Birth control refers to a set of behaviors, medications or devices followed in order to deliberately prevent or reduce the likelihood of becoming pregnant. Strategies and devices which are intended to reduce the risk of fertilization of an ovum by a spermatozoon can be referred to as contraception.
Oral contraceptive pills (OCPs):
OCPs work by inhibiting ovulation and thickening cervical mucus. When used correctly, they are 99 percent effective in preventing pregnancy. They have the often-desired side effects of regulating menstrual cycles and reducing the amount of bleeding and cramping associated with menses.
You have to take these medications on a daily basis. Effectiveness goes down if you miss doses. OCPs can also help reduce pre-menstrual symptoms and improve acne. Common side effects include nausea, breast tenderness, and initially, irregular bleeding. The most serious side effects are blood clots, heart attack and stroke. Serious side effects are fortunately rare, but can be more common in certain patients (due to other medications, illnesses, etc).
Vaginal contraceptive ring (NuvaRing):
The NuvaRing has the same hormones and mode of action as birth control pills, but is a monthly contraceptive. It is a small, flexible vaginal ring that you place in the vagina on a monthly basis. It is not painful, does not lead to vaginal infections, and for many women is very convenient. This has the lowest dose of estrogen available among OCPs, NuvaRing and OrthoEvra.
Contraceptive patch (OrthoEvra):
OrthoEvra also has the same hormones as the pill, but it is a weekly patch that is applied to the skin. It can be applied to the upper arm, stomach, hips/thighs or buttocks. Few women have sensitivity to the adhesive found in the patch.
Contraceptive injection (DepoProvera):
DepoProvera is an injectable contraceptive that contains only progesterone. It is given in the office every 12 weeks. Many women find this very convenient. It is very effective as birth control. It can cause irregular bleeding, though this often improves with the second and third injections. It can cause weight gain (usually less than 10 pounds). Once you stop DepoProvera, it can take months for some women to resume their normal menses.
Progesterone-only pills (POPs):
These pills are usually used for women who are breastfeeding or for women who cannot tolerate typical combination birth control pills. POPs do not reliably inhibit ovulation, but work by thinning the lining of the uterus and thickening cervical mucus. It is very important that they are taken at the same time every day, as being late or missing doses decreases their effectiveness. They are approximately 94-97 percent effective with good use. They are safe during breastfeeding and will not decrease milk supply.
Condoms are the only contraceptive method that also works to prevent sexually transmitted infections. They should be used for every sexual encounter, especially if you have more than one partner, your partner has other partners, or if you and your partner have not been screened for sexually transmitted infections by your doctor. A condom must be used every time you are sexually active. With correct use, they are 90 percent effective.
Spermicides are available as gels, creams, sponges and sheets. These can be used individually or with a condom, which leads to increased effectiveness. Used alone, spermicide is 75-80 percent effective.
A diaphragm is a non-hormonal method that fits like a cap over your cervix. It must be fitted by your doctor and then purchased at a pharmacy. Diaphragms must be used with spermicide and are inserted before intercourse. They then must stay in place for 6-24 hours post intercourse. A diaphragm can be kept in place for multiple sexual encounters, but new spermicide should be applied. As the patient, you have to be comfortable fitting a diaphragm in the correct place. If used correctly, the effectiveness is 88-94 percent.
Progesterone Intrauterine System (Mirena): The Mirena IUS is a 5-year reversible contraceptive that is inserted into the uterus through the cervix in your doctor’s office. It is mildly uncomfortable to have placed, but provides reliable contraception (greater than 99 percent) for 5 years. It can be removed sooner if desired. It releases a small amount of levonorgestrel daily. This helps thin the lining of the uterus, which leads to lighter, less painful periods for most women.
About 20 percent of women do not have a period when the Mirena is in place. After having a Mirena placed, many women experience irregular bleeding, but this regulates and becomes lighter and more regular after 3-6 months. Please visit http://www.mirena-us.com for more information.
Copper IUD (Paragard):
The Paragard IUD is similar to the Mirena in that it is an interauterine device that is placed in the uterus by your physician. Unlike the Mirena, it is hormone free. It works by producing a spermicidal environment inside the uterus. It can be used for up to 10 years and is also completely reversible. The efficacy of the Paragard is greater than 99 percent. Because it is hormone-free, most women’s menstrual cycles continue as they were prior to having the Paragard placed. See http://paragard.com for more details.
Skyla (levonorgestrel-releasing intrauterine system) is a hormone-releasing IUD that prevents pregnancy for up to 3 years. Skyla is similar to Mirena but provides more flexibility with a 3-year reversible contraceptive method instead of a 5-year method. It is also less likely to stop menses than Mirena. For more information, visit http://skyla-us.com.
Contraceptive insert (Nexplanon):
Nexplanon is a contraceptive device that is inserted into the upper arm. It can be placed in the office by your physician under local anesthesia. It is a progesterone-only contraceptive and is effective for up to 3 years. Its effectiveness is greater than 99 percent and it is rapidly reversible. The main disadvantage of this method is that it can cause irregular bleeding. Most women have the same number of days of bleeding as they did prior to having the Nexplanon placed, but the bleeding can be sporadic, throughout the month. See http://nexplanon-USA.com for more information.
Tubal ligation (postpartum, laparoscopic): Tubal ligation is a permanent method of contraception. If done immediately postpartum, it is performed by making a small incision at your umbilicus and removing a part of each fallopian tube. If done at any other time, it is typically performed using a laparoscope (a small camera). This involves a small incision at the umbilicus and often one other small incision. The tubes are then clamped or burned (depending on your physician’s choice). The risks and benefits of these two methods are the same. Risks of tubal litigation include bleeding, infection and damage to the surrounding structures. The effectiveness of this procedure is greater than 99 percent, however.
Tubal occlusion (Essure):
The Essure method is a way to perform tubal ligation without an incision. These procedures are performed through the cervix and uterus using a hysteroscope (camera that goes through the cervix). These procedures can be performed in the operating room or in the office. Recovery is very quick after these procedures. After the procedure, you will need effective contraception for 3 months. At that time, you will need to have a special X-ray called an HSG performed to make sure that your tubes are blocked. Please see http://essure.com for more information.
Vasectomy is the male form of permanent contraception. This procedure is performed by an urologist in his or her office. This is a highly effective form of contraception (greater than 99 percent) and is generally easy to perform. We can give you a referral to an urologist if your partner is interested in having a vasectomy.