Birth Control

Birth Control

Topic Overview

Is this topic for you?

Sometimes a woman may not
use birth control, or her method may fail. If this happens to you, you may
still be able to prevent pregnancy if you act quickly. For more information,
see the topic
Emergency Contraception.

What is birth control?

Birth control is any method
used to prevent pregnancy. Another word for birth control is contraception (say
“kon-truh-SEP-shun”).

If you have sex without birth control, there
is a chance that you could get pregnant. This is true even if you have not
started having
periods yet or you are getting close to
menopause.

The only sure way to prevent pregnancy is to not have sex. But
finding a good method of birth control you can use every time can help you
avoid an unplanned pregnancy.

What are the types of birth control?

There are
many different kinds of birth control. Each has pros and cons. Learning about
all the methods will help you find one that is right for you.

  • Long-acting reversible contraception (LARC) includes implants and intrauterine devices (IUDs). “Long-acting” means that they will prevent pregnancy for years. “Reversible” means that you can have them removed if you want to get pregnant later. Some LARC options use hormones.
    • Implants are inserted under the skin of the arm.
    • IUDs are placed in the uterus by a doctor. There are two main types of IUDs—the copper IUD and the hormonal IUD.
  • Hormonal methods include birth control
    pills, shots, the skin patch,
    and the vaginal ring. Birth control that uses
    hormones is very good at preventing pregnancy. Implants and hormonal IUDs also use hormones to prevent pregnancy.
  • Barrier methods include condoms,
    diaphragms, and sponges. In general, these do not prevent pregnancy as well as
    IUDs or hormonal methods do. Barrier methods must be used every time you have
    sex.
  • Natural family planning (also called fertility
    awareness) can work if you and your partner are very careful. You will need to
    keep good records so you know when you are fertile. And during times when you
    are fertile, you will need to skip sex or use a barrier method.
  • Permanent birth control (sterilization) gives you lasting
    protection against pregnancy. A man can have a
    vasectomy, or a woman can have her tubes tied (tubal ligation). But this is only a good choice if you
    are sure that you don’t want any (or any more) children.
  • Emergency contraception is a backup method to prevent
    pregnancy if you forget to use birth control or a condom breaks.

For hormonal or barrier methods to work best, you have
to use them exactly the way your doctor or the package instructions say. Even
then, accidents can happen. So it is a good idea to keep emergency birth
control on hand as backup protection.

How do you choose the best method?

The best method
of birth control is one that protects you every time you have sex. And with
many types of birth control, that depends on how well you use it. To find a
method that will work for you every time, some things to think about
include:

  • How well it works. Think about how
    important it is to you to avoid pregnancy. Then look at how well each method
    works. For example, if you plan to have a child soon anyway, you may not need a
    very reliable method. If you don’t want children but feel it is wrong to end a
    pregnancy, choose a type of birth control that works very
    well.
  • How much effort it takes. For
    example, birth control pills may not be a good choice if you often forget to
    take medicine. If you are not sure you will stop and use a barrier method each
    time you have sex, pick another method.
  • When you want to have children. For example, if you want to have children in the
    next year or two, birth control shots may not be a good choice. They can make it hard
    to get pregnant for several months after you stop them. If you never want to
    have children, natural family planning is not a good choice because it often
    fails.
  • How much the method costs. For
    example, condoms are cheap or free in some clinics. Some insurance companies
    cover the cost of prescription birth control. But cost can sometimes be
    misleading. An IUD costs a lot up front. But it works for years, making it
    low-cost over time.
  • Whether it protects you from infection. Latex condoms can help protect you from
    sexually transmitted infections (STIs), such as
    HIV. But they are not the best way to prevent
    pregnancy. To avoid both STIs and pregnancy, use condoms along with another
    type of birth control.
  • If you’ve had a problem with one kind of birth control. Finding the best method of birth control may involve trying
    something different. Also, you may need to change a method that once worked
    well for you.

If you are using a method now that you are not happy
with, talk to your doctor about other choices.

What health issues might limit your choices?

Some
birth control methods may not be safe for you, depending on your health. To
make sure a method is right for you, your doctor will need to know if
you:

  • Smoke.
  • Are or could be pregnant.
  • Are breastfeeding.
  • Have any serious health problems, such as
    heart disease,
    high blood pressure,
    migraine headaches, or
    diabetes.
  • Have had blood clots in the
    legs (deep vein thrombosis) or lungs (pulmonary embolism), or have a close family member who
    had blood clots in the legs or lungs.
  • Have ever had breast cancer.
  • Have a sexually transmitted infection.

How can you get birth control?

You can buy:

  • Condoms, sponges, and spermicides without a prescription at
    drugstores.
  • Emergency contraception without a prescription at most drugstores.

You need to see a doctor or other health professional
to:

  • Get a prescription for birth control pills
    and other methods that use hormones.
  • Have an IUD
    inserted.
  • Be fitted for a diaphragm or cervical cap.

Frequently Asked Questions

Learning about birth control:

For teens only:

Using birth control:

What should I know about:

Advantages and disadvantages:

How-to questions:

Ongoing concerns:

Birth Control Methods

There are many methods of
birth control. Learn about the different kinds of
birth control to help you choose the best one for you. When making your choice,
also consider that only a condom will help protect you from
sexually transmitted infections (STIs). To protect
yourself and your partner against STIs, use a condom (along with your chosen
birth control method) every time you have sex.

Long-acting reversible contraception (LARC)

Long-acting reversible contraception (LARC) is the best reversible method for preventing pregnancy. “Long-acting” means that they will prevent pregnancy for years. “Reversible” means that you can have them removed if you want to get pregnant later. LARC includes implants and intrauterine devices (IUDs).

  • The hormonal implant (such as Nexplanon) releases
    progestin to prevent pregnancy for about 3 years. It must be inserted and
    removed by a trained health professional. The actual implant is about the size
    of a matchstick and is inserted under the skin on the inside of the upper
    arm.
  • An
    intrauterine device (IUD) is a small device that is
    placed in the uterus to prevent pregnancy. There are two main types of IUDs:
    copper IUDs (such as ParaGard) and hormonal IUDs (such as Mirena or Skyla). Hormonal IUDs release a type of progestin. When an IUD
    is in place, it can provide birth control for 3 to 10 years, depending on the
    type.

The hormonal IUD typically reduces menstrual flow and cramping
over time. On the other hand, the copper IUD can cause longer and heavier
periods. But the hormonal IUD can have other side effects, including
spotting, mood swings, and breast tenderness. These side effects occur less
frequently than with other progestin-only methods.

Hormonal methods

Hormonal methods are very
reliable means of birth control. Hormonal methods use two basic
formulas:

  • Combination hormonal methods contain
    both
    estrogen and
    progestin (synthetic
    progesterone). Combination methods include
    pills (“the Pill”), the skin patch, and the ring.
  • Progestin-only hormonal methods include pills, also
    called “mini-pills” and a shot (such as Depo-Provera). If you
    can’t take estrogen, a progestin-only method may be an option for you. Implants and hormonal IUDs also release progestin.

Combination and progestin-only methods are prescribed for
women for different reasons. Each
type of method has its pros and cons.

  • Combination pills may reduce acne, pain
    during ovulation, and premenstrual symptoms. Both types of pill reduce heavy
    bleeding and cramping. Unlike the combination pill, the progestin-only pill can
    be taken by almost all women, including those who are breastfeeding. Depending on when you start taking either type of birth control pill, you may
    need to use a backup birth control method for the first week.
  • Patches or vaginal rings are similar to combination
    pills, but they don’t require taking a daily pill. The patch is changed weekly,
    and the ring is changed monthly (with 1 week off after 3 weeks of
    use).
  • Some birth control pills reduce severe mood and physical
    symptoms that some women get before they start their monthly periods. These
    symptoms are called
    premenstrual dysphoric disorder (PMDD). There are also birth
    control pills for women who want fewer periods or who want to stop having
    periods.
  • The birth control shot does not require
    taking a daily pill. Instead, you see your health professional once every 3
    months for the injection.

Barrier methods

Barrier methods
(including the diaphragm; cervical cap; male condom; female
condom; and spermicidal foam, sponge, gel, suppository, or film) prevent sperm
from entering the uterus and reaching the egg. Typically,
barrier methods are not highly effective, but they generally have fewer side
effects than hormonal methods or IUDs. Spermicides and condoms should be used
together or along with another method to increase their effectiveness. Barrier
methods can interrupt sex, because they must be used every time you have
sex.

Condoms (male or female) should always be used if you are
at risk of getting or spreading a
sexually transmitted infection, such as
genital herpes,
chlamydia, or
HIV.

Fertility awareness (periodic abstinence or natural family planning)

Fertility awareness requires that a
couple chart the time during a woman’s
menstrual cycle when she is most likely to become pregnant and avoid intercourse
or use a barrier method during that time. Fertility awareness is not a good
choice if you need a highly effective form of birth control.

Breastfeeding may work as a form of birth control in the first 6 months after
giving birth if you follow specific guidelines. For this method to work, you
must breastfeed your baby every time. You can’t use formula or other
supplements. This is called the
lactational amenorrhea method (LAM).

Permanent birth control (sterilization)

Sterilization is a surgical procedure done for men or women who decide
that they do not want to have any (or more) children. Sterilization is one of
the most effective forms of birth control. Sterilization is intended to be
permanent, and although you can try to reverse it with another surgery,
reversal is not always successful.

  • Tubal ligation. Tubal ligation is a
    surgical procedure where the fallopian tubes, which carry the eggs from the
    ovaries to the uterus, are tied, cut, or blocked.
  • Tubal implants. In this nonsurgical
    sterilization technique, a small metal coil, or
    tubal implant, is inserted into each fallopian tube. Over time, scar tissue
    grows around each tubal implant, permanently blocking the tubes. Most women are
    able to return home within a couple of hours after either procedure. You must
    use another form of birth control for 3 months after receiving tubal implants.
    At 3 months, you will need to have an X-ray taken to make sure that your tubes
    are closed.
  • Vasectomy. In this minor surgery, the vas deferens,
    the tubes that carry sperm from the
    testicles to the seminal fluid (semen), are cut and
    blocked so that the semen no longer contains
    sperm. This does not interfere with a man’s ability to
    have an erection or enjoy sex. Men must have a sperm count check after having a
    vasectomy before relying on this for birth control.

Female sterilization is more complicated, has higher
risks of problems after surgery, and is more expensive than male
sterilization.

Contraception following pregnancy

Birth control is
an important consideration after you have had a child. Your ability to become
pregnant again may return within 3 to 6 weeks after childbirth. Think about
what type of birth control you will be using, and make a plan during your
pregnancy. Most methods of birth control are safe and effective after delivery. But in the first couple of weeks after delivery or if you are breastfeeding, it’s best to use a method that doesn’t contain estrogen. Talk to your doctor about which type is best for you.

Choosing a Birth Control Method

With so many methods
available and so many factors to consider, choosing
birth control can be difficult. You may be able to
decide on a method by asking yourself the following questions:

Might I want to have a biological child in the future?

One of your first considerations might be to determine whether you want
permanent or temporary birth control. In other words, you should consider
whether you want to conceive any (or more) children. This is a decision that
will affect the rest of your life and can be made only after thinking it
through carefully.

If you know that you will not ever want to
conceive a pregnancy,
tubal ligation or tubal implants for you or a
vasectomy for your partner is a reasonable option to
consider.

If you are not sure about the future even though you
know how you feel now, a temporary method is a better choice. If you are young,
have few or no children, are choosing sterilization because your partner wants
it, or think it will solve money or relationship problems, you may regret your
decision later.

How much effort am I willing to put into my birth control?

Some birth control methods require more effort than others. Be honest about how much effort you are willing to put into birth control. Birth control must be used correctly in order to prevent pregnancy. If you
are not comfortable with or might not consistently use a birth control method
for any reason, that method is not likely to be reliable for you in the long
run.

  • Long-acting reversible contraception (LARC) (such as implants and IUDs) works to prevent pregnancy for 3 to 10 years. Once it is in place you don’t need to do anything.
  • Barrier methods (including the diaphragm; cervical cap; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) can interrupt sex and must be used every time you have sex.
  • Combination pills are taken each day. Progestin-only pills must be taken at the same time each day. If you miss a pill you will need to use a backup birth control method.
  • Patches are replaced 3 times each month.
  • Vaginal rings are inserted into the vagina one time each month.
  • Fertility awareness requires that a couple chart the time during a woman’s menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time.
  • Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is intended to be permanent.

How would an unplanned pregnancy affect my life?

If an unplanned pregnancy would seriously impact your plans for the
future, choose a birth control method that is highly effective. Or if you have
a stable relationship and income and plan to have children in the future
anyway, you may feel comfortable using a less reliable method.

How effective are different types of birth control?

Consider how important it is to you to avoid pregnancy, and then look at how well each birth control method works. Hormonal methods and IUDs work very well. Barrier methods such as condoms, diaphragms, and spermicides are only moderately effective. Fertility awareness is even less effective.

To be effective, birth control pills require you to take a pill every day. Barrier methods have to be used before sex. Fertility awareness requires that you watch your temperature and other signs closely. You must also avoid sex on days when you could get pregnant. If you are not willing to put in the effort, choose another method of birth control.

Consider how
comfortable you feel about using a particular method of birth control. If you
are not comfortable with or might not consistently use a birth control method
for any reason, that method is not likely to be reliable for you in the long
run.

How can I prevent sexually transmitted infections?

Unless you know that your partner has no other sex
partners and is free of
sexually transmitted infections (STIs), you are at risk
for STI infection. If you are at risk, protect yourself from infection every
time you have sex. Use a condom in addition to any other birth control method
you choose.

You can choose between a
male or female condom to reduce your risk for
HIV (the virus that causes AIDS),
gonorrhea,
syphilis,
chlamydia,
genital warts,
herpes,
pelvic inflammatory disease (PID), and other
infections.

What health factors could limit my choice of birth control?

If you have health problems or other risk factors, some
birth control methods may not be right for you.

  • Smoking. If you smoke more than 15 cigarettes
    a day and are 35 or older or have
    high blood pressure, a history of
    stroke, a history of
    blood clots, liver disease, or
    heart disease, you may not be able to use combined
    hormonal methods.
  • Migraines. If you have migraine headaches, talk
    to your health professional about whether you can try combined hormonal
    contraception.
  • Diabetes. If you have advanced or long-standing
    diabetes, discuss the risks of taking hormonal birth
    control methods with your health professional.
  • Breastfeeding. If you are breastfeeding, the estrogen in
    combined hormonal birth control can lower your milk supply. Progestin-only
    pills, an implant, both kinds of IUDs, or birth control shots do
    not affect your milk supply and are a good option for breastfeeding women.

Other health problems that might keep you from using a
particular birth control method are relatively rare, especially in young women. But before using any method, talk with your health professional
to see if it is safe for you.

What are some other considerations in choosing a birth control method?

Other things to consider when choosing a method of birth
control include:

  • Health benefits, such as decreased risk of sexually
    transmitted infections with condoms and reduced risk of ovarian cancer and
    uterine cancer with use of birth control pills for one year or
    longer.
  • Cost. Over time, the higher one-time cost of IUD
    insertion or sterilization surgery may be less than the continued costs of
    buying pills or condoms and spermicide.
  • If you are planning to become pregnant in the future. The amount of time it takes for a woman’s full fertility to return after stopping birth control varies for each woman
    and depends on the birth control method she is using.
  • Risks and side effects of the method. Some birth control methods may have a greater risk of causing certain health problems. And some methods cause more side effects than others. For example, hormonal birth control usually has more risks and side effects than barrier methods. Talk to your doctor about the risks and side effects.

Thinking about the pros and cons of hormonal birth control methods may help you choose the one that is best for you.

After you have looked at the facts about the different
methods and thought about your own values and needs, you can choose the method
that will work best for you. Using condoms with any method may increase its
reliability and helps to protect you from
sexually transmitted infections (STIs).

Are you interested in what others decided to do? Many people have faced
this decision. Personal stories may help you decide.

Emergency Contraception

You can use emergency
contraception if a condom breaks, you’ve forgotten a pill, you are taking other
medicines that may affect contraception medicines, or you have had
unprotected sex. Emergency contraception does not
protect against
sexually transmitted infections.

For more information, see the topic
Emergency Contraception.

When to Call a Doctor

For many methods of birth control, you’ll need to see your doctor to get a prescription. If you want to start birth control, talk with your doctor about options that are right for you. And if you have problems with a birth control method, talk with your doctor. He or she may recommend another birth control method or help you solve the problem you are having.

Other Places To Get Help

Organizations

Planned Parenthood Federation of
America
www.plannedparenthood.org

American Congress of Obstetricians and Gynecologists
(ACOG)
www.acog.org

Related Information

References

Other Works Consulted

  • American College of Obstetricians and Gynecologists (2010, reaffirmed 2016). Noncontraceptive uses of hormonal contraceptives. ACOG Practice Bulletin No. 110. Obstetrics and Gynecology, 115(1): 207–218. DOI: 10.1097/AOG.0b013e3181cb50b5. Accessed January 26, 2018.
  • American College of Obstetricians and Gynecologists (2015). Emergency contraception. Practice Bulletin No. 152. Obstetrics and Gynecology, 126(3): e1–e11. DOI: 10.1097/ACOG.0000000000001047. Accessed online September 18, 2015.
  • Committee on Practice Bulletins–Gynecology. (2017). Long-acting reversible contraception: Implants and intrauterine devices. ACOG Practice Bulletin No. 186. Obstetrics and Gynecology, 130(5): e251–e269. DOI: 10.1097/AOG.0000000000002400. Accessed January 26, 2018.
  • Curtis KM, et al. (2016). U.S. medical eligibility criteria for contraceptive use, 2016. MMWR. Recommendations and Reports, 65(2): 1–103. DOI: 10.15585/mmwr.rr6503a1. Accessed January 26, 2018.
  • Mishell DR (2007). Family planning: Contraception, sterilization, and pregnancy termination. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 275–325. Philadelphia: Mosby Elsevier.
  • Mishell DR (2012). Contraception. In L Goldman, A Shafer, eds., Goldman’s Cecil Medicine, 24th ed., pp. 1552–1555. Philadelphia: Saunders.
  • Stubblefield PG, Roncari, DM. (2012). Family planning. In JS Berek, ed., Berek and Novak’s Gynecology, 15th ed., pp. 211–269. Philadelphia: Lippincott Williams and Wilkins.

Credits

ByHealthwise StaffPrimary Medical Reviewer Sarah Marshall, MD – Family Medicine Kathleen Romito, MD – Family Medicine E. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC – Obstetrics and Gynecology

Current as ofFebruary 6, 2018