An array of options exists for the prevention of pregnancy. Many think of “birth control pills” or oral contraceptives when the subject of contraception is raised but there are many other choices.
Two broad categories are hormonal or non-hormonal options. Non-hormonal options include abstinence, which is the only method which is 100% effective. Barrier methods such as a male (87% or female condom (79%) may also provide some protection against sexually transmitted infections and are often recommended to be used in addition to other methods for better protection. Diaphragms (88%) are difficult to find but are used along with spermicide. Sponges, films and electrolyte solutions are available but slightly less effective (76%). These methods all require that some deliberate planning and preparation be performed before the sex act. The copper intrauterine device is placed inside your uterus in the physician’s office and therefore does not require any pre-coital maneuvers. The effectiveness of these methods is directly related to the amount of thought and planning which is required for it to work. As a result, condoms tend to have a wide range of effectiveness. The copper intrauterine device on the other hand is approximately 99% effective.
Side effects may occur even with non-hormonal methods. The chemicals may be irritating to the skin. The intrauterine device tends to make menstrual flow and cramps more severe.
Other non-hormonal methods include the natural family planning or calendar method which utilizes an awareness of your body’s cycle and avoiding sex during the fertile periods (76%). Some couples are able to use withdrawal as an effective method (80%), although failure rates are high due to the sperm which may leak out of the penis prior to ejaculation and the difficulty of properly timing the withdrawal from the vagina by the male partner.
Hormonal methods offer extensive choices. Oral contraceptive pills are generally either a progestin-only variety or a combination of an estrogen and progestin (most common). Often the choice depends on cost or side-effects, and usually the right pill can be found with perseverance and trial and error. Many low dose options are tried initially and then adjustments can be made to minimize problems such as unexpected bleeding. Many non-contraceptive benefits are present with these medications, such as improvement in acne and hair growth, decrease in the number of ovarian cysts, improvement in menstrual bleeding and cramping and management of endometriosis pain. Effectiveness is 92%.
Another popular choice is the hormonal intrauterine device. There are several types available with slightly different sizes and amounts of hormone and last from 3-6 years. These are 99.2% effective and once they are in place, do not require the patient to perform any pre-coital act; nevertheless, condoms are recommended as protection against infections. Many enjoy the decrease in menstrual flow, sometimes to the point of no menses which may occur with these intrauterine devices.
The hormonal implant is another effective method, up to 99+%, and is placed under the skin in the arm by a simple office procedure. This method lasts 3 years but requires a small office procedure to remove it.
A hormonal flexible ring which is inserted in the vagina is another option. The patient can insert and remove the ring herself. The hormones work similarly to oral contraceptives but the medication is absorbed through the vaginal skin into the body.
Depo medroxyprogesterone is an injectable medication which is highly effective (96%) for contraception, requiring injections either monthly or every 3 months. Often amenorrhea, or stopping of the menses, occurs with this method over time. A significant side effect is the loss of bone after one year of use and a small amount of weight gain, about 4# per year which limits its appeal.
When childbearing is complete, the consideration of surgical solutions can be effective, 99.5%. “Tubal ligation” or tying of the tubes is a permanent contraceptive choice. More recently, the procedure has been changed from simply blocking a small section of the tube to a complete removal of the tube. It has become evident that many ovarian cancers are originating in the Fallopian tube and therefore complete removal of the tubes may lower your risk for this malignancy, and likely reduces the chance of ectopic pregnancy. The tubes do not generate any hormonal products and therefore removal should not impact the hormone production from the ovaries.
Vasectomy is a surgical option for the male partner and is effective (99+%) and considered permanent. It is important to have the semen analysis checked post-procedure to ensure that the sperm are not present.