Birth control and contraception (overview)
There are many options to choose from when it comes to birth control (a selective method used to prevent pregnancy). Birth control is also known as ‘contraception’ and is mostly used to prevent an unwanted pregnancy. Some methods can also protect against contracting a sexually transmitted disease (STD).
Options range from natural family planning and over-the-counter birth control products to prescription contraceptives and even sterilisation. When considering which method is best for you (and or / your partner) it is wise to carefully consider your lifestyle, personal preferences and health status.
Questions you may ask yourself are:
‘How do I feel about planning for sex?’, ‘Am I comfortable inserting birth control devices into my body?’, ‘Would I rather take a pill at the same time every day or track my fertile days in my cycle?’ or ‘Do I want to end my ability to conceive or father a child?’
In deciding about the most appealing method for you, it’s important to honestly assess yourself and your needs, as well as those of a potential partner or the status of your relationship. Each may have different birth control wishes which may be influenced by your sexual activity (if you have sex often or you are not in a monogamous relationship). Whatever decision you reach with a partner, it is important that it is mutually beneficial.
You may only want to make use of birth control for a period of time before strategically planning to conceive and have children. You may want to make a more permanent choice (preventing pregnancy or the fathering of a child indefinitely) and consider an option that you are most comfortable with.
Birth control options come in various forms. No single method is necessarily right for everyone. It’s important to know what the different options are, understand how they work or affect the body, and consider the pros and cons before making a selection.
Questions to ask yourself
How important is it for you to avoid a pregnancy? Before making any decision, it is important to carefully assess your reasons, and their level of importance, for wanting a method of birth control in the first place. The best method is usually the one that offers the most protection every time you have sex and is easy and convenient to use.
When considering the various types, their pros and cons, and your own preferences, it is also important to consider the following types of questions:
- Is it safe?
- How effective is it?
- What are the costs involved?
- How often do I need to take it or use?
- Will this contraception method require a visit with a doctor or a prescription?
- Is this method easy to use?
- Will I remember to make use of this method?
- Are there any components or ingredients that I may be allergic to?
- Does it contain hormones?
- Could there be other side effects?
- Will it protect me (to some degree) against sexually transmitted diseases and infections?
- Is any preparation right before having sex necessary?
- Is a quick reversal possible?
- Will it reduce monthly bleeding and cramping during menstruation? (Females)
- Is this method noticeable? Will my sex partner be aware that I am using it?
- Will this method affect my sex drive / sensation during sex?
Types of birth control
The type of birth control method you choose to use is a very personal one for both men and women. Some are more effective than others. The main reason behind a decision to use a contraceptive method is usually to prevent an unwanted pregnancy. The below types are sorted by how effective they are at preventing a pregnancy.
Extremely effective (99-100%):
- Abstinence: As the saying goes, “prevention is better than cure.” Pregnancy is 100% avoidable by practicing abstinence (not having sex at all) although this may not be realistic for the greater majority of people.
- Intrauterine device (IUD): A small t-shaped piece of plastic that is placed inside a women’s uterus by a medical professional. This prevents a man’s sperm from fertilising an egg. There are two types of IUD, hormonal IUDs and Copper IUDs. Hormonal IUDs are available in several different types, and release a small amount of hormones into the uterine cavity. This can thicken cervical mucus and prevent sperm penetration, or alter the uterine lining to make it inhospitable for a fertilised egg to implant. In some cases, the released hormones suppresses ovulation (the release of eggs from the uterus). A copper IUD on the other hand, releases copper ions which damage sperm and disrupt their motility, thereby preventing them from travelling through the woman’s cervical mucus and fertilising the egg/s released during ovulation.
- Implants: A soft plastic rod is placed just under the skin of a woman’s arm by a medical professional. Synthetic progestin hormones are then released into the body via the rod gradually over a period of 3 years. This works by preventing ovulation in a woman.
- Sterilisation: A permanent method of birth control that involves cutting or blocking the tubes that carry eggs to a woman’s uterus (tubal ligation) or those which carry a man’s sperm (vasectomy).
Highly effective (approximately 91%)
- Injection: A progestin hormone is injected into the body and is slowly absorbed. The hormone prevents eggs from leaving the ovaries in a woman’s body, blocking ovulation. Generally, an injection lasts for a period of 12 weeks. If this method is chosen, it is important to receive subsequent shots on schedule if you wish to maintain this means of contraception.
- Patch: A small, sticky patch is worn on the surface of the skin. The patch sends steady levels of hormones into the bloodstream.
- Vaginal ring: A soft, plastic ring is placed inside the vagina. The ring releases a steady dose of sex hormones.
- Birth control pills (oral contraceptives): A set of pills taken daily at the same time. Pills contain levels of oestrogen and progesterone hormones which work by preventing the release of eggs from a woman’s ovaries.
Effective (approximately 80%)
- Condoms: A thin, disposable wrap placed over the erect penis of a man just prior to sex. If used correctly, this prevents a man’s sperm from entering a woman’s vagina. Condoms are also highly effective for protecting from infections (sexually transmitted infections or STIs) such as HIV/AIDS.
- Cervical barriers: These can be diaphragms, caps or shields. Usually a small rubber cup that is filled with spermicidal jelly and place inside the vagina, over the cervix right before sexual intercourse. Sperm is then prevented from entering a woman’s uterus.
Moderately effective (approximately 70%)
- Spermicides: These are chemical developed to kill off sperm and usually come in jelly, cream or foam forms. Spermicides are commonly used together with a cervical barrier.
- Birth Control Sponge: A small foam pad that is soaked in a spermicide. The sponge is then placed inside the vagina and over the cervix.
- Fertility tracking: A woman can carefully track the changes in her body as a way to determine where in her cycle she is most fertile and when she is not. A sexually active woman is less likely to fall pregnant on days she is not at her most fertile (although this is not entirely impossible). Additional protection can include the use of a barrier method (the use of a condom) if following this type of birth control.
Contraceptive pills are available soon after a person has had unprotected sex (sexual intercourse without the use of a birth control method). These emergency contraceptive pills are often referred to as the ‘morning after pill’, and can be used as a backup if one has forgotten to use a birth control method or the type used has a higher chance of failing.
Emergency contraceptives can help to prevent an unwanted pregnancy for up to 5 days after unprotected sex, but will not be effective if a woman is already pregnant (i.e the fertilised embryo has been implanted in the wall of the uterus).
Contraceptive methods that are ineffective forms of birth control include douching, feminine hygiene products, homemade condoms or urinating after intercourse, although the latter can help to prevent urinary tract infections (UTI’s) in many cases, but more on that elsewhere.
Choosing a birth control method
With so many options available, choosing one method can be overwhelming. It is a very personal choice. One method may be ideal for one person, but not comfortable for another for various reasons.
Educating yourself about each type is important. It’s also important to gain the right knowledge about each from professionals who know each method well and can offer expert advice. There are many myths out there which can distort your view and cause misunderstanding with regards to fact and fiction.
Seek out expert information from your doctor or clinic, then weigh up the pros and cons of each method as it applies to your own lifestyle and future plans. For some, a combination of methods may offer the best means of protection against pregnancy and STIs / STDs.
The more you know, the more in control of your sexual health you can be.
Advantages and disadvantages of each birth control type
Birth control methods have been tested with care and those that are recommended as options are considered safe to use. It’s important to know what the pros and cons of each type are before deciding on the method best for you.
- Abstinence: This prevention method is completely free and has no health risks. One of the downsides is that it requires self-control. If you change your mind and decide to have sex, a birth control method of some kind is recommended. Another factor to consider is that an STD infection is still possible through oral sex and sometimes skin-to-skin contact (such as touching or rubbing others’ genitals).
- Intrauterine device (IUD): A copper IUD can last approximately 10 years and a hormonal IUD up to 5 years. For many this is high on the list of advantages. Other factors considered pros for this method are that you do not have to stop or interrupt sex to use it and it is completely undetectable during intercourse. Downsides are that it cannot protect against STDs, must be inserted by a doctor, can have a high upfront cost, or cause irregular bleeding or spotting (bleeding between menstrual periods or after sex). It rarely happens, but an infection can occur in some people when an IUD is inserted.
- Implants: This method is effective for up to 3 years, is convenient and private. Upfront costs of an implant can be high as they must be inserted (and removed) by a doctor with specialised training. Other downsides include the possibility of infection at the site of insertion, an inability to protect against STDs, or changes in menstrual periods (irregular bleeding).
- Sterilisation: This method is permanent and is a good choice for men and women who do not want to conceive or have children. Men and women can have a sexually active lifestyle without risk of pregnancy. Sterilisation is a surgical procedure which must be done by a qualified medical professional. It does not protect against STDs, has a high upfront cost (if you do not have health insurance or a plan that will cover the procedure cost) and typically carries risks associated with the surgery.
- Injection: Shots are required 4 times a year (every 12 weeks – this is when effects begin to wear off). This method is not detectable to anyone else and can reduce the risk of endometrial cancer. In some cases, women may stop having menstrual periods altogether. Downsides include a lack of protection against STDs, each shot requires a visit to your doctor, irregular bleeding or spotting and a possible decrease in the strength of your bones (due to a lowering of the body’s natural oestrogen levels).
- Patch: This method is easier to use than birth control pills, does not cause any interruptions to sexual activity and only needs to be changed once a week. Downsides can be that you will need to remember to change your patch once a week, a prescription is required, and it cannot protect against STDs. A patch may also cause irregular bleeding or spotting and should never be used if a person has a blood clotting disorder.
- Vaginal ring: These are reversible, do not cause any interruptions to sexual activity and can also help a woman’s menstrual periods become more regular, lighter and less painful. In some instances, it has been noted that a vaginal ring can play a role in clearing up acne (because of the hormones released into the body). Vaginal rings should not be used if you have a blood clotting disorder. Other disadvantages are that it does not offer protection against sexually transmitted infections, must be acquired via prescription from a doctor and must be both inserted and removed by yourself every month (many are not comfortable with this).
- Birth control pills (oral contraceptives): This popular method is a reversible form of contraception and is often favoured because it can reduce menstrual cramps, help make menstrual periods regular and lighter, reduce problems with acne, lower a woman’s risk of ovarian cancer and endometrial cancer, as well as ovarian cysts. Other pros are the variety of different types and dosages available for women to choose from, and a low monthly cost (which is covered by some health insurance plans). The downsides are that birth control pills can interfere with other medications you may be taking, or may be rendered ineffective by these, and can cause mood changes and other minor side effects. Most minor side effects will go away within the first few months of use. Pills do not protect against STDs and must be taken every day at the same time. A prescription from a doctor is required.
- Condoms: Barrier protection via condoms are easy to purchase over-the-counter without a prescription. Condoms are inexpensive and are often free at a family planning clinic. Another advantage is that condoms do provide some protection against sexually transmitted infections and STDs. Liquid used to package condoms or the latex can cause an allergic reaction for some people. Other disadvantages include the perceived inconvenience of having to interrupt foreplay to put a condom on before having sex, or the changes in sensation during sex. Condoms are not at all effective if they break or tear during sex.
- Cervical barriers: This type is re-usable, protects against some STDs, does not use hormones which some people have adverse reactions to, and can be inserted 24 hours before sex (this can also be a disadvantage if planning ahead to insert the barrier properly is not always possible). It can happen that a person may be allergic to the barrier material or spermicide used with the barrier.
- Spermicides: These chemicals can provide some lubrication during sex, can be bought over-the-counter without a prescription and do not contain any hormones which will alter any functions in the body or influence a woman’s menstrual periods. Spermicides are also safe for breastfeeding women and smokers. Spermicides are not effective protectors against STDs, and may cause allergic reactions or irritation if used more than twice a day. Some may consider the use of spermicide an irritation if they have to interrupt sex to use.
- Birth Control Sponge: These can be bought over-the-counter without a prescription, are easy to insert and can be used for a 24-hour period (multiple times). Sponges contain no chemicals or hormones, but can still cause an allergic reaction if you have an allergy to a spermicide which is used. Sponges do not offer protection against sexually transmitted infections (STDs).
- Fertility tracking: Plus sides to tracking your levels of fertility during your cycle are that there are no health risks and no additional hormones or chemicals able to access your body. Fertility tracking can be tricky and you will need to learn how to check and record body signs from a trained expert. If this method is to work for you, it requires keeping a daily record. This can be done by means of mobile calendars, electronic devices or applications to help track changes. Tracking is a method that works best for women who have regular periods. It cannot protect you from sexually transmitted infections.
Risk factors, complications and side effects
Something to take into consideration when choosing a birth control method is your overall health. Factors relating to your health may put you at risk (whether in a mild or serious capacity) for experiencing problems.
Some birth control methods may merely just not be safe for you. If in doubt, consult your doctor to help you assess levels of safety. Your doctor will likely want to know the following in order to assist you as some health issues may limit your choices:
- Do you smoke?
- Are you pregnant?
- Is there a possibility you could be pregnant?
- Are you breastfeeding?
- Do you have other serious health conditions, such as heart disease, high blood pressure, headaches and migraines or diabetes?
- Have you ever had deep vein thrombosis (blood clots in the legs)?
- Have you ever had other blood clot disorders in the lungs, such as pulmonary embolism?
- Do you have a close family member who has had blood clots in the legs or lungs?
- Have you been diagnosed with and treated for breast cancer?
- Have you had a sexually transmitted infection, such as gonorrhoea?
Birth control side effects
- IUDs: Insertion can be painful for some women. Other women may experience heavier menstrual periods (or more irregular ones) and more discomfort with cramps. These types of side effects often go away within the first 6 months of use. Risk of an infection is highest when the IUD is inserted. It is not a recommended birth control method for women who may have or who have had an STI, might be pregnant, have untreated cervical cancer, uterine cancer, or who experience unexplained vaginal bleeding. The copper IUD isn’t recommended for women who are allergic to copper or who have Wilson’s disease (a rare genetic condition that causes copper poisoning in the body). Other risk factors include women who have severe liver disease, and those who have or have had breast cancer.
- Implant: An implant can sometimes move or migrate from the initial site of implantation (usually in the upper arm, right under the skin), making it difficult for your medical professional to find and remove (after a maximum of 3 years).
- Sterilisation: Men may opt for a vasectomy as a more permanent solution for birth control. A reversal is possible in some circumstances, but is a more complicated procedure (making it not always possible to reverse). Short term risk include swelling, bruising, bleeding inside the scrotum, presence of blood in the semen, and infection. Long term complications can lead to fluid build-up in the testicle/s and chronic pain. Women can opt for 2 different types of sterilisation: surgical (called tubal ligation) and non-surgical. Tubal ligation prevents pregnancy immediately after the procedure. Non-surgical sterilisation may take up to 3 months to be effective. Some tubal ligations may be reversible, but this is not often successful. A non-surgical sterilisation is not reversible at all. Non-surgical sterilisation is not an option for women who only have one fallopian tube, have had one or both fallopian tubes closed or obstructed or are allergic to contrast dye used in X-rays. Possible risks and complications can include infection and bleeding. Where a doctor is using inserts for sterilisation, there is a risk of the implant becoming dislodged or damaged in the uterus. Some women have experienced long-term chronic pelvic pain. In both male and female sterilisation procedures, although rare, tubes may heal after sterilisation. If this happens, pregnancy may occur. More often than not, however, this pregnancy will be ectopic (the foetus implants in the fallopian tube instead of the uterus). This can be life-threatening.
- Injection: If used correctly, the risk of pregnancy can be reduced in most women to as little as 1%. Common side effects include headaches, abdominal pain, dizziness, nervousness, decreased sex drive, weight gain, acne, stomach bloating, hot flushes, insomnia, achy joints, nausea, sore breasts, hair loss, depression, and decreased bone density. Although rare, more serious side effects can occur and will require immediate medical attention. These instances include major depression, pus or pain near the injection site (arm or buttocks), unusual or prolonged vaginal bleeding, yellowing of your skin or the whites of your eyes caused by bile flow problems, breast lumps, or migraines with aura (a blight, flashing sensation that precedes migraine pain).
- Patch: Less than 1% of women who correctly use the patch fall pregnant. When things do go wrong, as can happen with any hormonal form of birth control, the following side effects may be experienced: deep vein thrombosis, stroke, heart attack, pulmonary embolism.
- Vaginal ring: There is a slight risk of blood clotting, which can also occur with the use of birth control pills or patches (due to additional hormones in the body). With this comes an increased risk of deep vein thrombosis, stroke, pulmonary embolism and heart attack. Women who fall into a high-risk category (and for whom an oestrogen containing contraception will not be recommended) are those who smoke and are older than 35 years of age.
- Birth control pills (oral contraceptives): Every woman reacts differently to hormones, with many experiencing unpleasant side effects. Side effects that may stabilise or even go away within a few months can include decreased sex drive, nausea, spotting (or bleeding between menstrual periods), and breast tenderness. More serious side effects and complications include heart attack, stroke, deep vein thrombosis and pulmonary embolism. Women who are most at risk for developing blood clots are overweight, have high blood pressure, smoke and are on bed rest for long periods of time.
- Condoms: Male and female condoms can cause skin irritation (contact dermatitis) due to allergy or latex sensitivity (in this case you can opt for other varieties made from polyurethane or polyisoprene). A man or a woman can also experience dryness, discomfort or allergic reactions to spermicides, lubricants, scents and other chemicals used in condoms. Female condoms can be bothersome and uncomfortable to insert or wear during sex.
- Cervical barriers: Side effects are rare but can include urinary tract infections, vaginal irritation or allergic reactions to spermicide. Cervical caps are easy to use incorrectly, and can also slide or be pushed out of place during intercourse. Many women (and men) find them uncomfortable as well.
- Vaginal sponge: A sponge can break, especially when trying to remove it. If this happens and you can’t get all of the pieces out, you need to see our doctor as soon as possible to avoid an infection. If you are allergic to sulphites (a chemical often found in wine or food), you should not use this method of birth control or the spermicide that it is used with. Some are at an increased risk of toxic shock syndrome (TSS) which causes symptoms of fever, shock and organ damage.
- Emergency contraceptive pill: It is possible to experience side effects with ‘the morning after’ contraception option. These can include nausea, abdominal pain, unexpected bleeding or spotting, fatigue, headaches, dizziness, vomiting and breast tenderness.
How effective are birth control pills?
Birth control pills can be highly effective in preventing an unwanted pregnancy. The combination pill has up to 5% failure rate and the progestin-only pill has a 9% failure rate (with typical use).
Progestin pills must be taken within the same 3-hour time period on a daily basis. Combination pills offer more flexibility and can be taken at the same time every day (but with a 12-hour window).
Certain medications such as some antibiotics, HIV medications, anti-seizure drugs and St. John’s wort can make either pill less effective.
If you experience diarrhoea or vomiting, or have had a stomach illness while on a contraceptive pill, it may not be as effective in preventing a pregnancy. It is wise to use a backup method of contraception.
What are the different types of birth control pills?
Combination pills contain synthetic (or man-made) forms of the hormones oestrogen and progestin. Most of the pills in a monthly cycle are active (contain hormones) and the remaining pills inactive (do not contain hormones).
Combination pills come in different varieties. These include monophasic pills (one-month cycle pills where each pill provides the same dose of hormone), multiphasic pills (one-month cycles which provide different levels of hormones) and extended-cycle pills (typically used in 13-week cycles).
Progestin-only pills contain progestin without oestrogen. Also known as the ‘mini-pill’, these can be used by women who aren’t able to take oestrogen (for health or other reasons). In this type, all pills in the cycle are active. You may or may not have a menstrual period when taking progestin-only pills.
How old do you have to be to get your tubes tied?
From a legal standpoint, it is generally acceptable for you to do what you wish with your reproductive system as an adult. In some countries, a girl of any age can consent to using contraception methods of her choice.
Legally, a woman can receive a tubal ligation procedure (‘getting her tubes tied’) at the age of consent (18 to 21 years and above, depending on the country in which you reside). This age can vary from country to country and can also be influenced by what you doctor feels is best. The procedure is regarded as a minimally invasive one, but does come with risk factors and complications (thus requiring consent).
A man who is 18 years of age and above, and considered mentally sound, can have a vasectomy. Doctors are not legally required to perform any procedure if they feel uncomfortable doing so or deem unsafe for any reason. All doctors have a professional and ethical obligation to do what they feel is in the best interests of their patients.