom must be worn at all
times during intercourse to prevent pregnancy.
- Condoms are available in most
drug and grocery stores. Some family planning clinics offer free
condoms.
- Latex condoms help prevent HIV
and other STDs. Polyurethane condoms may give some protection
against STDs, but they are not as effective as latex
ones.
- About 14 pregnancies occur over
1 year out of 100 couples using male condoms, and about 21
pregnancies occur over 1 year out of 100 couples using female
condoms. They are more effective when spermicide is also
used.
- Risks include irritation and
allergic reactions, particularly to latex.
- Condoms are used only
once.
SPERMICIDES
- Spermicides are chemical
jellies, foams, creams, or suppositories that kill
sperm.
- They can be purchased in most
drug and grocery stores.
- This method used by itself is
not very effective. About 26 pregnancies occur over 1 year out of
100 women using this method alone.
- Spermicides are generally
combined with other methods (such as condoms or diaphragm) as extra
protection.
- Warning: The spermicide
nonoxynol-9 can help prevent pregnancy, but also may increase the
risk of HIV transmission.
- Risks include irritation and
allergic reactions.
DIAPHRAGM AND CERVICAL
CAP
- A diaphragm is a flexible rubber
cup that is filled with spermicidal cream or jelly.
- It is placed into the vagina
over the cervix, before intercourse, to prevent sperm from reaching
the uterus.
- It should be left in place for 6
to 8 hours after intercourse.
- Diaphragms must be prescribed by
a woman's health care provider, who determines the correct type and
size of diaphragm for the woman.
- About 5-20 pregnancies occur
over 1 year in 100 women using this method, depending on proper
use.
- A similar, smaller device is
called a cervical cap.
- Risks include irritation and
allergic reactions to the diaphragm or spermicide, and urinary
tract infection. In rare cases, toxic shock syndrome may develop in
women who leave the diaphragm in too long. A cervical cap may cause
an abnormal Pap test.
VAGINAL SPONGE
- Vaginal contraceptive sponges
are soft synthetic sponges saturated with a spermicide. Prior to
intercourse, the sponge is moistened, inserted into the vagina, and
placed over the cervix. After
intercourse, the sponge is left in place for 6 to 8
hours.
- It is quite similar to the
diaphragm as a barrier mechanism, but you do not need to be fitted
by your doctor. The sponge can be purchased over the
counter.
- In April 2005, the FDA granted
re-approval for the Today sponge to return to the U.S.
market.
- About 18 to 28 pregnancies occur
over one year for every 100 women using this method.
- The sponge may be more effective
in women who have not previously delivered a baby.
- Risks include irritation,
allergic reaction, trouble removing the sponge. In rare cases,
toxic shock syndrome may occur.
COMBINATION BIRTH CONTROL
PILLS
- Also called oral contraceptives
or just the "pill", this method combines the hormones estrogen and
progestin to prevent ovulation.
- A health care provider must
prescribe birth control pills.
- The method is highly effective
if the woman remembers to take her pill consistently each
day.
- Women who experience unpleasant
side effects on one type of pill are usually able to adjust to a
different type.
- About 2 to 3 pregnancies occur
over 1 year out of 100 women who never miss a pill.
- Birth control pills may decrease
a woman's risk for ovarian cancer.
- Birth controll pills may cause a
number of side effects, including dizziness, irregular menstrual
cycles, nausea, mood changes, and weight gain. In rare cases, they
can lead to high blood pressure, blood clots, heart attack, and
stroke.
THE MINI-PILL
- The "mini-pill" is a type of
birth control pill that contains only progestin, no
estrogen.
- It is an alternative for women
who are sensitive to estrogen or cannot take estrogen for other
reasons.
- The effectiveness of
progestin-only oral contraceptives is slightly less than that of
the combination type. About 3 pregnancies occur over a 1 year
period in 100 women using this method.
- Risks include irregular
bleeding, weight gain, and breast tenderness.
THREE-MONTH PILL
(SEASONALE)
- In 2003, the FDA-approved an
estrogen and progestin pill called Seasonale. It is taken for three
straight months, followed by one week of inactive
pills.
- A women gets her period about
four times a year, during the 13th week of her cycle.
- Seasonale is available by
prescription.
- Fewer than 2 out of 100 women
per year get pregnant using this method.
- The risks are similar to other
birth control pills. Some women may have more spotting between
periods.
- The pills must be taken daily,
preferably at the same time of day.
PROGESTIN IMPLANTS
- Implants are small rods
implanted surgically beneath the skin, usually on the upper arm.
The rods release a continuous dose of progestin to prevent
ovulation.
- Implants work for 5 years. The
initial cost is generally higher than some other methods, but the
overall cost may be less over the 5-year period.
- The Norplant implant has been
removed from the U.S. market. A similar implanted rod system,
Implanon, is available. It works for 3 years.
- Less than 1 pregnancy occurs
over 1 year out of 100 women using this type of
contraception.
HORMONE INJECTIONS
- Progestin injections, such as
Depo-Provera, are given into the muscles of the upper arm or
buttocks. This injection prevents ovulation.
- A single shot works for up to 90
days.
- Less than 1 pregnancy occurs
over 1 year in 100 women using this method.
- Sometimes the effect of this
medication lasts longer than 90 days. If you are planning to become
pregnant in the near future, you might consider a different
method.
SKIN PATCH
- The skin patch (Ortho Evra) is
placed on your shoulder, buttocks, or other convenient location. It
continually releases progestin and estrogen. Like other hormone
methods, a prescription is required.
- The patch provides weekly
protection. A new patch is applied each week for three weeks,
followed by one week without a patch.
- About 1 pregnancy occurs over 1
year out of 100 women using this method.
- Estrogen levels are higher with
the patch than with birth control pills. In theory, higher estrogen
levels may increase your risk of blood clots.
VAGINAL RING
- The vaginal ring (NuvaRing) is a
flexible ring about 2 inches wide that is placed into the vagina.
It releases the hormones progestin and estrogen.
- A prescription is
required.
- The woman inserts it herself. It
stays in the vagina for 3 weeks. At the end of the third week, the
woman takes the ring out for 1 week. The ring should not be removed
until the end of the 3 weeks.
- About 1 pregnancy occurs over 1
year out of 100 women using this method.
- Side effects (nausea, breast
tenderness) are less severe than those caused by birth control
pills or patches.
- Risks include vaginal discharge
and vaginitis, as well as those similar to the combined birth
control pill.
IUD
- The IUD is a small plastic or
copper device placed inside the woman's uterus by her health care
provider. Some IUDs release small amounts of progestin. IUDs may be
left in place for 5 - 10 years, depending on the device
used
- IUDs can be placed at almost any
time.
- IUDs are safe and work well.
Fewer than 1 out of 100 women per year will get pregnant using an
IUD.
- Risks and complications include
cramps, bleeding (sometimes severe), and perforation of the
uterus.
NATURAL FAMILY
PLANNING
- This method involves observing
certain body changes in the woman (for example, changes in cervical
mucus and basal body temperature) and recording them on a calendar
to determine when ovulation occurs. The couple abstains from
unprotected sex for several days before and after the day ovulation
is believed to occur.
- This method requires education
and training in recognizing the body's changes, as well as a great
deal of continuous and committed effort.
- About 15 to 20 pregnancies occur
over 1 year out of 100 women using this method (for those who are
properly trained).
TUBAL LIGATION
- During tubal ligation, a woman's fallopian tubes
are cut, sealed, or blocked by a special clip, preventing eggs and
sperm from entering the tubes. It is usually performed immediately
after childbirth, or by laparoscopic surgery.
- Tubal ligations are best for
women and couples who believe they never wish to have children in
the future. While viewed as a permanent method, the operation can
sometimes be reversed if a woman later chooses to become
pregnant.
VASECTOMY
- A vasectomy is a simple, permanent procedure
for men. The vas deferens (the tubes that carry sperm) are cut and
sealed.
- A vasectomy is performed safely
in a doctor’s office using a local anesthetic to numb the
area.
- Vasectomies are best for men and
couples who believe they never wish to have children in the future.
While often viewed as a permanent method, they can sometimes be
reversed.
EMERGENCY ("MORNING AFTER") BIRTH
CONTROL
- The "morning after" pill
consists of two doses of hormone pills taken as soon as possible
within 72 hours after unprotected intercourse.
- The pill is available without a
prescription for purchase by anyone 18 years and older.
- The pill may prevent pregnancy
by temporarily blocking eggs from being produced, by stopping
fertilization, or keeping a fertilized egg from becoming implanted
in the uterus.
- The morning after pill may be
appropriate in cases of rape; having a condom break or slip off
during sex; missing two or more birth control pills during a
monthly cycle; and having unplanned sex.
- Risks include nausea, vomiting,
abdominal pain, fatigue, and headache.
UNRELIABLE METHODS
- Coitus
interruptus is the withdrawal of the penis from the vagina prior to ejaculation. Some semen
frequently escapes prior to full withdrawal, enough to cause a
pregnancy.
- Douching shortly after
sex is ineffective because sperm can make their way past
the cervix within 90 seconds after ejaculation.
- Breastfeeding.
Despite the myths, women who are breastfeeding can become
pregnant.
CALL YOUR HEALTH CARE PROVIDER
IF:
- You would like to further
information about birth control options
- You want to start using a
specific method of birth control that requires a prescription or
needs to be inserted by a health care provider
- You have had unprotected
intercourse or method failure (for example, a broken condom) within
the past 72 hours, and you do not want to become
pregnant
References
MacIsaac L.Intrauterine
contraception: the pendulum swings back. Obstet Gynecol Clin
North Am. 2007 March;34(1):91-111, ix.
Mishell DR. Family planning:
contraception, sterilization, and pregnancy termination. In: Katz
VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive
Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap
14.
US Food and Drug Administration.
Birth Control Guide. Rockville, MD: FDA Office of Public
Affairs; December 2003.
Review Date: 12/31/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine,
Division of General Medicine, Department of Medicine, University of
Washington School of Medicine; and Susan Storck, MD, FACOG, Chief,
Eastside Department of Obstetrics and Gynecology, Group Health
Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching
Faculty, Department of Obstetrics and Gynecology, University of
Washington School of Medicine. Also reviewed by David Zieve, MD,
MHA, Medical Director, A.D.A.M., Inc.
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