The method of birth control you choose as a woman or together as a couple may vary over time, and it is critical for a sexually active woman to remain as well informed of her options as possible. The following table is a compilation of the choices currently available and can serve as a helpful guide to making this important decision.
| Method |
Reliability* |
Protection against HIV/STD's? |
Pros & Cons |
| Intra-uterine Devices (IUD/IUS) |
| (All) |
99% |
No |
Pros:
Longevity
Low side effect profile
High initial cost, but low when averaged out over lifespan of device
Cons:
Recommended principally for women in monogamous relationships
Can be expelled or become disloged
Not recommended for women with fibroids
|
• ParaGard (Copper T) IUD
|
|
|
ParaGard can remain in place for up to 10 yr
Fertility usually resumes immediately upon removal
Can be accompanied by increase in volume and duration of menstrual flow |
| • Mirena IUS |
|
|
Mirena can remain in place for 5 yr
Possible delay in return of fertility once Mirena is removed
Releases levonorgestrel (LNg), a synthetic progestin, just in uterus. Reduces menstrual volume in time but spotting can occur in initial 6–12 months
May cause benign ovarian cysts
Can rarely cause hormonal side effects similar to those seen with oral birth control pills, such as mood swings, breast tenderness, headaches, and acne. |
| Sterilization |
(All)
|
>99% |
No |
Pros/Cons:
Surgical risks
Permanence
Cost-effective over time
These methods can in some (few) cases be reversed, depending on method and individual |
| • Tubal ligation |
|
|
Tubal ligation immediately effective |
| • Vasectomy |
|
|
Vasectomy not immediately effective; it may take months before full sterility is achieved |
| Hormonal Methods |
• Birth control pills (Oral contraceptive pills - BCP's/OCP's)
Options include:
-- 20–35-mcg combined pills
-- Regular or extended-cycle use pills
-- Pills with shortened pill-free interval option
-- Progestin-only ‘mini-pills' |
95–99% |
No |
Pros:
High rate of efficacy
Relatively convenient
Multiple options available
Regulates menstrual cycle
Decreased risk of endometrial and ovarian cancer, endometriosis, PID
Cons:
Undesirable risk and side effect profile in some women
Not affordable for all women
Drug interactions
|
| • Vaginal ring (NuvaRing) |
~99% |
No |
Pros/Cons:
Same as w/BCP's, above
Other advantages:
Privacy
Use allows for more normal vaginal moisture and flora, reducing yeast infections for some women
Protection from pregnancy one month at a time
Other disadvantages:
Contraindicated with certain pelvic conditions, e.g., prolapse, endometriosis, susceptibility to irritation, etc. |
• Transdermal birth control patch (Ortho Evra) |
~99%
(less reliable for women >198 lb) |
No |
Pros/Cons:
Similar to those of BCP's, as above, except exposure to synthetic estrogen is ~60% higher, with resultant higher risk profile for thromboembolic events |
• Depo-Provera injection
|
99.7% |
No |
Pros/Cons:
Same as w/BCP's, above
Other advantages:
Effective 24 hr
following injection
Other disadvantages:
Side effects can be significant and long-lasting, including reduction in bone density, depression, and weight gain |
| • Contraceptive implants |
99% |
|
Pros:
Longevity: Different systems last from 3-5 yr
Fertility returns relatively quickly
Cons:
Can be difficult to remove
Potential for scarring
Side effects can in some cases be significant and long-lasting |
| Barrier Methods |
| • Male condom |
87–98% |
Yes, except for STI's contracted from genital areas not covered* |
Pros:
Convenience and availability
Multiple options
Inexpensive
Allows greater male partner participation
Cons:
Reduced spontaneity
Reduced sensation
Some users experience allergies |
| • Female condom |
79–95% |
Yes; only abstinence provides better protection* |
Pros:
Can be placed up to 8 hr in advance
Good protection against STI’s
Does not require fitting by health care practitioner
Cons:
Only 1 style currently available
More costly than male condoms |
| • Female cervical cap |
Varies: 68–91% |
No |
Pros:
Can be inserted up to 6 hr in advance
Very few side effects
Several designs on market
Cons:
Relatively low efficacy,* especially in women who have given birth
Some types require fitting by health care practitioner; limited to 4 sizes
Not widely available
Some users experience allergies |
| Spermicidal Methods |
| • Today Sponge |
89–91** |
No |
Pros:
Immediate and continuous protection for 24-hr period
One size fits all and easy to insert
Cons:
Cost
Removal can be tricky for some
Some users experience sensitivities /allergies to spermicide |
| • Diaphragm with contraceptive jelly or foam |
80–94% |
Some* |
Pros:
Few side effects
Can be inserted up to 6 hr in advance
Can be used for intercourse during menses to collect flow
Cons:
May reduce spontaneity
Requires fitting/periodic refitting
Some users experience allergies
Some consider method to be “messy” |
| • Vaginal contraceptive film, foam, inserts |
74–94%;
efficacy maximal when used in conjunction with barrier method
|
No |
Pros:
Readily available
Relatively inexpensive
Lubrication
Cons:
No protection from STI’s/HIV infection
Some users experience irritation and/or allergies
“Messiness” factor
Must be inserted within an hour before intercourse |
| Fertility Awareness Methods (FAM): |
Examples:
• Basal Body Temperature (BBT)
• Sympto-thermal
• Billings Ovulation
• "Rhythm"
|
88–98% |
No |
Pros:
Zero health risks or side effects
Enhances body
awareness and partner intimacy
Inexpensive
Cons:
Requires significant partner education, cooperation, and daily attention
Relatively high failure rate
Not ideal in perimenopause years or for women with otherwise irregular cycles |
* Assumes perfect use. Actual effectiveness rates vary significantly. Statistics from Our Bodies, Ourselves (Boston Women’s Health Book Collective, 2005).
** McClure D., & D. Edelman. 1985. Worldwide method effectiveness of the Today vaginal contraceptive sponge. Adv. Contracept. 1: 305–11.
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.