Think Beyond the Pill
When it comes to birth control, women have more options than ever — but more choices also means there’s a lot more to consider. So how can you choose which pregnancy prevention method is right for you?
The most important step is to weigh your options with your doctor; you’ll want to find out how each form of birth control will affect your health, says Sara Newmann, MD, assistant professor in the department of obstetrics, gynecology, and reproductive sciences at the University of California San Francisco. Factors like high blood pressure, your smoking habits, and a history of breast cancer should all have an impact on your pick.
But before you meet with your doc, take a look at our list of pros and cons of birth control methods.
The Diaphragm and Sponge With Spermicide
These are barrier methods of birth control. The diaphragm comes as a flexible cup that you place in your vagina to block sperm from entering your uterus, and use with spermicide. You have to be fitted for a diaphragm by your doctor, who should check it every one or two years to make sure no holes have developed. Recently gained or lost weight? You’ll also want to have it checked to ensure you still have the best fit. The sponge is soft foam coated with spermicide. The device looks like a donut, and covers the cervix when you insert it into your vagina.
Pros
You can insert your diaphragm anywhere from just before sex up to 24 hours before intercourse. It’s a great option if you have medical conditions, such as a history of breast cancer, that make it unsafe to use hormones for birth control. The sponge is over-the-counter, small, and also won't affect your hormones.
Cons
To be most effective, a diaphragm should be used with spermicide and left in place for six hours after having sex. This may increase your risk for urinary tract infections, but urinating after sex can help you avoid infection. If you are at risk of HIV infection, these are not the best choices because spermicide increases risk of getting HIV from your partner. And, says Newman, the diaphragm is only 88 percent effective for preventing pregnancy, as is the sponge in women who have not yet had a baby.
Birth Control Pills
There are a slew of birth control pills for women to choose from — including ones that are progestin only or a combination of estrogen and progestin.
Pill Pros
Fortunately, if you pop the Pill flawlessly, the failure rate can be as low as 1 percent. Combination birth control pills can also lead to less painful menstrual cramps, lighter periods, and fewer symptoms of premenstrual syndrome. The Pill may also provide protection against pelvic inflammatory disease, infections, endometrial cancer, and ovarian cancer. Progestin-only pills are ideal for women who are breastfeeding because they don’t affect milk production. They are also safer for women who have a history of blood clots or have uncontrolled high blood pressure. Both types of contraception help regulate your periods, and you can even use them to control how many periods you have a year.
Pill Cons
The Pill has an 8 percent failure rate — and that’s because it’s hard to remember to take regularly. If you’re on a progestin-only pill, it’s especially important to take it at the same time every day. Birth control pills can cause spotting, breast tenderness, nausea, and low sex drive. Combination pills carry a risk of blood clots in your legs and increase your risk of stroke if you smoke, Newmann says.
The Patch and the Ring
The patch and the ring are both hormonal methods of contraception containing estrogen and progenstin like the Pill is, but these don’t require you take a pill every day. The patch is a small piece of plastic that sticks on your stomach, buttock, arm, or torso and is replaced weekly. The ring is a small, flexible device that is placed inside the vagina and left for three weeks at the time, but it is taken out for the other week of the month.
Pros:
Both of these birth control options share all the benefits of combination pills — they’re just more convenient. Plus, they can be used continuously to allow you to skip periods, Newmann says. Like the Pill, they’re 92 percent effective for preventing pregnancy, and can be even more effective if used exactly as instructed.
Cons:
The patch can cause skin reactions in some women. And like the Pill, both the patch and the ring can cause side effects such as spotting, headaches, bloating, and breast tenderness. You shouldn’t use them if you’re predisposed to blood clots, have uncontrolled high blood pressure, or get migraines with aura. The ring has additional possible side effects of vaginal discharge or irritation.
Hormone Shots
A shot of progestin in the arm offers women pregnancy prevention for three months at a time. It blocks ovulation, and also makes it more difficult for sperm to travel because of an increase in cervical mucus.
Hormone Shot Pros:
When the hormone shot is administered properly by a healthcare worker, fewer than 1 in 100 women will get pregnant. And, hey: You don’t have to think about birth control every day, every week, or even every month. The shot may reduce risk of uterine cancer, and protect you from pelvic inflammatory disease, according to the American Congress of Obstetricians and Gynecologists, ACOG.
Hormone Shot Cons:
You’ll have to go to your doctor to get the shot, and the shots tend to cause more irregular bleeding than the Pill, patch, or ring, particularly during the first three to six months, Newmann says. Also, prolonged use can lower your bone density and so you should get a bone density test if you use this contraception method for five years continuously, However, bone loss is reversible once you stop using the hormone medication. If you plan to become pregnant in the future, you’ll have to plan ahead if you’re using hormone shots. It can take anywhere from 3 to 18 months to start ovulating again after stopping them.
The IUD
An IUD, or intrauterine device, is a T-shaped device that’s inserted into the uterus by your doctor. You’ll need to choose between one that contains copper or the hormone progestin.
IUD Pros:
The IUD is a very effective contraception option — pregnancy occurs in less than 1 in 100 women who use one. It is invisible from the outside, and you don't need to use spermicide with it. Copper IUDs can be left in for 12 years, and an IUD containing hormones can be left in for five. The copper IUD can even be used for emergency contraception if it’s inserted within five days of unprotected sex. Another benefit of the IUD is that although long-term, it's reversible, and you can become pregnant after having it removed.
IUD Cons:
IUDs can cause an increase in cramping. If you have a sexually transmitted infection at the time it’s inserted, your risk for pelvic inflammatory disease increases, Newmann says.
Hormone Implants
A piece of plastic (about the size of a matchstick), this long-term form of contraception contains progestin. It is inserted by your doctor just under the skin of the upper arm and prevents pregnancy for three years.
Hormone Implant Pros:
You won’t have to worry about birth control for three whole years.The method is also invisible. And it’s as effective as an IUD — less than 1 in 100 women will get pregnant with a hormone implant in place. If you plan on having a baby, you can still become pregnant after having the implant removed.
Hormone Implant Cons:
Most women will experience irregular bleeding throughout the first year, but eventually women stop getting periods on this method, Newmann says. If irregular bleeding is a problem, estrogen can be given to counteract it.
Fertility Awareness
Know your cycle well? All you may need to do is use a barrier method (such as a condom) during the days that you’re fertile. Preventing pregnancy through fertility awareness can be done by tracking your cycle on a calendar, monitoring your cervical mucus, and taking your body temperature.
Fertility Awareness Pros:
You can forget about prescriptions, devices, and taking hormones with this natural birth control approach.
Fertility Awareness Cons:
You’ll need to make a strong commitment to monitor your cycle. Even with careful attention, there’s still a large margin of error because women can ovulate on a different day of every cycle, Newmann says. And because sperm can stay active for up to six days after sex, you have to use a barrier method for six days before you ovulate. The failure rate for using a combined method of checking your body temperature, monitoring cervical mucus, and watching the calendar is high, about 25 percent, Newmann says.
Abstinence
Ever considered ceasing sexual activity altogether? Practicing abstinence is one birth control option that can’t fail. Some people practice periodic abstinence, Newmann says.
Abstinence Pros:
Totally refraining from sex is the only foolproof way to prevent pregnancy.
Abstinence Cons:
Refraining from sex is certainly not feasible for everyone — nor is it easy. “We’re all human beings and we all have a sex drive,” Newmann says. If abstinence is your only plan, you should always have a back-up contraception on hand, such as condoms.
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