CONTRACEPTION: HOW TO CHOOSE A METHOD
THAT'S RIGHT FOR YOU
You've made the important decision to practice birth control -- and now you are faced with another: which method? As you'll see, there are several available, and with good reason; because no two people are alike, no one method is right for everyone.This page is designed to help you make an informed decision about birth control measures. In it, you'll find an introduction to the many contraceptive options available to you. Then, with your doctor's or health care provider's help you'll be able to decide on one that works best with your lifestyle and your needs.
On this page you'll find (shortcut to scrolling):
- Female Reproductive Anatomy
- Ovulation and Conception
- When am I most likely to conceive?
- Birth control options:
- Other Options - http://www.familydoctor.org/online/famdocen/home/women/contraceptive/016.html
Your doctor or health care provider can best answer any questions you might have. Be sure to keep in touch with her or him for regular checkups, too...to get the most out of your contraceptive choice.
Female Reproductive Anatomy
The uterus, or womb, is a muscular chamber about the size and shape of a pear. This is where a fertilized egg can implant and develop into a baby.
The cervix is the opening of the uterus through which sperm enter to fertilize an egg and through which a baby usually leaves the uterus.
The vagina is the passageway between the uterus and the outside of the body. This is the canal through which a baby is delivered and where the penis is inserted during sexual intercourse.
The ovaries are two walnut-sized structures located on either side of the uterus. Each holds thousands of tiny egg follicles-clusters of cells that contain an immature egg at their centers. The ovaries also produce hormones needed for reproduction.
The fallopian tubes connect the ovaries and the uterus. About 4 inches long, they each begin at an opening on either side of the uterus and end in a funnel that surrounds (but doesn't attach to) each ovary.
Ovulation & Conception
About once a month, the lining of the uterus begins to thicken in preparation to receive and nourish a fertilized egg. At the same time, several egg follicles begin to mature, but usually only one develops fully, with a mature egg inside.
It moves to the surface of the ovary, and the follicle comes apart, releasing the egg into the fallopian tube. This process is called ovulation. Over the next few days the sides of the fallopian tube squeeze periodically to push the egg to the uterus.
If the egg is not fertilized during this critical time, it will disintegrate in the uterus. And, since the thickened uterine lining is no longer needed, it will be shed over a period of 2 to 8 days. This discharge, containing blood, cells, and other secretions, is menstrual flow, or "a period." The time interval from one period to the next is the menstrual cycle.
Just after ovulation, while the egg is on its way toward the uterus, it may be fertilized by a man's sperm, which is deposited during sexual intercourse. Several million sperm can be contained in the semen released from the penis; only one such sperm must reach the egg -- usually while it is still in the fallopian tube -- for a pregnancy to occur. This process is conception. Once fertilized, the egg takes several days to travel down the fallopian tube to the uterus, where it implants in the uterine lining and begins to develop into a baby.
When am I most likely to conceive?
Every women's cycle is different; it is possible to conceive on almost any day in your cycle. For women with 28-day menstrual cycles, ovulation is likely to occur 14 days before the next menstrual period is expected.
Because sperm can survive in the fallopian tubes for 2 or 3 days, the most fertile period begins 2 to 3 days before ovulation. Although the egg may be in the fallopian tube for 2 or 3 days, the fertile period usually ends by the time the unfertilized egg reaches the uterus. It's important to remember, however, that your fertile period may vary from the norm and may even change from cycle to cycle. If you're interested in determining your own cycle, consult with your doctor or health care provider.
BIRTH CONTROL OPTIONS
Combination Oral Contraceptives (Birth Control Pills)- How do combination oral contraceptives work?
The process of ovulation is directed by hormones, chemicals made by the body. Some hormones signal for egg follicles to mature in the ovary, others trigger the thickening of the uterine wall. Combination oral contraceptives consist of man-made versions of two of these hormones, estrogen and progestin; taken daily, they block the usual hormone "messages" that direct ovulation. No eggs are produced, so conception is prevented. Other effects of combination oral contraceptives help prevent sperm from reaching the egg and reduce the chance of the egg implanting in the uterus.
There are several kinds of combination oral contraceptives, with different levels and types of hormones. Some pills contain a constant dose of both hormones (progestin and estrogen). Others, called "phasic birth control pills," deliver varying levels of hormones throughout your cycle.
Every woman's cycle is different, and so are her needs in an oral contraceptive. Your doctor or health care provider can determine a type that is right for you.
- What do I have to do?
Combination birth control pills are a very simple birth control method to use; you only need to take them once daily, at the same time each day. Then, for 7 days each month, you stop taking the pills (or you take inactive "placebo" pills). During this "time off," you will usually experience bleeding similar to a normal menstrual period.
When taking the active pills, you must take one every day in order to be protected.
- Are oral contraceptives right for me?
Oral contraceptives are one of the most effective forms of reversible birth control currently available. Only your doctor or health care provider can determine if you're a suitable candidate for birth control pills. When used correctly, they are more than 99% effective, making "the pill" the most popular method of contraception. Oral contraceptives are considered safe for most women. The pill does not offer protection against sexually transmitted diseases (STDs). Serious as well as minor side effects have been reported in women using oral contraceptives. You should discuss these risks with your doctor or health care provider.
Progestin-Only Birth Control Pills ("POPs")
- How do progestin-only oral contraceptives work?
Unlike combination birth control pills, progestin-only pills or "POPs" contain no estrogen and they have a lower dose of progestin than combination birth control pills. Because they are so low dose, they are sometimes called the "minipill." Progestin-only oral contraceptives work in three different ways: (1) they make the cervical mucus at the entrance to the womb (the uterus) too thick for the sperm to get through to the egg, (2) they prevent ovulation (release of the egg from the ovary) in about half of the users, and (3) they also affect other hormones, the fallopian tubes, and the lining of the uterus. In typical use, progestin-only pills are 95% effective; therefore, they are somewhat less effective than combination pills.
- What do I have to do?
Like combination birth control pills, progestin-only pills are a very easy birth control method to use. You only need to take "POPs" once daily, at the same time each day. Progestin-only pills differ form combination pills in that they have to be taken continuously. There are no inactive "placebo" pills.
- Are progestin-only pills right for me?
Progestin-only pills are especially appropriate for women who cannot or should not take estrogen-including women who are breast feeding, since "POPs" have no negative effects on breast-feeding performance and are safe for the infant. They also provide progestin-only contraception without surgery or injections. In addition, if you wish to discontinue the pill and become pregnant, POPs will not delay your return to fertility. However, it is very important to take POPs at the same time every day. Menstrual irregularities such as spotting and bleeding between periods are more common than with combination oral contraceptives.
Intrauterine Device (IUD)
- How does the IUD work?
The IUD is a small, soft and flexible plastic device which "gives" gently when you press it. IUDs contain copper (or the hormone progestin) and are placed in the uterus by your doctor or health care provider during an office visit. The copper IUD begins working from the moment of insertion. It may be used for up to 10 years; however, it can be removed at any time by your physician or health care provider, giving you the flexibility of determining how long you want to use it. It is a highly effective contraceptive and is thought to work by reducing the sperm's ability to swim and by preventing sperm from reaching and/or fertilizing the egg. The modern copper IUD has a high efficacy rate -- over 99% -- and is one of the most effective and convenient forms of birth control available.
- What do I have to do?
IUDs are probably one of the easiest methods of contraception to use because you don't need to think about them every day. Your doctor or health care provider can insert an IUD during a routine office visit, and once it is in place, you only need to check the placement regularly, at least once a month. Schedule regular follow-up visits with your doctor or health care provider, and have your IUD replaced as he or she directs.
- Is an IUD right for me?
Your doctor or health care provider will help you determine if an IUD is an appropriate birth control method for you. Patients satisfaction with IUDs is among the highest of any reversible method. The IUD is a method that does not require daily attention and has a high degree of effectiveness as well as convenience.
Diaphragm
- How does a diaphragm work?
A diaphragm is a soft rubber, latex, or silicone cup that is used with spermicidal jelly or cream and inserted into the vagina to cover the opening at the bottom of the uterus, called the cervix (see footnote). The diaphragm works in two ways: it provides a physical barrier to semen, and it holds the spermicidal jelly or cream, which kills sperm before they can enter the uterus and fertilize an egg. When used properly-which means always using jelly or cream-the diaphragm is highly effective; if your partner uses a condom at the same time, its effectiveness is greatly enhanced.
- What do I have to do?
Spermicide is applied to the diaphragm, which is inserted into the vagina so that it covers the cervix and is held securely in place behind the pubic bone and rear wall of the vagina. If you have intercourse again, you need to add more spermicidal jelly or cream each time. This is inserted with a special applicator while the diaphragm is still in place. The diaphragm should remain in place for 6 hours after intercourse and should be removed as soon as possible thereafter.
Each time you use your diaphragm, you should check it to make sure there are no holes or tears in it. It should be replaced every 2 years or sooner. Also, have your diaphragm size checked by your doctor or health care provider once a year, after you've had a pregnancy, and if you've gained or lost more than 10 pounds.
- Is the diaphragm right for me?
Your doctor or health care provider can tell you if the diaphragm is a suitable birth control method for you. It requires substantial user involvement: applying spermicide, inserting, removing, cleaning, proper storage. Use of a diaphragm may increase risk of urinary tract infections. Toxic shock syndrome has been reported in some women using diaphragms. Consider it if you prefer a birth control method you only have to use when you need it and if you're committed to following the procedures for using it properly. For many women, it's an easy habit to get used to.
Spermicides
- How do spermicides work?
Used as directed, spermicides kill sperm, thus preventing them from reaching and fertilizing an egg. Some, like jellies and creams, are designed for use with a diaphragm or cervical cap. Although effective when used by themselves, their failure rate is higher. Others, such as suppositories (small, waxy pellets containing spermicides) or contraceptive foam (spermicide in a can that looks and feels like shaving cream), may be used without a diaphragm.
You can buy spermicides without a prescription.
- What do I have to do?
Contraceptive creams and jellies, if not used with a diaphragm or cervical cap, can be inserted directly into the vagina with a special applicator. Another birth control method, such as a condom, should be used at the same time.
Contraceptive foam comes in a small can with a plunger-type applicator. To apply, fill the applicator with foam, and insert into the vagina 15 to 30 minutes before intercourse. Suppositories should be inserted with a finger or an applicator 15 to 30 minutes before intercourse.
Spermicides must be reapplied if you have intercourse again.
- Are spermicides right for me?
Spermicides are convenient, portable, and relatively inexpensive to use. Ask your doctor or health care provider to recommend a spermicide type that's best for you. They can be coupled with barrier methods such as a diaphragm or condom for greater effectiveness. However, you must wait at least 15 minutes before intercourse can take place. Spermicides are not as effective as prescription methods.
Cervical Cap
- How does the cervical cap work?
The cervical cap is a smaller version of the diaphragm, made of slightly thicker rubber. It is filled with spermicidal jelly or cream and inserted so that it fits snugly on the cervix (see footnote). This provides both a barrier and a sperm-killing agent, to prevent sperm from entering the uterus and fertilizing an egg. Again, using spermicidal cream or jelly is absolutely necessary.
When used properly, the cervical cap is about as effective as a diaphragm. - What do I have to do?
The cap is filled with spermicidal jelly or cream and inserted so that it covers the cervix. You don't have to reapply spermicidal cream or jelly each time you have intercourse. You should check for proper placement of the cap prior to intercourse. It must be left in place at least 6 hours following intercourse, but not longer than 36 hours.
When you first begin to use your cervical cap, you should have a Pap test taken within a few months. Rarely, abnormal cell growth may occur in the cervix during the first few months of cap use. This condition usually corrects itself, but sometimes requires medical treatment. Each time you use your cervical cap, check it for cracks or tears, and replace it as soon as it shows signs of deterioration. Have your cap rechecked once a year or following a pregnancy. - Is the cervical cap right for me?
Your doctor or health care provider can tell if you are a suitable candidate for the cervical cap. It can be inserted several hours before intercourse, allowing increased spontaneity. However, the cervical cap is difficult to insert and may become dislodged. It must be cleaned and properly stored after each use. Consider it if you prefer a birth control method that has to be used only when you need it.
Condoms ("Rubbers")
- How do condoms work?
A condom is a thin shield fitted directly on a man's penis. It traps the semen expelled from the penis during intercourse, preventing sperm from fertilizing an egg.
There are many types of condoms available; most are made of latex rubber, but some are made from animal tissue like lambskin (also called "natural" condoms). They may be lubricated or ribbed or treated with a spermicide (see footnote). Latex condoms, especially those that are treated with a spermicide, help prevent both partners from giving each other STDs. Condoms can be bought without a prescription.
Although condoms are quite effective, they may tear or slip off during intercourse. - What do I have to do?
A man must put on a condom when his penis is erect, but before intercourse. Afterward, he should withdraw immediately to prevent leakage. It's a good idea to use an additional form of birth control in case of leakage or breakage. Possible choices: spermicide suppositories, jelly, cream, or foam; a diaphragm or cervical cap. - Are condoms right for me?
Virtually any male can wear a condom; it's convenient, inexpensive, easy to obtain, and highly portable. The added protection against STDs makes it a good choice if you have more than one sexual partner. However, condoms can reduce sexual spontaneity and sensation, and may break or leak, posing a heightened risk of pregnancy.
Injection (Depo Provera)
- How do injections work?
Contraceptive injections are given to you by your doctor or health care provider as a hormone "shot" into the muscle of your upper arm. Once administered, a low dose of this hormone, progestin, is released into your system over a period of 3 months. This progestin suppresses ovulation and provides effective contraception for 3 months. - What do I have to do?
Once your doctor gives you an injection, there's nothing you have to do for 3 months. However, scheduling regular visits with your doctor or health care provider for an injection every 3 months is important to make sure you are protected. - Is an injection right for me?
It's up to you and your doctor or health care provider to decide if the injection method is right for you. It may be appropriate if you want long-term contraception without daily or intercourse-related contraceptive use. However, the injection requires an office visit every 3 months, and immediate discontinuation is not possible. Menstrual irregularities, such as spotting and bleeding between periods, are common. There may be other side effects such as weight gain or a delay in return to fertility.
Female Condoms
- How do female condoms work?
The female condom is a lubricated plastic sheath with rings on each end. The ring on one end is open and remains outside the vagina, covering part of the labia. The ring on the other end is closed with the plastic and looks like a diaphragm. It's placed in the vagina so that it covers the cervix, preventing sperm from entering the uterus. The sheath between the two rings forms a pouch to line the entire vaginal area.
Like the use of the male latex condom, use of a female condom can help prevent the transmission of STDs. Female condoms are available without a prescription. - What do I have to do?
The female condom can be inserted up to 8 hours before intercourse. Follow the package directions for correct insertion. It's important that the closed ring section hugs the cervix. Additional spermicide may be used before and after the condom is in place. Since this condom is made from polyurethane rather than latex, oil-based spermicides and lubricants will not damage it.
The female condom should be removed immediately after intercourse, before you stand up. As with any condom, it is a one-use-only item, and should be properly disposed of after use. - Are female condoms right for me?
Like the male condom, the female condom offers protection against STDs as well as contraception. Additionally, the woman controls its use (unlike use of a male condom). However, the female condom is more cumbersome to use, more visible, and less comfortable than a male condom.
Natural Family Planning (The "Rhythm Method")
- How does natural family planning work?
Natural family planning is based on the fact that fertilization is most likely to occur just before, during, or just after ovulation. By carefully monitoring yourself daily, you may be able to determine when you are ovulating-and thus predict when you are most fertile. At those times you can practice birth control just by avoiding intercourse. While more effective than no birth control at all, natural family planning has a high failure rate-because even the most regular cycle may vary month to month. It is the least effective birth control method. - What do I have to do?
To monitor your ovulation, you need to use a calendar daily. You can note your ovulation using two different methods: (1) basal body temperature (BBT) and (2) cervical mucus charting.
The BBT method is based on the fact that just before ovulation, your body temperature drops and then rises steadily for a few days. If you take your temperature daily and plot it on a chart, you will probably be able to see a pattern. This pattern helps you find your most fertile days and abstain from intercourse at those times.
Cervical mucus charting requires that you take a sample of any mucus (discharge) from your vagina daily. Close to or during ovulation, the mucus should become clear, elastic, and slippery. If you chart your cervical mucus findings, you may see a pattern that will allow you to predict your next fertile period. - Is natural family planning right for me?
Natural family planning is best used only by women with very regular, predictable cycles. Ask your doctor or health care provider if you are an appropriate candidate. Consider natural family planning if you choose not to use a birth control device and if you are willing to stick to a time-consuming schedule of daily readings.
Sterilization
Sterilization is an operation to prevent a woman from getting pregnant or a man from fathering a child. The sterilization procedure for women is called tubal sterilization. The procedure for men is called vasectomy. Sterilization is usually safe and free of problems. It is a permanent method of birth control and is a very effective way to prevent pregnancy.
Sterilization is an important decision. Although there is a slight chance that pregnancy can occur after the procedure, it should be thought of as permanent. You and your partner must be certain that you do not want any more children -- now or in the future.
FOOTNOTE: When using a birth control method made of latex, DO NOT use oil-based spermicide and/or lubricants (i.e. petroleum jelly) as they will damage the latex.
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