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CONTRACEPTION

WHAT IS CONTRACEPTION?

Contraception, also called birth control, is prevention of pregnancy.

ARE THERE NATURAL FORMS OF BIRTH CONTROL?

Yes, but these methods, listed below, are not as effective as medical or surgical methods of preventing pregnancy.

  • Withdrawal method:  Also known as the “pull out” method, where the man pulls out before ejaculation
  • Fertility awareness: Woman keeps track of her menstrual period and tries to avoid sex on certain days, such as when she is ovulating
  • Breastfeeding: Breastfeeding your baby can prevent pregnancy after a baby is born in some women. You should discuss this with your doctor if considering.

I AM INTERESTED IN CONTRACEPTION. WHAT ARE MY OPTIONS?

  • Combined Hormonal Birth Control
  • Progestin-only Hormonal Birth control
  • Barrier methods
  • Long-Acting Reversible Contraception
  • Sterilization

COMBINED HORMONAL BIRTH CONTROL

There are three main types: the pill, skin patch, and the vaginal ring.

Each of these contain two hormones: estrogen and progestin.

  • How they work:  They prevent pregnancy by stopping ovulation (they prevent the egg from being released by ovaries). They also cause cervical mucus to thicken, making it harder for sperm to get into the uterus.
  • Efficacy: If used correctly and consistently, there is 1% chance getting pregnant. With typical use (not always used correctly or consistently, there is a 9% chance of getting pregnant.
  • Risk: May increase the risk of blood clots, heart attack and stroke in women older than 35 years old who smoke or women with risk factors for cardiovascular disease (high cholesterol, high blood pressure, diabetes and history of stroke, heart attack or blood clots).
  • "The Pill:" Requires a prescription. It is taken daily by mouth usually for 21 days. Side effects may include: headache, nausea, breast tenderness, breakthrough bleeding.
  • Skin Patch: This is a small patch that sticks to the skin and releases estrogen and progestin. It can be placed on the buttocks, chest, upper back, arm, abdomen. You wear it for 3 weeks and when you take it off, you’ll have you’re period on the 4th the week. You can place a new one. It is less effective in women over 198 lbs. Side effects may include: Skin irritation, breast tenderness, headache and break through bleeding.
  • Vaginal Ring: This is a flexible plastic ring that is placed in the upper vagina. It releases estrogen and progestin. Your doctor can prescribe it and show you how to use it.  It stays inside for 21 days. You then remove it and keep it out for 7 days. During this time you’ll have your period. After the 7 days, you place a new ring for another 21 days.  Once in, it’s usually not noticeable but if desired, you may take it out for up to 3 hours during intercourse. Side effects may include: Headache, nausea, breast tenderness, vaginal discharge, vaginal irritation, breakthrough bleeding.

PROGESTIN-ONLY BIRTH CONTROL

This can be an oral pill or injection and it contains the hormone, progestin. Efficacy is similar to combined hormonal options. Other progestin only options will be discussed below (implant and IUD).

  • How they work:  Progestin causes cervical mucus to thicken making it harder for sperm to get to the egg. Risks: avoid in women with lupus and history of breast cancer.
  • Efficacy: If used correctly and consistently, there is 1% chance getting pregnant. With typical use (not always used correctly or consistently, there is a 9% chance of getting pregnant.
  • Risk: Should be avoided in women with lupus and history of breast cancer. Bone loss may occur. Women at risk for cardiovascular disease or with history of stroke, vascular disease or poorly controlled high blood pressure are at increased risk of these events.
  • Progestin Pill: Requires prescription and is taken every day for 28 days. Must take it at the same time every day. If you miss a pill, take it right away and use back up contraception. Side effects may include: bleeding/spotting, headaches, nausea, and breast tenderness
  • Progestin Injection: One injection prevents pregnancy for 3 months at a time, and therefore the injections need to be repeated every 3 months by your physician.

WHAT ARE THE BARRIER METHODS OF CONTRACEPTION?

These include the diaphragm, sponge, cervical cap, male condom, female condom and spermicide.

  • How they work:  All barrier methods work through the principle of preventing sperm from entering the uterus.
  • Efficacy: Using a barrier method together with spermicide offers the best level of barrier method protection
  • Risks: If a condom breaks or tears, consider using emergency contraception. Some women may also be allergic to spermicide. Consult your physician if you experience vaginal irritation after use.
  • Diaphragm/Cervical Cap: Fits over cervix and prevents sperm from entering uterus. These require fitting by a doctor, must be used with spermicide, and have to be left in place for 6-8 hours after sex. Once this time has passed, the diaphragm should be removed. The cervical cap can remain in place for up to 24 hours.
  • Spermicide: Jelly, cream, foam or suppository that is inserted into the vagina. It should be placed 30 minutes before sex and remain in place for 6-8 hours after. Spermicide alone does not offer protection against sexually transmitted infections.
  • Condoms: Provide the best protection against sexually transmitted infections and are inexpensive. Male or female condoms should be removed right away after sex and discarded.
  • Sponge: A soft foam, shaped like a doughnut and it has spermicide. It is inserted into the vagina to cover the cervix.

WHAT IS LONG-ACTING, REVERSIBLE CONTRACEPTION?

There are two general categories: The Intrauterine Device (IUD) and birth control implant. These are the most effective forms of reversible birth control, last several years and are easy to use.

  • What is an IUD?:  T-Shaped plastic device that a doctor places into the uterus. Once it is placed, you don’t have to do anything to prevent pregnancy, and it is easily removable if you change your mind. There are two types: Hormonal IUD, which releases progestin and can be used up to 5 years. Non-hormonal IUD or the copper IUD can be used for up to 10 years.
  • Efficacy: Less than 1% of women using this method will become pregnant.
  • Risks: An IUD may become dislodged and come out in 5% of users, or rarely, can pierce the wall of uterus (1 out of 1000 chance). In these cases, infection of uterus and fallopian tubes may occur (pelvic inflammatory disease).
  • Side effects of IUD: Copper IUDs may increase menstrual pain and bleeding in first few months. Hormonal IUD can cause spotting, irregular bleeding, and overall menstrual bleeding may decrease over time. Headaches, nausea, depression and breast tenderness may also occur.
  • What is a birth control implant?: This is a small rod that releases progestin after being placed under the skin in the upper arm. It prevents ovulation and causes cervical mucus to thicken.  It prevents pregnancy for up to 3 years. They are easily removable if you change your mind.
  • Side effects of implants: Can cause unpredictable bleeding, less menstrual pain, and bleeding may stop all together. Mood changes, headaches, acne, or depression may occur.

WHAT IS STERILIZATION?

A permanent method of birth control; for women this involves tubal occlusion, which closes fallopian tubes so the egg can’t get to the uterus to be fertilized.  This is considered irreversible.

  • Tubal ligation:  The fallopian tubes are surgically cut, blocked or sealed to prevent pregnancy. It can be done right after delivering baby or another time. Usually done in the operating room.
  • Hysteroscopic tubal sterilization: Tiny coils are passed into the fallopian tube. Scar tissue is allowed to develop around the coil, which blocks the fallopian tube. This takes 3 months to become effective and back up birth control should be used for 3 months. After 3 months, an xray is done to make sure the tubes are closed. Risks include injury to the uterus and fallopian tubes.
  • Male sterilization:  During a vasectomy (male sterilization), the vas deferens which are the tubes that carry sperm, are sealed so that sperm can no longer pass. This prevents sperm from getting to the egg and can be done in an office. It is generally safer than female sterilization.

WHAT IS EMERGENCY CONTRACEPTION?

This is offered referred to as the morning after pill. It is a type of contraception used after unprotected sex or if birth control was forgotten, broke or used incorrectly. It prevents pregnancy if taken within 120 hours of unprotected intercourse. There are three types: Plan B or One Step (hormone pill), Ella (non-hormonal pill) or the copper IUD.

|    © 2014-2018 copyright Taraneh Shirazian, MD

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Joan H. Tisch Center for Women's Health

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Phone: 646-754-3300

 

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