Birth Control Methods

Leading forms of birth control are:

• Birth control pills
• Condoms
• Depo-provera contraception - the birth control shot
• Ortho-Evra patch
• Nuva-Ring
• Emergency contraceptive pills
• Mini-pills (progestin-only pills)
• Natural family planning - fertility awareness
• Cervical cap, IUD, diaphragm, implants, spermicides

Frequently Asked Questions about Birth Control

Is douching after intercourse an effective method of birth control?

No.  Sperm move too quickly.  Before you can douche, sperm are already in the uterus.  Don't rely on other makeshift methods either (such as withdrawal or condom substitutes).

 Can a woman get pregnant the first time she has intercourse?

Yes. She can even get pregnant if she's menstruating or breastfeeding.

Think before you react, know the facts about birth control and sexually transmitted diseases.  The results of your actions may last the rest of your life.

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Birth control pillscontain two hormones, estrogen and progestin. They work by stopping ovulation (release of an egg) and by making the lining of the uterus (womb) thinner. For every 100 women who use birth control pills exactly as instructed each year, only one will become pregnant.

What are the advantages of the pill?

• Decrease the risk of cancer of the ovaries
• Decrease the risk of cancer of the lining of the uterus (endometrial cancer)
• Decrease menstrual blood loss (lighter periods)
• Decrease menstrual cramps and pain
• May improve acne
• Highly effective in preventing pregnancy
• May prevent tubal pregnancies and pelvic inflammatory disease (PID) 
   
  

What are the disadvantages of the pill?

• Do not provide protection against sexually transmitted infections including HIV-AIDS.
• May increase the risk of heart attack, strokes, and blood clots (especially in women who smoke and or are over the age of 40).
• May cause mood changes, nausea, irregular spotting, breast tenderness, and appetite changes (particularly in the first few months on the pill).
• Requires a prescription.
• Possible increase in the frequency or severity of headaches in migraine sufferers.
• Certain medications interfere with the birth control pill's protection against pregnancy (examples include Rifampin for tuberculosis, Dilantin and Tegretol for seizures, and some antibiotics).
• Possible liver tumor (very rare). 

Are birth control pills safe?

Birth control pills are safe for most women. You should not take birth control pills if you have certain medical problems such as liver disease, cancer, a history of a heart attack, blood clots, or stroke. Women who smoke and are over the age of 35 should not take birth control pills. Women of all ages who take birth control pills should not smoke.

How reliable are they?

The pill is 99.5% effective, but can be affected by certain medications.

How do I take birth control pills?

Most women use the Sunday start method. This method decreases the chance of the menstrual period beginning on a weekend. When using this method, the first pill is taken on the first Sunday after the menstrual period begins. Regardless of the day of the week your period starts, the first birth control pill is taken on Sunday. Follow your health care provider’s advice about beginning pills if it differs from the Sunday start method.

Do I have to use condoms, too?

The use of condoms is strongly recommended.

If used consistently, condoms help provide protection against sexually transmitted infections including HIV and HIV-AIDS. Birth control pills do not provide protection against these infections.

Also if you miss a pill, take certain medications, have vomiting or diarrhea, the birth control pill may not be as effective in preventing pregnancy so you will need to use condoms as a "backup" for the rest of the pill package.

Know the signs of serious health problems from using the pill:

If you ever experience any of the following danger signs while taking the birth control pill, contact your health care provider at once or go to the emergency room:

• Abdominal pain (severe)
• Chest pain (severe), shortness of breath
• Headaches (severe), dizziness, weakness, or numbness
• Eye problems (loss or blurring of vision), speech problems
• Severe leg pain in the calf or thigh

What if I decide to have a baby?

See your health care provider for preconception counseling before stopping your birth control pills and begin taking folic acid (400 mcg) per day to help in the prevention of certain birth defects of the spine and brain. Folic acid can be found as a single supplement or in a multivitamin. Women should have a minimum of two or three regular periods after stopping the birth control pill before trying to get pregnant. This may take up to six months. During this time, foam and condoms are a good birth control method to use. It is also very important not to smoke, drink alcohol, or use drugs not prescribed by your health care provider, either prior to or during a pregnancy.

All women of childbearing age should take a multivitamin that contains folic acid regardless of her plans for a pregnancy.

Women should do a monthly self-breast examination and have a yearly examination done by a nurse practitioner or physician that includes a clinical breast examination and Pap Smear. Your health care provider can teach you how to do the self-breast examination. It's a lifesaver.

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Condoms (rubbers) are made out of latex, a thin plastic called polyurethane or animal skin (not recommended). There are condoms for males and females. The male condom looks like a long, thin deflated balloon and the female condom has flexible rings at both ends. The female condom is inserted into the vagina (closed end) and the opened area goes on the outside of the vagina.

What are the advantages of male and female condoms?

• Condoms are safe and effective in preventing pregnancy and the spread of sexually transmitted infections.
• Condoms are the best method of preventing infections if two people are going to have sex.
• No prescription is needed and condoms are readily available.
  Men may "last longer" when they use a condom (which will prolong sex).
• Polyurethane transmits heat and may make sex more fun, and can be used by those with latex allergy.

What are the disadvantages of the condom?

• Condoms are sometimes described as odd looking and may decrease sensation or make noise during sex.
• Some people are allergic to the latex condoms and animal skin condoms are not as effective.
• Female condoms are more expensive and are less readily available than male condoms.
• May take practice to use them correctly (especially the female condom).
• Can slip off or out of place, be torn by fingernails, become damaged from heat, age, and some vaginal medications, creams, and oil-based lubricants.
• May interrupt spontaneous sex by having to stop and put on the condom. Some men have trouble keeping an erection with a condom on. 

How reliable are condoms?

The condom is 90-98 percent effective if used correctly each and every time.  More effective if used with film, gel or foam.

Do I need to use condoms if my partner and I use another form of birth control? How about if I only have sex with one person?

Even if you use another birth control method, you should consider using condoms for infection protection.

• You should always use a condom if you or your partner have ever had a sexually transmitted infection such as gonorrhea, chlamydia, genital warts or HIV, or are HIV positive.
• If you are uncertain, practice safer sex and either use a condom or abstain from sex.
• You should make condoms a routine part of sex if you (or your partner) have more than one partner.

Where can I get condoms?

You do not need a prescription to buy condoms. Condoms are available at drug stores, many grocery stores, and your local health department. Anyone can buy condoms; there is no age limit. Female condoms are more difficult to find than male condoms and are not always available.

Buy condoms that have already been lubricated. DO NOT use Vaseline, massage oils, mineral oil, or other products for lubrication. These products can weaken the condom and cause it to break!
Use a new condom every time you have sex. NEVER use a condom more than once!

Check the expiration date on the condom and do not use an expired (outdated) condom. Heat can ruin a condom. Do not keep condoms in your wallet or glove compartment!

How to use a condom:

Males

• Do not allow the penis to enter or touch the woman's vagina (sex organ) before putting on the condom.
• Make sure to squeeze the air out of the tip of the condom (air bubbles can make it break).
• Roll the condom on the erect (hard) penis. Do not unroll the condom before putting it on.
• Put the condom on before the penis touches the woman's vagina.
• The tip of the condom will hold the semen ("come") at the time of ejaculation ("climax").
• After ejaculation, but before the penis becomes limp, hold onto the condom by the rim at the base of the penis and SLOWLY pull the penis and condom out of the vagina. If this is not done correctly, the condom may slip off inside the woman's vagina and the sperm could spill out.

Remember

• Throw away the condom.
• DO NOT allow the penis to touch the woman's body after removing the condom.
• Squeeze the air out of the tip
• Unroll condom onto the penis
• Hold rim of condom against penis while pulling out
• Remove condom and throw it away

Females (Reality female condom)

• Rub the outside of the pouch together to make sure the lubrication is evenly spread.
• If more lubricant is needed, use about two drops of the lubricant provided with the condom.
• Open the pouch with the OPEN end hanging down. The CLOSED end should be at the top.
• Squeeze the inner ring (closed end) with the thumb and middle finger.
• Insert the inner ring and pouch (closed end) high into the vagina past the pubic bone.
• Make sure the condom is inserted straight and not twisted. Its slippery, so take your time!
• Now the outside ring (open end) lies against the outside of the vagina (outer lips) about 1"
• Guide the penis into the vagina with your hand to avoid having the entire condom go inside your vagina.
• The vagina will expand during intercourse and take up some of the condom's slack.
• After sex, to remove the female condom, squeeze and twist the outer ring GENTLY to keep the sperm inside the pouch, and pull out the remainder of the condom.
• Throw the used condom away. Do not reuse!
• If the condom slips during sex and the open end enters the vagina, STOP immediately and take the condom out and start over with a NEW condom.
• For further information, read the package insert completely before using the Reality Female Condom.

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Depo-Provera Contraception
 

• Do you have trouble remembering to take pills?
• Prefer a more private birth control method? 
• Need reliable birth control and cannot take or do not want birth control pills?

What are birth control shots?

The" shot" is a medicine called Depo-Provera, which contains a hormone very similar to the hormone (progesterone) a woman normally produces during the last two weeks of her menstrual cycle. This hormone is given by injection (a shot) every 11-13 weeks and works by stopping an egg from leaving the ovaries. Pregnancy cannot occur if an egg is not present for the male's sperm to fertilize.

What are the advantages of using Depo-provera for birth control.

• Nothing needs to be taken daily or used at the time of intercourse
• Is very effective in preventing pregnancy (99% or more)
• Privacy is a major advantage (No one can tell you are using this method)
• May help with menstrual cramping and PMS
• May help prevent cancer of the ovaries and uterus
• Can be used by many women who cannot take birth control pills
• Can be used by breastfeeding women (after 6 weeks of nursing)
  

What are the disadvantages of the birth conrol shot?

• Women who use Depo-Provera may lose significant bone mineral density.  Bone loss is greater with increasing duration of use and may not be completely reversible. Therefore, Depo-Provera should be used as a long-term birth control method (longer than 2 years) only if other birth control methods are inadequate.  If you have questions about this information, please discuss  with your healthcare provider.
• Depo-Provera usually causes menstrual periods to be very irregular.
• You may spot or bleed off and on all month or not have any bleeding at all. (This is considered normal.)
• Some women gain weight. To avoid weight gain, watch your calories and exercise.
• You must return every 12 weeks to the clinic to get your injection.
• Depo-Provera DOES NOT protect you against HIV/AIDS or other sexually transmitted infections.
• It may be several months before your periods return to normal after stopping the shot .
• A few women experience acne, headaches, hair growth or loss, or have an allergy to Depo-Provera.

Know the health warning signs

If you experience any of the following symptoms while using the birth control shot, contact your doctor or emergency provider as soon as possible:

• Chest pain or shortness of breath
• Severe headache, blurred vision, or loss of vision
• Heavy bright red bleeding from your vagina (more than 1 pad/tampon every 2 hours)
• Severe pain, pus, or bleeding at the site of the injection
• You think you might be pregnant
• You have a late period after your periods have been on time
• Severe abdominal pain

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Have you ever had sex unexpectedly, had a condom slip off or break, forgotten to take your birth control pills or been caught without having your act together?

If the answer is yes to any one of these questions, you need to know about emergency contraceptive pills (ECPs).

What are ECPs?

Two special doses of birth control pills taken up to five days or 120 hours after unprotected intercourse to prevent pregnancy. The pills either keep an egg from leaving the ovary or change the lining of the uterus (womb) to prevent pregnancy. ECPs prevent pregnancy about 75 percent of the time when taken in the correct dosage at the right time. 

What are the disadvantages and side effects of ECPs?

• Nausea occurs about 50 percent of the time and vomiting about 20 percent of the time. 
• A prescription is required and ECPs cannot be obtained over the counter.
• Since ECPs are not as effective as other contraceptives, they are not recommended as your regular form of birth control and you are strongly encouraged to choose another form of birth control for regular use. 
   

How do you take ECPs?

Your health care provider will prescribe the particular pill that you should use. To prevent nausea and vomiting, you may consult with your health care provider about the possibility of using Dramamine or another anti-nausea medication. If you vomit within two hours after a dose of ECPs, you will need to repeat the dose or they may not be effective in preventing pregnancy.

If you experience any of the following symptoms while using ECPs (side effects are very rare) contact your doctor or emergency provider as soon as possible:

• Severe pain in your calf or thigh
• Severe abdominal pain
• Chest pain or shortness of breath
• Severe headache, dizziness or numbness
• Blurred vision, loss of vision, or trouble speaking
• Yellowing of the skin

You should get your next menstrual period within 21 days after taking ECPs, however, if you do not get your period, contact your health care provider for a pregnancy test.

To avoid another emergency contraceptive visit, make an appointment with the family planning clinic for a reliable method of birth control.
Remember, ECPs do not protect you against sexually transmitted infections including HIV/AIDS 

Emergency Contraception:  A Cost-Effective Approach to Preventing Unintended Pregnancy by James Trussell, PhD.

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What are mini-pills?

"Mini-pills" contain a single hormone (Progestin) and usually work by stopping an egg from leaving the ovaries and/or making the lining of the uterus (womb) thinner. This keeps you from getting pregnant. The mini-pill does not contain the hormone estrogen. Among typical users of the mini-pill, about 5 out of 100 women will experience an accidental pregnancy in the first year. This means the mini-pill is about 95% effective in preventing pregnancy if taken exactly as directed.

What are the advantages of the mini-pill?

• Safe for use while breastfeeding (after the baby is 6 weeks old).
• Provides protection against cancer of the ovaries and uterine lining.
• Less cramping with periods.
• Less bleeding with periods or have no periods.
• Less chance of having anemia (low blood) because of less bleeding.
• Provides protection against pelvic inflammatory disease (PID).
• May decrease PMS (premenstrual syndrome) symptoms.
• Can be taken by women who have side effects or complications on birth control pills containing estrogen.
  

What are the disadvantages of the mini-pill?

• Menstrual irregularity including skipping periods is common with mini-pill use.
• If a woman continues to have regular periods while taking the mini-pill she should use condoms as a backup method to prevent an accidental pregnancy.
• Pills must be taken every day and at the same time.
  Some women experience depression, appetite changes, or weight gain on Progestin-only methods.
• Protection from pregnancy may be lowered when the pill is taken with certain drugs.
• Do not provide any protection against AIDS or other sexually transmitted infections. (Condoms are highly suggested to help reduce the risk of infections).
• Mini-pills require a prescription, may not be as readily available as combination birth control pills, and usually are more expensive. 

How do you take mini-pills?

• Take your birth control pill at the same time every day.
• Check the pill package every morning to make sure you took your pill the day before.
• Take your birth control pill every day. You do not have any days that you do not take your pill.
• As soon as you finish one package, start a new one.

You must use condoms as backup protection for the first 7 days when you start mini-pills. 

What to I do if I miss a mini-pill or take it later in the day?

• If you miss one pill but remember within 12 hours, take the missed pill at once.
• Take your next pill at the usual time even if it means taking two pills in one day.
• If you are more than three hours late taking a mini-pill, use your back-up method for at least 48 hours (2 days).
• If you miss two or more mini-pills in a row, there is a good chance you could become pregnant.
• Use your back up method until you start your period and take 2 mini-pills for two days, then resume taking one mini-pill a day.
• If your menstrual period does not begin within four to six weeks, call the clinic for a pregnancy test.

Mini-pills are safe for most women. You should not take mini-pills if you have certain medical problems such as liver disease, have unexplained vaginal bleeding, or have difficulty taking a pill at the same time everyday.

Women should not smoke and take mini-pills. Your health care provider can discuss with you whether the mini-pill is safe for you after doing a medical history and physical examination.

Know the health warning signs

If you ever experience any of the following danger signs while taking the mini-pill, contact your health care provider at once or go to the emergency room.

• Abdominal pain (severe)
• Chest pain (severe)
• Headaches (severe), dizziness, weakness, or numbness
• Eye Problems (loss or blurring vision), speech problems
• Severe leg pain in the calf or thigh

What if I decide to have a baby?

If you decide to have a baby, see your health care provider before discontinuing the mini-pill and begin taking 400 mcg of folic acid daily to help prevent birth defects of the spine and brain. Folic acid can be found as a single supplement or in multivitamins. A woman should have two or three regular menstrual periods off of the mini-pill before trying to get pregnant. It is recommended that you use foam and condoms for contraception during this time. Remember, do not smoke, drink alcohol, or use drugs not prescribed by your health care provider, either prior to or during a pregnancy.

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Fertility Awareness
 
Fertility awareness is a method of identifying when you are fertile by being aware of changes in your body. You are actually fertile only a few days in your monthly cycle. There are 3 primary signs that occur when you are fertile (ability to become pregnant). They include temperature changes, cervical fluid changes, and a change in the position of your cervix. The fertility awareness method permits you to use this information so that you can abstain from intercourse when you are most fertile (or if planning a pregnancy, helps you time intercourse with your fertile days).

What are the changes that take place during my fertile days?

• Waking temperatures rise above your normal baseline on the days following ovulation
• Cervical fluid is dry after menstruation then becomes wet, looks like raw egg white at ovulation and dries up quickly afterwards
• The cervix rises, becomes softer and open before ovulation and then drops and becomes firm 

What are the advantages of this method?

• Helps you learn about your body
• Helps you know when to have sex during your cycle to become pregnant, if that is your goal
• Useful in conjunction with other contraceptive methods such as condoms, foam or diaphragms

What are the disadvantages of using this method?

• Requires discipline and daily charting of fertility signs, which is time consuming
• Abstinence is required at the time in your cycle when your sexual urge is usually at its peak
• Only successful if you have regular menstrual cycles and a cooperative partner
• Fertility Awareness has a high failure rate unless combined with another birth control method
• This method does not protect you from HIV/AIDS or other sexually transmitted infections

Where Can I Learn More About Fertility Awareness?

Ask your health care provider for more information or for a referral to a clinician with specialized training and experience with this method.

The following reading material is very helpful in understanding this method:

Taking Charge of Your Fertility: The Definite Guide to Natural Birth Control and Pregnancy Achievement, by Toni Weschler

Fertility Awareness Handbook, by Barbara Kass-Anese (check with your local library).

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A cervical cap is a small rubber cup that fits snugly over the cervix. Similar to the diaphragm, the cap must always be used with a spermicide.

Advantages: The cap can be left in place up to 48 hours.

Disadvantages: The cap may be difficult to insert and users must be monitored by a health care provider for possible cervical changes.

Reliability: 90-95 percent effective. Weight gain or loss can affect fit and effectiveness.

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The IUD (Intrauterine Device)

An IUD is inserted into the uterus by a health care provider and prevents pregnancy by affecting the sperm, egg or uterine lining.

Advantages: It can be left in place up to 10 years, depending on the type of IUD used.

Disadvantages: Using an IUD increases the risk of pelvic infection, especially if either partner has multiple partners. It may also cause cramps and bleeding for a few days after insertion.

Reliability: 96-98 percent effective.

Diaphragm
 
A rubber cup covers the cervix, blocking the opening of the uterus.   Spermicide is used inside the cup. Together, they prevent the sperm from reaching the egg.

Advantages:  A diaphragm can last several years.

Disadvantages: It must be left in place for six hours after sex. Using one may increase the risk of bladder infections.

Reliability: 96-98 percent effective.

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Spermicides

Spermicides are chemicals that kill sperm. They may come as a foam, cream or jelly and should be used with a condom, diaphragm or cervical cap.

Advantages: Spermicides are inexpensive and available in drugstores.

Disadvantages: They must be applied just before intercourse and left in place for 6-8 hours. They can be messy.

Reliability:

Foam: 71 percent effective if foam is used alone (not good); 98 percent effective if used with a condom (very good).

Gel: 98 percent effective in the first 30 minutes; effectiveness drops to 86 percent after 2 hours.

Film: 97 percent alone; 99 percent effective when used with a condom.

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The Ortho-Evra Patch is a 4.5-cm square patch that is worn for a one week duration for three consecutive weeks.  It is usually worn on the lower abdomen or buttocks (but it may be also be applied to the upper outer arm or to the upper torso, except on breasts).  The fourth week is patch-free and menses (your period) will occur that week. 

The patch contains the two hormones estrogen and progestin.  It prevents pregnancy by suppressing ovulation, thickens cervical mucus, and thins the lining of the uterus.  It is 99% effective with correct usage.

Advantages of the Patch

• You do not have to take anything on a daily basis
• Remains an option throughout a woman's reproductive years
• Like combined oral contraceptives, the patch may regulate periods and decrease menstrual discomfort
• The return to fertility is likely excellent as with combined oral contraceptives

Disadvantages of the Patch

• May experience breakthrough bleeding or spotting 
• Does not provide protection against HIV/AIDS or sexually transmitted diseases (STDs). Condoms are highly suggested to help reduce the risk of infections
• Must remove and replace weekly
• Some women may experience nausea, headaches or breast tenderness
• Women who weigh more than 198 pounds should know that the patch may be less effective and they should consider using a backup contraceptive method.

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The Nuva-Ring is a flexible ring two inches in diameter and 1/8 inch thick.  It contains the two hormones estrogen and progestin. It is inserted into the vagina for 3 weeks and then removed to allow for the menstrual period. A new ring is then inserted during intercourse.

The Nuva-Ring works by suppressing ovulation. It is 99.7% effective with perfect use.

Advantages of the Nuva-Ring

• Low chance of irregular bleeding
• Ring stays in place for 21 days so you do not have to remember to take birth control everyday
• Easy to use - only need to remember to insert and remove ring
• No special accuracy is required for ring placement (medicine is absorbed anywhere in the vagina)
• A woman and her partner are not likely to feel the ring
• Unlike pills, the ring maintains a steady release of hormones

Disadvantages of the Nuva-Ring:

• May experience bleeding beyond the ring-free week
• Slight chance (2-5 percent) of device-related problems
• Slight chance (2 percent) of ring expulsion
• Side effects may include: headache, nausea, weight gain, breast tenderness, painful periods, depression
• Does not protect woman from getting HIV/AIDS or STDs. Condoms are highly suggested to help reduce the risk of infections. 
• Woman with history of genital prolapse, severe constipation, or frequent vaginal infections may require closer follow-up.