Birth Control

Barrier methods are convenient and removable, and are a good option for women who are unable to use hormonal methods of contraception. They work by preventing sperm from entering the uterus. Failure rates for barrier methods differ depending on the method.

Barrier methods that do not require a healthcare provider visit include the following:

• Male condom. This is a single-use thin latex or polyurethane sheath that is applied over the penis before intercourse. This method has the additional benefit of reducing the risk of spreading Sexually Transmitted Infections (STIs). When used correctly, the effectiveness is 88-95%.

• Female condom. This is a single-use thin plastic pouch that is inserted into the vagina before intercourse. It also reduces the risk of STI transmission.

• Spermicide. This method works by killing sperm cells. There are different forms, including foam, jelly, cream and suppository. It should be inserted high into the vagina 30 minutes prior to intercourse and should be left in place for 6 to 8 hours after in order to prevent pregnancy. The effectiveness is approximately 82%.

Methods that require a healthcare provider visit include:

• Diaphragm. This is a shallow, flexible latex cup that is inserted into the vagina before intercourse. Spermicide should be used along with a diaphragm. The diaphragm should remain in place for 6 to 8 hours after intercourse to prevent pregnancy, and should be removed within 24 hours. The effectiveness is approximately 94%.

• Cervical cap. This is a silicone cup, similar to a diaphragm but smaller and more rigid. The cap should remain in place for 6 to 8 hours after intercourse to prevent pregnancy, and should be removed within 48 hours. The effectiveness ranges from 74 to 91%.

Hormonal methods of birth control use hormones to regulate or prevent ovulation; thicken cervical mucus, which helps block sperm from reaching the egg; or thin the lining of the uterus. They are highly effective if used consistently and correctly, but in typical use, they have a range of failure rates.

• Combined oral contraceptive (COC), also known as "the pill". COCs contain synthetic oestrogen and progesterone, which function to inhibit ovulation. A woman takes a daily pill, preferably at the same time each day. Many types of oral contraceptives are available, and your doctor can help to determine which type best meets a woman's needs. Compliant usage has an effectiveness of 98-99%.

• Contraceptive patch. This is a thin patch applied to the skin and releases hormones through the skin into the bloodstream. The patch is placed on the lower abdomen, buttocks, outer arm, or upper body. A new patch is applied once a week for 3 weeks, and no patch is used on the fourth week to allow for a withdrawal bleed.

• Progesterone-only pill (POP). A woman takes a daily pill, preferably at the same time each day. POPs interfere with ovulation and thicken cervical mucus, making it difficult for sperm to swim into the uterus or enter the fallopian tube. POPs alter the normal cyclical changes in the uterine lining and may result in unscheduled or breakthrough bleeding.

• Injectable birth control. This method involves the injection of progestin into the arm or buttocks once every 3 months. A temporary loss of bone density occurs while on this treatment option, but the bone loss is generally regained after the injections are discontinued. Most patients using injectable birth control should eat a diet rich in calcium and vitamin D or take vitamin supplements while using this medication.

• Implants. These are flexible, plastic, matchstick-sized rods which release synthetic progesterone. The implant is surgically inserted under the skin of the upper arm and can remain implanted for up to 3 years. After which, it can be replaced or removed, depending on whether the patient still desires birth control. Inserting the implant is a simple procedure that can be done in the clinic by your doctor. The contraceptive implant has a failure rate of less than 1%.

• Intrauterine device (IUD). This is a small, umbrella-shaped device that is inserted by a healthcare provider into the uterus to prevent pregnancy. Once in place, the IUD can function effectively for many years without any hassle. After the recommended length of time, or when the woman no longer requires contraception, the IUD can be either replaced or removed. There are 2 types of IUDs: the hormonal IUD and the copper IUD.

  • Hormonal IUD. Also known as the intrauterine system (IUS), the device intermittently releases a progestin hormone called levonorgestrel into the uterus. This hormone causes thickening of the cervical mucus, inhibits sperm from reaching or fertilizing the egg, thins the uterine lining, and prevents ovulation. The IUS can be left in place for up to 5 years, but some research suggests that the effectiveness may last up to 7 years. The IUS has a failure rate of less than 1%. This method may also be used to treat heavy menstrual bleeding because the hormone often reduces or eliminates uterine bleeding.

  • A copper IUD prevents sperm from reaching and fertilizing the egg, and it may prevent the egg from attaching in the womb. If fertilization of the egg does occur, the physical presence of the device prevents the fertilized egg from implanting into the lining of the uterus. The failure rate of the copper IUD is also less than 1%, and may remain in the body for up to 10 years. Copper IUDs are not recommended for women who may be pregnant, have pelvic infections, or had uterine perforations during previous IUD insertions. They are also not recommended for women who have cervical or endometrial cancer, unexplained vaginal bleeding, or pelvic tuberculosis.

Emergency contraception can be used to prevent an unintended pregnancy after unprotected sexual intercourse has occurred. There are 2 types: emergency contraceptive pills, and the copper-eluting IUD. Read more about emergency contraception here.

Sterilization is a permanent form of birth control that either prevents a woman from getting pregnant or prevents a man from releasing sperm. The sterilization procedure usually involves surgery. These procedures usually are not reversible.

• A sterilization implant is a non-surgical method for permanently blocking the fallopian tubes. A healthcare provider threads a thin tube through the vagina and into the uterus to place a soft, flexible insert into each fallopian tube. Incisions are not necessary. During the next 3 months, scar tissue forms around the inserts and blocks the fallopian tubes.

• Tubal ligation is a surgical procedure in which the fallopian tubes are cut or tied, thereby eliminating the path between the ovaries and the uterus.

• Vasectomy is a surgical procedure performed on a man, in which the vas deferens are cut or tied, thereby blocking the path between the testes and the penile urethra. It can take as long as 3 months for the procedure to be fully effective, and a follow-up semen analysis can be performed to confirm that there is no sperm in the semen.