The method of birth control you choose as a woman or together as a couple may vary over time, and it is critical for a sexually active woman to remain as well informed of her options as possible. The following table is a compilation of the choices currently available and can serve as a helpful guide to making this important decision.
Intra-uterine Devices (IUD/IUS)
| Reliability* | 99% |
| Protection against HIV/STD’s? | NO |
Pros:
- Longevity
- Low side effect profile
- High initial cost, but low when averaged out over lifespan of device
Cons:
- Recommended principally for women in monogamous relationships
- Can be expelled or become disloged
- Not recommended for women with fibroids
Intra-uterine Devices (IUD/IUS)
| Reliability* | 99% |
| Protection against HIV/STD’s? | NO |
Pros:
- Longevity
- Low side effect profile
- High initial cost, but low when averaged out over lifespan of device
Cons:
- Recommended principally for women in monogamous relationships
- Can be expelled or become disloged
- Not recommended for women with fibroids
Intra-uterine Devices (IUD/IUS)
| Reliability* | 99% |
| Protection against HIV/STD’s? | NO |
Pros:
- Longevity
- Low side effect profile
- High initial cost, but low when averaged out over lifespan of device
Cons:
- Recommended principally for women in monogamous relationships
- Can be expelled or become disloged
- Not recommended for women with fibroids
| Method | Reliability* | Protection against HIV/STD’s? | Pros & Cons |
|---|---|---|---|
| Intra-uterine Devices (IUD/IUS) | |||
| (All) |
99%
|
No
|
Pros: Longevity
Low side effect profile High initial cost, but low when averaged out over lifespan of device Cons: Can be expelled or become disloged Not recommended for women with fibroids |
| • ParaGard (Copper T) IUD | ParaGard can remain in place for up to 10 yr
Fertility usually resumes immediately upon removal Can be accompanied by increase in volume and duration of menstrual flow |
||
| • Mirena IUS | Mirena can remain in place for 5 yr
Possible delay in return of fertility once Mirena is removed Releases levonorgestrel (LNg), a synthetic progestin, just in uterus. Reduces menstrual volume in time but spotting can occur in initial 6–12 months May cause benign ovarian cysts Can rarely cause hormonal side effects similar to those seen with oral birth control pills, such as mood swings, breast tenderness, headaches, and acne. |
||
| Sterilization | |||
| (All) |
>99%
|
No
|
Pros/Cons: Surgical risks
Permanence Cost-effective over time These methods can in some (few) cases be reversed, depending on method and individual |
| • Tubal ligation | Tubal ligation immediately effective | ||
| • Vasectomy | Vasectomy not immediately effective; it may take months before full sterility is achieved | ||
| Hormonal Methods | |||
| • Birth control pills (Oral contraceptive pills – BCP’s/OCP’s)
Options include: — 20–35-mcg combined pills — Regular or extended-cycle use pills — Pills with shortened pill-free interval option — Progestin-only ‘mini-pills’ |
95–99%
|
No
|
Pros: High rate of efficacy
Relatively convenient Multiple options available Regulates menstrual cycle Decreased risk of endometrial and ovarian cancer, endometriosis, PID Cons: Not affordable for all women Drug interactions |
| • Vaginal ring (NuvaRing) |
~99%
|
No
|
Pros/Cons: Same as w/BCP’s, above
Other advantages: Use allows for more normal vaginal moisture and flora, reducing yeast infections for some women Protection from pregnancy one month at a time Other disadvantages: |
| • Transdermal birth control patch (Ortho Evra) |
~99%
(less reliable for women >198 lb) |
No
|
Pros/Cons: Similar to those of BCP’s, as above, except exposure to synthetic estrogen is ~60% higher, with resultant higher risk profile for thromboembolic events |
| • Depo-Provera injection |
99.7%
|
No
|
Pros/Cons: Same as w/BCP’s, above
Other advantages: Other disadvantages: |
| • Contraceptive implants |
99%
|
Pros: Longevity: Different systems last from 3-5 yr
Fertility returns relatively quickly Cons: Potential for scarring Side effects can in some cases be significant and long-lasting |
|
| Barrier Methods | |||
| • Male condom |
87–98%
|
Yes, except for STI’s contracted from genital areas not covered*
|
Pros: Convenience and availability
Multiple options Inexpensive Allows greater male partner participation Cons: Reduced sensation Some users experience allergies |
| • Female condom |
79–95%
|
Yes; only abstinence provides better protection*
|
Pros: Can be placed up to 8 hr in advance
Good protection against STI’s Does not require fitting by health care practitioner Cons: More costly than male condoms |
| • Female cervical cap |
Varies: 68–91%
|
No
|
Pros: Can be inserted up to 6 hr in advance
Very few side effects Several designs on market Cons: Some types require fitting by health care practitioner; limited to 4 sizes Not widely available Some users experience allergies |
| Spermicidal Methods | |||
| • Today Sponge |
89–91**
|
No
|
Pros: Immediate and continuous protection for 24-hr period
One size fits all and easy to insert Removal can be tricky for some |
| • Diaphragm with contraceptive jelly or foam |
80–94%
|
Some*
|
Pros: Few side effects
Can be inserted up to 6 hr in advance Can be used for intercourse during menses to collect flow Cons: Requires fitting/periodic refitting Some users experience allergies Some consider method to be “messy” |
| • Vaginal contraceptive film, foam, inserts |
74–94%; |
No
|
Pros: Readily available
Relatively inexpensive Lubrication Cons: Some users experience irritation and/or allergies “Messiness” factor Must be inserted within an hour before intercourse |
| Fertility Awareness Methods (FAM): | |||
| Examples:
• Basal Body Temperature (BBT) • Sympto-thermal • Billings Ovulation • “Rhythm” |
88–98%
|
No
|
Pros: Zero health risks or side effects
Enhances body awareness and partner intimacy Inexpensive Cons: Relatively high failure rate Not ideal in perimenopause years or for women with otherwise irregular cycles |
* Assumes perfect use. Actual effectiveness rates vary significantly. Statistics from Our Bodies, Ourselves (Boston Women’s Health Book Collective, 2005).
** McClure D., & D. Edelman. 1985. Worldwide method effectiveness of the Today vaginal contraceptive sponge. Adv. Contracept. 1: 305–11.
Jick, S., et al. 2006. Risk of nonfatal venous thromboembolism with oral contraceptives containing norgestimate or desogestrel compared to oral contraceptives containing levonorgestrel. Contraception, 73 (6), 566–570.
Jick, S., et al. 2006. Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception, 73 (3), 223–228.
Maine Center for Reproductive Health. May 2006. How dangerous is Ortho Evra? Newsletter.
Medscape.com. 2006. Should symptomatic menopausal women be offered hormone therapy? Medscape General Medicine, 8 (3), 40. URL: https://www.medscape.com/viewarticle/537095_4 (accessed 02.08.2007).
Winer, R., 2006. Condom use and the risk of genital human papillomavirus infection in young women. NEJM, 354 (25), 2645–2654. URL: https://content.nejm.org/cgi/content/abstract/354/25/2645 (accessed 02.19.2007; abstract only; subscription required for full access).
Additional resources for women
Our Bodies, Ourselves: A New Edition for a New Era, 2005 edition.
From the Boston’s Women’s Health Book Collective.
Women’s Bodies, Women’s Wisdom, by Christiane Northrup, MD.
CDC website for STDs:
https://www.cdc.gov/nchstp/dstd/disease_info.htm#GenInfo
Planned Parenthood website section on STDs:
https://www.plannedparenthood.org/sexual-health/stis-stds-101.htm
Planned Parenthood section on birth control options:
https://www.plannedparenthood.org/birth-control-pregnancy/birth-control-4211.htm
