Guide to Birth Control
Author's Note: 

As a labor and delivery nurse I have met women using every single kind of birth control listed below. If it is not obvious from my job title, I meet these women as they are coming in to deliver their babies. The only type of birth control that I have never personally seen in my line of work is abstinence (not having sex at all). I get it that this is not always a feasible method for us healthy, sexual beings so the bottom line is: Be careful out there! Take care of yourselves and be sure to choose your birth control carefully and wisely. Make sure you know how to use it properly – and you USE IT!

The purpose of birth control is to prevent unwanted pregnancy. There are many different methods of birth control depending on your age, health, lifestyle, and preference. As with anything, a health care provider should be consulted before beginning any one of these methods. We really are out there to help you answer any questions and guide you into making the best decision possible for you.

Birth control options include barrier methods, which physically prevent the sperm from meeting the egg, and hormonal methods, which disrupt the woman's natural cycle to prevent her entering a fertile period each month. There are also surgical and behavioral methods, which will be covered in a future article.

Barrier Methods

Condoms are a common barrier method used to prevent pregnancy. The function of the condom is to create a barrier between sperm and the vagina. If the sperm can’t get into the vagina (and therefore the uterus or fallopian tubes) a woman cannot get pregnant. Condoms are a pretty simple method, but not without faults. One of the main reason condoms fail is they are either used improperly or not at all. Condoms are 85% effective based on their typical use, and 99% effective if used every time, and used correctly every time. A lesser seen reason for failure is breakage. Protection against a large number of sexually transmitted diseases (STDs) is an added benefit for condom use. They are also relatively inexpensive.

The male condom is a thin sheath worn over the penis. Most commonly made of latex, polyurethane and animal tissue condoms are also available. To use a condom it is placed on top of the head, or glans, of the erect penis. While pinching the reservoir tip, the condom is rolled over the head and down the shaft to the base of the penis. The penis is fully covered by the condom and worn throughout intercourse. After ejaculation the man, while holding the condom, removes his penis from the vagina and then removes the condom from his penis. The ejaculate remains in the condom and the condom is then disposed. The male condom provides great protection against many STDs.

The female condom is a polyurethane sheath worn inside of the vagina. It has two flexible rings, one at each end of the sheath. The female condom is inserted by squeezing one of the rings and inserting it into the vagina anchoring the ring against the cervix. The second ring remains outside of the vaginal opening and covers the labia and perineum. It can be inserted up to 8 hours before intercourse and is removed immediately after. Like the male condom it keeps the ejaculate in the condom so none is left inside the woman. The female condom is not to be used at the same time as a male condom. The female condom provides protection against some STDs.

The diaphragm is another barrier method of birth control. It is a silicone disc with a flexible ring that is inserted into the vaginal opening and secured around the cervix. Spermicidal cream or jelly is put into the diaphragm before it is inserted for additional protection. The diaphragm acts as a barrier so that the sperm cannot get through the cervix and into the uterus. It can be placed 6 hours before intercourse but spermicide should be re-applied 2 hours before intercourse. The diaphragm stays in place during intercourse and remains inside for at least 6 hours after intercourse. It should not be left in place longer than 24 hours or the risk for Toxic Shock Syndrome increases. The diaphragm must be fitted by a health care professional as women come in different shapes and sizes and fit is key for effectiveness. A woman should be refitted every year, if weight fluctuates or has a baby. The diaphragm itself should be replaced every 2-3 years. The efficacy of the diaphragm depends on the use by the woman. If used perfectly the diaphragm is 91% effective. It does not protect against STDs.

The cervical cap (Lea’s shield, FemCap) is very similar to the diaphragm; it too covers the cervix and prevents sperm from entering. The main visual difference is the size of the cervical cap. It is smaller and fits more snuggly around the cervix. The cervical cap comes in three sizes based on a woman’s obstetrical history, whether or not she has ever been pregnant or delivered a baby. An advantage over the diaphragm is the cervical cap can be left in place for 48 hours without reapplication of spermicidal cream or jelly. It needs to remain in place for at least 8 hours after the last intercourse. Cervical caps are 84-91% effective for women who have never given birth and 68-74% effective for women who have given birth. It does not protect against STDs.

Hormonal Methods

The birth control pill in its simplest explanation is just that, a pill. The main purpose of the pill is to suppress ovulation or preventing the release of an egg from the ovaries. By suppressing ovulation there is no egg present to be fertilized by sperm, therefore no pregnancy can occur. The additional hormones also thicken the cervical mucus and thin the uterine lining. The thickened mucus makes it more difficult for the sperm to get to the egg and the thinned lining makes it more difficult for a fertilized egg to implant in the uterus. The pill is taken every day by the woman. It is based on a 28 day cycle and contains 21 “active” pills and 7 “inactive” pills. The inactive pills contain no medication but encourage the woman to maintain the habit of taking a pill every day. The “active” pills contain a varying concoction of hormones (estrogen, progestin, progesterone) depending on the brand of pill. The pill is 99% effective when used properly. A prescription is required to get the pill. The pill does not protect against STDs.

The “mini” pill contains only progesterone. The mini pill works by thickening the cervical mucus and possibly by also thinning the uterine lining. To maintain the efficacy of the mini pill it is very important to take it at the same time every day and never to skip a pill. This could cause the cervical mucus to thin and put a woman at risk for pregnancy. This pill is often prescribed for breastfeeding mothers because progesterone alone does not have much effect on lactation. A prescription is required to get the mini pill. The mini-pill does not protect against STDs.

The shot (Depo-Provera) is a shot in the upper arm. It is an injectable progestin that, like the pill, suppresses ovulation preventing the presence of an egg for fertilization. The shot is given every three months (four times a year) by a health care provider. It is 99.7% effective when used properly. It does not protect against STDs.

The patch (Ortho-Evra) is a small sticker/patch that contains the hormones estrogen and progestin. It is applied to a woman’s abdomen, buttocks or upper body and changed weekly for three consecutive weeks. This is followed by one week without a patch. The woman’s body continuously absorbs the hormones from the patch into the bloodstream throughout each week that it is applied. The patch has a 99% effective rate when used properly. A prescription is required to get the patch, but it does not have to be administered or changed by a health care provider. The patch does not protect against STDs.

The ring (NuvaRing) is a flexible, circular ring that is inserted into the woman’s vagina. It releases the hormones estrogen and progestin throughout a woman’s cycle that prevent ovulation. It is left in the vagina for three weeks and then removed. It is replaced with a new ring one week later. Like the pill the hormones released by the ring cause the woman not to ovulate, therefore preventing pregnancy to occur. A prescription is required to get the ring, but it does not have to be administered or changed by a health care provider. The ring does not protect against STDs.

The implant (Implanon) is a match-stick sized plastic tube inserted, by a health care provider, into the upper arm. It is effective for three years, then must be replaced. The implant works by continuously releasing progestin which prevents ovulation. It does not protect against STDs.

Emergency Contraception (Plan B) is an option when the original form of birth control has failed or none was used. It is not meant for use as a primary form of birth control but is a phenomenal option if an “oops” or accident occurs. It is an all progestin pill, similar to the mini pill, but in a larger dose. It can be taken within 72 hours of unprotected intercourse but the efficacy diminishes the longer you wait to take it. It is NOT an abortion pill; it will not work if you are already pregnant and does not affect an existing pregnancy. Plan B is available without a prescription at any pharmacy if you are over 17 years old. If you are under 17, you will need a prescription. It can be obtained by a woman or man. It does not protect against STDs.

The IUD can be a barrier or a hormonal method, depending on the type. The IUD or intra-uterine device (ParaGard, Mirena) is a plastic T shaped device inserted into the uterus. It acts to irritate the uterine lining making it difficult for anything to implant. The IUD has changed dramatically from its forefathers of 30 years ago. It has been re-designed and researched to provide a safe, convenient method of birth control. There are two different types of IUDs: one that contains the hormone progestin and one that contains copper. The IUD is placed by a health care provider through the vagina, through the cervix into the uterus. Once the IUD is inserted there are strings that hang down out of the cervix so the woman can confirm that it is in the correct place by doing her own internal exam. The benefit of the IUD is its longevity of 5 years (hormone) or 12 years (copper). It is a great option for birth control for a woman in a steady, monogamous relationship who has already had at least one child. The IUD has a 99% efficacy rate but does not protect against STDs.

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