Not all contraceptive methods are appropriate for all situations, and the most appropriate method of birth control depends on a woman's overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases. Individuals should consult their health care providers to determine which method of birth control is best for them. Some types carry serious risks, although those risks are elevated with pregnancy and may be higher than the risks associated with the various methods.
The different methods of contraception include:1,2
Designed to prevent sperm from entering the uterus, barrier methods are removable and may be an option for women who cannot use hormonal methods of contraception. Types of barrier methods include:
- Male condoms. This condom is a thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Male condoms are generally made of latex or polyurethane, but a natural alternative is lambskin (made from the intestinal membrane of lambs). Latex or polyurethane condoms reduce the risk of spreading sexually transmitted diseases (STDs). Lambskin condoms do not prevent STDs. Male condoms are disposable after a single use.
- Female condoms. These are thin, flexible plastic pouches. A portion of the condom is inserted into a woman's vagina before intercourse to prevent sperm from entering the uterus. The female condom also reduces the risk of STDs. Female condoms are disposed of after a single use.
- Diaphragms. Each diaphragm is a shallow, flexible cup made of latex or soft rubber that is inserted into the vagina before intercourse, blocking sperm from entering the uterus. Spermicidal cream or jelly should be used with a diaphragm. The diaphragm should remain in place for 6 to 8 hours after intercourse to prevent pregnancy, but it should be removed within 24 hours. Traditional latex diaphragms must be the correct size to work properly, and a health care provider can determine the proper fit.
A diaphragm should be replaced after 1 or 2 years. Women also need to be measured again for a diaphragm after giving birth, having pelvic surgery, or gaining or losing more than 15 pounds.3 Newer diaphragms, such as the Silcs diaphragm, are designed to fit most women and do not require fitting by a health care provider. The Silcs diaphragm is currently in clinical trials for approval by the U.S. Food and Drug Administration (FDA) and other regulatory agencies.
- Cervical caps. These are similar to diaphragms, but smaller, more rigid, and less noticeable. The cervical cap is a thin silicone cup that is inserted into the vagina before intercourse to block sperm from entering the uterus. As with a diaphragm, the cervical cap should be used with spermicidal cream or jelly. The cap must remain in place for 6 to 8 hours after intercourse to prevent pregnancy, but it should be removed within 48 hours. Cervical caps come in different sizes, and a health care provider determines the proper fit.4 With proper care, a cervical cap can be used for 2 years before replacement.2 Currently, FemCap is the only cervical cap approved by the FDA.
- Contraceptive sponges. These are soft, disposable, spermicide-filled foam sponges. One is inserted into the vagina before intercourse.5 The sponge blocks sperm from entering the uterus, and the spermicide also kills the sperm cells. The sponge should be left in place for at least 6 hours after intercourse and then removed within 30 hours after intercourse. Currently, the Today® Vaginal Contraceptive Sponge is the only sponge approved by the FDA.
- Spermicides. A spermicide destroys sperm. A spermicide can be used alone or in combination with a diaphragm or cervical cap. The most common spermicidal agent is a chemical called nonoxynol-9 (N-9). It is available in several concentrations and forms, including foam, jelly, cream, suppository, and film. A spermicide should be inserted into the vagina close to the uterus no more than 30 minutes prior to intercourse and left in place 6 to 8 hours after intercourse to prevent pregnancy. Spermicides do not prevent the transmission of STDs and may cause allergic reactions or vaginitis (pronounced vaj-uh-NAHY-tis).6
Hormonal methods of birth control use hormones to regulate or stop ovulation and prevent pregnancy. Ovulation is the biological process in which the ovary releases an egg, making it available for fertilization. Hormones can be introduced into the body through various methods, including pills, injections, skin patches, transdermal gels, vaginal rings, intrauterine systems, and implantable rods. Depending on the types of hormones that are used, these pills can prevent ovulation; thicken cervical mucus, which helps block sperm from reaching the egg; or thin the lining of the uterus. Health care providers prescribe, monitor, and administer hormonal contraceptives.
- Combined oral contraceptives ("the pill"). Combined oral contraceptive pills (COCs) contain different combinations of the synthetic estrogens (pronounced ES-truh-juhns) and progestins (proh-JES-tins) and are given to interfere with ovulation. A woman takes one pill daily, preferably at the same time each day. Many types of oral contraceptives are available, and a health care provider helps to determine which type best meets a woman's needs. Use of COC pills is not recommended for women who smoke tobacco and are more than 35 years old or for any woman who has high blood pressure, a history of blood clots, or a history of breast, liver, or endometrial cancer.
- Progestin-only pills (POPs). A woman takes one pill daily, preferably at the same time each day. Progestin-only pills may interfere with ovulation or with sperm function. POPs thicken cervical mucus, making it difficult for sperm to swim into the uterus or to enter the fallopian tube. POPs alter the normal cyclical changes in the uterine lining and may result in unscheduled or breakthrough bleeding. These hormones do not appear to be associated with an increased risk of blood clots.
- Contraceptive patch. This is a thin, plastic patch that sticks to the skin and releases hormones through the skin into the bloodstream. The patch is placed on the lower abdomen, buttocks, outer arm, or upper body. A new patch is applied once a week for 3 weeks, and no patch is used on the fourth week to enable menstruation.4 Currently, Ortho Evra® is the only patch that is FDA approved.
- Injectable birth control. This method involves injection of a progestin, Depo-Provera® (DMPA—depo medroxyprogesterone acetate), given in the arm or buttocks once every 3 months.7 This method of birth control can cause a temporary loss of bone density, particularly in adolescents. However, this bone loss is generally regained after discontinuing use of DMPA. Most patients using injectable birth control should eat a diet rich in calcium and vitamin D or take vitamin supplements while using this medication.
- Vaginal rings. The ring is thin, flexible, and approximately 2 inches in diameter. It delivers a combination of a synthetic estrogen (ethinyl estradiol) and a progestin. The ring is inserted into the vagina, where it continually releases hormones for 3 weeks. The woman removes it for the fourth week and reinserts a new ring 7 days later. Risks for this method of contraception are similar to those for the combined oral contraceptive pills, and a vaginal ring is not recommended for any woman with a history of blot clots, stroke, or heart attack, or with certain types of cancer.4 Currently, the NuvaRing® is the only FDA-approved vaginal ring. A new contraceptive vaginal ring that can be used for 13 cycles is under clinical development.
- Implantable rods. Each rod is matchstick-sized, flexible, and plastic. A physician surgically inserts the rod under the skin of the woman's upper arm. The rods release a progestin and can remain implanted for up to 5 years.4 Currently, Implanon®, which releases etonorgestrel, is the only implantable rod available in the United States. A two-rod method, Jadelle®, which releases levonorgestrel, is FDA approved but not currently distributed in America. A new levonorgestrel-releasing, two-rod method, Sino Implant, is in clinical development.
- Emergency Contraceptive Pills (ECPs). ECPs are hormonal pills, taken either as a single dose or two doses 12 hours apart, that are intended for use in the event of unprotected intercourse. If taken prior to ovulation, the pills can delay or inhibit ovulation for at least 5 days to allow the sperm to become inactive. They also cause thickening of cervical mucus and may interfere with sperm function. ECPs should be taken as soon as possible after semen exposure and should not be used as a regular contraceptive method. Pregnancy can occur if the pills are taken after ovulation or if there is subsequent semen exposure in the same cycle.
An IUD is a small, T-shaped device that is inserted into the uterus to prevent pregnancy. A health care provider inserts the device. An IUD can remain and function effectively for many years at a time. After the recommended length of time, or when the woman no longer needs or desires contraception, a health care provider removes or replaces the device.
- A copper IUD releases a small amount of copper into the uterus, causing an inflammatory reaction that generally prevents sperm from reaching and fertilizing the egg.4 If fertilization of the egg does occur, the physical presence of the device prevents the fertilized egg from implanting into the lining of the uterus. Copper IUDs may remain in the body for 12 years. A copper IUD is not recommended for women who may be pregnant, have pelvic infections, or had uterine perforations during previous IUD insertions. It also is not recommended for women who have cervical cancer or cancer of the uterus, unexplained vaginal bleeding, or pelvic tuberculosis. Currently, ParaGard® is the only FDA-approved copper IUD.
- A hormonal IUD releases a progestin hormone into the uterus.4 The released hormone causes thickening of the cervical mucus, inhibits sperm from reaching or fertilizing the egg, thins the uterine lining, and also may prevent the ovaries from releasing eggs. Hormonal IUDs can be used for up to 5 years. Currently, Mirena®, a levonorgestrel-releasing IUD, is the only FDA approved hormonal IUD that is available.
Sterilization is a permanent form of birth control that either prevents a woman from getting pregnant or prevents a man from releasing sperm. A health care provider must perform the sterilization procedure, which usually involves surgery. These procedures usually are not reversible.
- A sterilization implant is a nonsurgical method for permanently blocking the fallopian (pronounced fuh-LOH-pee-uhn) tubes.8 A health care provider threads a thin tube through the vagina and into the uterus to place a soft, flexible insert into each fallopian tube. No incisions are necessary. During the next 3 months, scar tissue forms around the inserts and blocks the fallopian tubes so that sperm cannot reach an egg. After 3 months, a health care provider conducts tests to ensure that scar tissue has fully blocked the fallopian tubes. A backup method of contraception is used until the tests show that the tubes are fully blocked.
- Tubal ligation (pronounced TOO-buhl lahy-GEY-shuhn) is a surgical procedure in which a doctor cuts, ties, or seals the fallopian tubes. This procedure blocks the path between the ovaries and the uterus. The sperm cannot reach the egg to fertilize it, and the egg cannot reach the uterus.9
- Vasectomy (va-SEK-tuh-mee) is a surgical procedure that cuts, closes, or blocks the vas deferens (pronounced vas DEF-uh-renz). This procedure blocks the path between the testes and the urethra (yoo-REE-thruh).10 The sperm cannot leave the testes and cannot reach the egg. It can take as long as 3 months for the procedure to be fully effective. A backup method of contraception is used until tests confirm that there is no sperm in the semen.
- Department of Health and Human Services, Office on Women's Health. (2011). Birth control methods fact sheet. Retrieved June 4, 2012, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.cfm# [top]
- Planned Parenthood Federation of America, Inc. (2012). Birth control. Retrieved June 4, 2012, from http://www.plannedparenthood.org/health-topics/birth-control-4211.htm [top]
- Allen, R.E. (2004). Diaphragm fitting. American Family Physician, 69, 97–100.
- Food and Drug Administration, Office of Women's Health. (2011). Birth control guide. Retrieved June 23, 2012, from http://www.fda.gov/downloads/ForConsumers/ByAudience/ForWomen/FreePublications/UCM282014.p [top]
- Mayer Laboratories, Inc. (2012). Product details. Retrieved June 4, 2012, from http://www.todaysponge.com/about.html [top]
- American College of Obstetricians and Gynecologists. (2011). Barrier methods of contraception. Retrieved June 4, 2012, from https://www.acog.org/~/media/For%20Patients/faq022.pdf?dmc=1&ts=20120604T212254575 (PDF - 294 KB) [top]
- National Center for Biotechnology Information. (2010). Medroxyprogesterone injection. Retrieved June 6, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000283 [top]
- Conceptus. (2012). What is essure? Retrieved June 8, 2012, from http://www.essure.com/what-is-essure/overview [top]
- National Library of Medicine, MedlinePlus. (2012). Tubal ligation. Retrieved June 7, 2012, from http://www.nlm.nih.gov/medlineplus/tuballigation.html [top]
- National Library of Medicine, MedlinePlus. (2012). Vasectomy. Retrieved June 7, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/002995.htm [top]