Birth Control: I Have How Many Options?!
Ah yes, the dreaded question, “But you’re on birth control right?”… Long gone are the days of learning to use condoms with a banana, the awkward birds and the bees talk with your parents, AND of condoms and oral contraceptive pills (OCP’s) being your only birth control options. And sure, it may be taboo to talk about birth control – but someone's got to get the conversation started ;)
There are multiple different birth control options for both male and female. Each method has different pros and cons including: effectiveness rates and price. Effectiveness depends on multiple factors including using the method properly and at the right time. Before we get started, it is important to remember that only condoms protect against STIIs and HIV. OK, let me break it down for you:
What is it?: A latex or non latex sheath that covers the penis and prevents the passage of semen in to the vagina – this then prevents the sperm from reaching and fertilizing the egg.
Pros: No prescription needed/easy to access; offers STI and HIV protection; low cost; no hormonal side effects; immediately effective
Cons: May dull sensation; interrupts intercourse; latex allergies; condom failure such as using the wrong size or breakage; 15% user failure rate
2. Pulling Out:
What is it?: Exactly like it sounds! The male removes his penis, or “pulls out” before ejaculating, which then prevents the sperm from entering the vagina.
Pros: No cost; no interruption; no hormonal side effects; effective immediately
Cons: High user error; high failure rate; messy; if having sex multiple times sperm may still be present and passed along to the ladies
3. Foams, Jellies, Creams, Sponges, Films etc.:
What is it?: These products contain ingredients that disable sperm. They have a high failure rate when used alone and are often suggested to be used with another form of birth control. Note - some of these are also female options!
Pros: Low cost; easy to use; no hormonal side effects; effective immediately; provides extra lubrication
Cons: High failure rate when used alone; messy; may cause skin irritation; can interrupt intercourse
What is it?: OCPs are small pills that are taken daily for 3-4 weeks of your cycle. Most birth control pills are monophasic, meaning they give you a continuous dose of estrogen and progestin throughout your cycle. Mini pills contain only progestin. The estrogen stops your body from ovulating, while the progestin thickens cervical mucous making it difficult for sperm to reach the egg and making the uterine lining inhospitable for egg implantation.
Pros: Reversible; creates regular cycles; decreased menstrual flow, relieves dysmenorrhea (painful periods), acne and PMS; decreased rates of endometrial and ovarian cancers with 10 years of use
Cons: Requires prescription; not immediately effective; requires consistent daily use; many side effects including: spotting, amenorrhea (loss of periods), decreased libido, mood swings, weight gain, headaches, blood clots; increased risk of breast and cervical cancer; cause nutritional deficiencies in B vitamins, vitamin C, folic acid and zinc.
2. Transdermal Patch: What is it?: The patch works similarly to OCPs, except you wear a patch rather than take a pill every day. The effectiveness, pros and cons are the same!
3. Nuva Ring:
What is it?: The nuva ring is a vaginal ring that provides a constant dose of estrogen and progestin to the body. It works similarly to OCPs. The ring stays in place for 3 weeks and is removed during menstruation.
Pros: Reversible; regulates cycles; decreased dysmenorrhea and PMS
Cons: Requires prescription, similar to OCPS; dislodgement of ring; user error of 8%
4. Hormonal IUD:
What is it?: The most common hormonal IUD is mirena. It is a small rod that is implanted into the uterus. It slowly releases progestin to create the cervical mucus and endometrial lining changes. It may also prevent ovulation. It can stay in place for several years
Pros: Long term; immediately effective; decreased dysmenorrhea; decreased menstrual flow; no estrogen; immediately reversible; no need for daily medication or having to insert before sex; local hormonal influence (vs systemic via the pill)
Cons: Requires prescription; bleeding irregularities and amenorrhea; possibility of expulsion; high cost (but one time only); possibility of partner discomfort
5. Copper IUD (non hormonal):
What is it?: Similar to the hormonal IUD, it is a copper wire that is inserted into the uterus. It prevents fertilization by creating changes to the endometrial lining and affects sperm and egg mobility by causing inflammation.
Pros: Long term; immediately effective; no hormonal side effects; immediately reversible; decreased risk for endometrial cancer; no need for daily medication or having to insert before sex; cheaper than hormonal IUD
Cons: Requires prescription; increased menstrual flow; bleeding irregularities and amenorrhea; pain and dysmenorrhea; possibility of expulsion; risk of infertility
What is it?: a progestin releasing rod that is implanted in the skin of the upper arm. Similar to other methods with progestin, it thickens cervical mucus and alters the lining of the uterus.
Pros: Effective immediately; no estrogen; does not induce bone loss; decreased dysmenorrhea and endometriosis symptoms; decreased risk of endometrial cancer; lighter and fewer periods; 1 in 3 women will stop having a regular cycle (pro or con?)
Cons: Requires prescription; amenorrhea; delayed return to optimal fertility; irregular bleeding; change in sex drive; weight gain; acne; headaches
7. Injection (Depo-provera):
What is it?: This injection contains only progestin, which thickens cervical mucous and changes the endometrial lining. Only 4 doses are needed per year.
Pros: Effective immediately; no estrogen; decreased dysmenorrhea, endometriosis symptoms; decreased risk of endometrial cancer
Cons: Requires prescription; amenorrhea; delayed return to optimal fertility (9 months); irregular bleeding, weight gain; bone loss (due to estrogen suppression); not for use in women who have had breast cancer
8. Female Condoms:
What is it?: A latex or polyurethane sheath that is placed into the vaginal up to 8 hours before intercourse. Similar to male condoms, female condoms prevent the sperm from reaching the uterus.
Pros: No prescription needed; HIV and STI protection; no hormonal effects; effective immediately
Cons: May be uncomfortable during intercourse; more expensive than male condoms; messy; user failure rate of 21%
9. Diaphragm, Cervical Cap, Lea Shield:
What is it?: A diaphragm is a latex dome that is positions over the cervix. A cervical cap and the Lea shield are made out of silicone. All three prevent the entry of sperm into the uterus. It is inserted before sex and must remain in place for 6 hours after intercourse.
Pros: Inserted before intercourse/ no interruptions; no hormonal side effects; effective immediately
Cons: Should be used with spermicide; requires prescription; cannot be used with oil based lubricants; requires fitting by health care provider; may become dislodged during intercourse; may cause skin irritation; increase risk of UTIs; user error rate of 16%
Other options include: Family planning method/ Fertility awareness based methods and sterilization (vasectomy or tubal sterilization).
Now that you have all the facts, talk to your health care professional about which options may be right for you. There are lots of great resources out there for more information on birth control options. Check out these sites!
1. Planned Parenthood, retrieved from: https://www.plannedparenthood.org/
2. Lecture given by Dr Lisa Watson, ND: Contraception and Abortion. 2016.