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Birth Control Methods

What is the best birth control?
The answer to that question depends on your definition of "best." The choice of birth control depends on factors such as a person's health, frequency of sexual activity, number of partners, and desire to have children in the future. No contraceptive method is 100% effective against pregnancy or disease. The only 100% effective guarantee is abstinence (not having intercourse).

Some birth control methods can be somewhat effective, however, in preventing transmission of sexually transmitted diseases (STDs), including HIV. Contraception effectiveness rates for preventing pregnancy and STDs vary greatly depending on the method used.

Check out the following chart:

Data adapted from: R. Hatcher, J. Trussell, F. Stewart, et al., Contraceptive Technology, 17th Revised edition, New York, NY: Irvington Publishers Inc. (in press). Table prepared by FDA: 5/13/97 ^ top

What are barrier methods?
Barrier methods are contraceptives that prevent the passage of bodily fluids from one person to another. Examples of barrier methods include condoms, cervical caps, diaphragms, sponges, and dental dams. Only dental dams and condoms are recommended agents of HIV transmission prevention.

Male Condom: The male condom is a sheath placed over the erect penis before penetration, preventing pregnancy by blocking the passage of sperm. Because they act as a mechanical barrier, condoms prevent direct vaginal contact with semen, infectious genital secretions, and genital lesions and discharges. A condom can only be used once! Most condoms are made from latex rubber, while a small percentage are made from lamb intestines (sometimes called "lambskin" condoms). Condoms can also be made from a type of plastic called polyurethane. For people who are sensitive to latex, polyurethane is a good alternative. The condom has many slang names, including "rubber," "wrapper," and "raincoat." Except for abstinence, latex condoms are the most effective method for reducing the risk of infection from viruses that cause AIDS, other HIV-related illnesses, and other STDs.

Some condoms are prelubricated. These lubricants don't provide more birth control or STD protection. Non-oil-based lubricants, such as water or K-Y jelly, can be used with latex or lambskin condoms, but oil-based lubricants, such as petroleum jelly (Vaseline), lotions, or massage or baby oil, should not be used because they can weaken the material.

Female Condom: The female condom consists of a lubricated polyurethane sheath shaped similarly to the male condom. The closed end, which has a flexible ring, is inserted into the vagina, while the open end remains outside, partially covering the labia. The female condom, like the male condom, is available without a prescription and is intended for one-time use only. It should not be used together with a male condom because they may slip out of place.

Diaphragm: A diaphragm is available only by prescription and must be sized by a health professional to achieve a proper fit. It is a dome-shaped rubber disk with a flexible rim that covers the cervix so sperm can't reach the uterus. Before inserting the diaphragm, you must apply a spermicide cream or jelly as an extra precaution. A diaphragm will protect for six hours after it is inserted. For intercourse after the six-hour period, or for repeated intercourse within this period, fresh spermicide should be place in the vagina with the diaphragm still in place. The diaphragm should be left in place for at least six hours after the last intercourse but not for longer than a total of 24 hours because of the risk of toxic shock syndrome (TSS). The diaphragm can be effective when used properly, but has a higher failure rate than oral contraceptives.

Dental Dam: A dental dam is a square of rubber which is placed over the labia or anus during oral-vaginal or oral-anal sex. It has not shown to be as effective as condoms for reducing STD transmission in heterosexual relationships.

Cervical Cap: The cap is a soft rubber cup with a round rim, sized by a health professional to fit snugly around the cervix. It is available by prescription only and, like the diaphragm, is used with spermicide. It protects for 48 hours and for multiple acts of intercourse within this time. Wearing it for more than 48 hours is not recommended because of the risk, though low, of toxic shock syndrome. Also, with prolonged use of two or more days, the cap may cause an unpleasant vaginal odor or discharge in some women. Women must be aware of the relatively high failure rate before choosing the cervical cap.

Sponge: The sponge, a donut-shaped polyurethane device containing the spermicide nonoxynol-9, is inserted into the vagina to cover the cervix. A woven polyester loop is designed to ease removal. The sponge protects for up to 24 hours and for multiple acts of intercourse within this time. It should be left in place for at least six hours after intercourse but should be removed no more than 30 hours after insertion because of the risk, though low, of toxic shock syndrome. The sponge is not the most effective birth control method and women must be aware of the failure rate before choosing the sponge as their only method of birth control. ^ top

Are there any contraceptive creams or lotions?
Vaginal spermicides are available in foam, cream, jelly, film, suppository, or tablet forms. All types contain a sperm-killing chemical. Studies have not produced definitive data on the efficacy of spermicides alone, but according to the authors of Contraceptive Technology, a leading resource for contraceptive information, the failure rate for typical users may be 21 percent per year.

Package instructions must be carefully followed because some spermicide products require the couple to wait 10 minutes or more after inserting the spermicide before having sex. One dose of spermicide is usually effective for one hour. For repeated intercourse, additional spermicide must be applied. And after intercourse, the spermicide has to remain in place for at least six to eight hours to ensure that all sperm are killed. The woman should not douche or rinse the vagina during this time.

How does the Pill work and why is it so popular?
Oral contraceptives have been on the market for more than 35 years and are the most popular form of reversible birth control in the United States. The "pill" allows greater sexual spontaneity with a high rate of effectiveness, and has played a major role in the sexual freedom of women. This form of birth control suppresses ovulation (the monthly release of an egg from the ovaries) by the combined actions of the hormones estrogen and progestin. Besides preventing pregnancy, the pill offers additional benefits. As stated in the labeling, the pill can make periods more regular. It also has a protective effect against pelvic inflammatory disease, an infection of the fallopian tubes or uterus that is a major cause of infertility in women, and against ovarian and endometrial cancers.

If a woman remembers to take the pill every day as directed, she has an extremely low chance of becoming pregnant in a year. But the pill's effectiveness may be reduced if the woman is taking certain medications, including some antibiotics. Birth control pills are safe for most women-statistically safer even than delivering a baby--but they carry some risks.

Is the Pill safe? What are some of the associated risks?
Newer versions of the Pill have lower doses of hormones which has reduced the risk of side effects. However, outside factors can contribute to an increased risk of cardiovascular disease, high blood pressure, blood clots, and blockage of the arteries. Women who smoke--especially those over 35--and women with certain medical conditions, such as a history of blood clots or breast or endometrial cancer may be advised against taking the pill due to higher risk of dangerous side effects.

More mild side effects of the pill, which often subside after a few months' use, include nausea, headache, breast tenderness, weight gain, irregular bleeding, and depression.

Does the Pill cause cancer?
One of the biggest questions has been whether the pill increases the risk of breast cancer in past and current pill users. An international study published in the September 1996 Journal Contraception concluded that women's risk of breast cancer 10 years after going off birth control pills was no higher than that of women who had never used the pill. During pill use and for the first 10 years after stopping the pill, women's risk of breast cancer was only slightly higher in pill users than non-pill users. ^ top

What is the "morning after" pill?
Doctors sometimes prescribe higher doses of combined oral contraceptives for use as "morning after" pills to be taken within 72 hours of unprotected intercourse to prevent the possibly fertilized egg from reaching the uterus. On June 28, 1996, FDA's Advisory Committee for Reproductive Health Drugs concluded that certain oral contraceptives are safe and effective for this use. The "morning after" pill (also referred to as "emergency contraception") has been officially recognized as safe and effective by the Food and Drug Administration as of February 1997.

This emergency contraception method is different from another "morning after" pill used widely in Europe - known as RU486 or mifepristone. The FDA approved RU486 for use in the in United States in September 2000. Unlike emergency contraception, which acts before implantation of the fertilized egg, RU486 is an antiprogestin, which causes the uterine lining to shed after implantation. For this reason, RU 486 is sometimes referred to as an "abortion pill," although it can only be used up to six weeks after conception. RU 486 must be given by a physician in three separate doses.

I heard of something called the minipill; what is that?
The minipill is another type of oral contraceptive. Although taken daily like combined oral contraceptives, minipills contain only the hormone progestin and no estrogen. They work by reducing and thickening cervical mucus to prevent sperm from reaching the egg. They also keep the uterine lining from thickening, which prevents a fertilized egg from implanting in the uterus. These pills are slightly less effective than combined oral contraceptives.

Minipills can decrease menstrual bleeding and cramps, as well as the risk of endometrial and ovarian cancer and pelvic inflammatory disease. Because they contain no estrogen, minipills don't present the risk of blood clots associated with estrogen in combined pills. They are a good option for women who can't take estrogen because they are breastfeeding, because estrogen-containing products cause them to have severe headaches or high blood pressure, or for other reasons.

Side effects of minipills include menstrual cycle changes, weight gain, and breast tenderness.

What are birth control shots?
The hormone progestin can be delivered to a women's body through an injection. Depo-Provera, approved by FDA in 1992, is injected by a health professional into the buttocks or arm muscle every three months. Depo-Provera prevents pregnancy in three ways: It inhibits ovulation, changes the cervical mucus to help prevent sperm from reaching the egg, and changes the uterine lining to prevent the fertilized egg from implanting in the uterus. The progestin injection is extremely effective in preventing pregnancy, in large part because it requires little effort for the woman to comply: She simply has to get an injection by a doctor once every three months.

The benefits are similar to those of the minipill and another progestin-only contraceptive, Norplant. (See below) Side effects are also similar and can include irregular or missed periods, weight gain, and breast tenderness.

What is Norplant?
Norplant, approved by FDA in 1990, and the newer Norplant 2, approved in 1996, are the third type of progestin-only contraceptive. Made up of small rubber rods, this contraceptive is surgically implanted under the skin of the upper arm, where it steadily releases the contraceptive steroid levonorgestrel.

The six-rod Norplant provides protection for up to five years (or until it is removed), while the two-rod Norplant 2 protects for up to three years. Norplant failures are rare, but are more likely in women with increased body weight.

Some women may experience inflammation or infection at the site of the implant. Other side effects include menstrual cycle changes, weight gain, and breast tenderness. Another important but less obvious change may be loss of bone mass. ^ top

What is the IUD?
An IUD is a T-shaped device inserted into the uterus by a healthcare professional. Two types of IUDs are available in the United States: the Paragard Copper T 380A and the Progestasert Progesterone T. The Paragard IUD can remain in place for 10 years, while the Progestasert IUD must be replaced every year.

It's not entirely clear how IUDs prevent pregnancy. They seem to prevent sperm and eggs from meeting by either immobilizing the sperm on their way to the fallopian tubes or changing the uterine lining so the fertilized egg cannot implant in it.

IUDs have one of the lowest failure rates of any contraceptive method. "In the population for which the IUD is appropriate--for those in a mutually monogamous, stable relationship who aren't at a high risk of infection--the IUD is a very safe and very effective method of contraception," says Lisa Rarick, M.D., director of FDA's division of reproductive and urologic drug products.

What are the possible health risks from IUD?
The Dalkon Shield IUD was taken off the market in 1975. This IUD was associated with a high incidence of pelvic infections and infertility, and some deaths. Today, serious complications from IUDs are rare, although IUD users may be at increased risk of developing pelvic inflammatory disease. Other side effects can include perforation of the uterus, abnormal bleeding, and cramps. Complications occur most often during and immediately after insertion.

Is there any sort of family planning or birth control where you don't have to take pills, apply any products, or receive any implants or injections?
For many reasons, religious and health, some couples use fertility awareness as their main method of contraception. Also known as natural family planning or periodic abstinence, fertility awareness means abstinence (no sexual intercourse) on the days of a woman's menstrual cycle when she could become pregnant, or using a barrier method of birth control on those days.

Because a sperm may live in the female's reproductive tract for up to seven days and the egg remains fertile for about 24 hours, a woman can get pregnant within a substantial window of time--from seven days before ovulation to three days after. Methods to approximate when a woman is fertile are usually based on the menstrual cycle, changes in cervical mucus, or changes in body temperature, or over the counter ovulation detection kits.

How effective is withdrawal as a birth control method?
In this method, also called coitus interruptus, the man withdraws his penis from the vagina before ejaculation. In theory, fertilization is prevented because the sperm don't enter the vagina.

Withdrawal has a high failure rate, in part because even if the man is able to withdraw on time, pre-ejaculatory fluid may contain traces of sperm. This pre-ejaculatory fluid can enter the vagina before full ejaculation and is much harder to anticipate and control. Also, withdrawal doesn't provide protection from STDs, including HIV. Infectious diseases can be transmitted by direct contact with surface lesions and by pre-ejaculatory fluid. ^ top

Is there any permanent birth control?
Surgical sterilization is a contraceptive option intended for people who don't want children in the future. It is considered permanent because reversal requires major surgery that is often unsuccessful; both men and women can be sterilized.

Female sterilization blocks the fallopian tubes so the egg can't travel to the uterus. Sterilization is done by various surgical techniques, usually under general anesthesia. Complications from these operations are rare, but can include infection, hemorrhage, and problems related to the use of general anesthesia.

Male sterilization, called a vasectomy, involves sealing, tying or cutting the tiny tube that carries the sperm from the testicle to the penis, known as the vas deferens.

Vasectomy involves a quick operation, usually less than 30 minutes, with possible minor post-surgical complications, such as bleeding or infection.

If I use any birth control, does that protect me from HIV (the virus that causes AIDS) and from sexually transmitted disease (STDs)?
Some people mistakenly believe that by protecting themselves against pregnancy, they are automatically protecting themselves from HIV, the virus that causes AIDS, and other sexually transmitted diseases (STDs), also called venereal diseases. But the male latex condom is the only contraceptive method considered highly effective in reducing the risk of HIV and STD transmission.

Unlike latex condoms, lambskin condoms are not recommended for STD prevention because they are porous and may permit passage of viruses like HIV, hepatitis B and herpes. Polyurethane condoms are an alternative method of STD protection for those who are latex-sensitive.

There is a female condom, and it may provide some protection against STDs, because it is a barrier method that works in much the same way as the male condom. Both condoms should not be used together, however, because they may not both stay in place.

According to an FDA advisory committee panel that met Nov. 22, 1996, it appears, based on several published scientific studies, that some vaginal spermicides containing nonoxynol-9 may reduce the risk of gonorrhea and chlamydia transmission. However, use of nonoxynol-9 may cause tissue irritation, raising the possibility of an increased susceptibility to some STDs, including HIV.

As stated in their labeling, birth control pills, Norplant, Depo-Provera, IUDs, and lambskin condoms do not protect against STD infection. For STD protection, a male latex condom can be used in combination with non-condom methods. The relationship of the vaginal barrier methods--the diaphragm, cap and sponge--to STD prevention is not yet clear.

Source: National Women's Health Information Center ^ top