Susan L. Grant MD and Margaret Klugman RPA
Obstetics and Gynecology Board Certified




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New York, New York 10028
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What is birth control?

Also called: Contraception

Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ways. These include:

  • Preventing sperm from getting to the eggs - condoms, diaphragms and intrauterine devices (IUDs) work this way
  • Keeping the woman's ovaries from releasing eggs that could be fertilized - birth control pills work this way
  • Sterilization, which permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant

Your choice of birth control should depend on several factors. These include your health, frequency of sexual activity, number of sexual partners and desire to have children in the future. Your health care provider can help you select the best form of birth control for you.

What Kind of Birth Control Is Best for You?

Many Products Can Help Prevent Pregnancy

If you and your partner don't want to have a baby at this time, there are many different products that can help prevent pregnancy.

The types of birth control that are most reliable for preventing pregnancy are birth control pills, injections, implants, IUDs, and sterilization. Of every 100 women who use one of these types of birth control for a year, about 1 to 5 women will become pregnant.

Latex condoms for men and diaphragms with spermicide are less effective. Of every 100 women who rely on them for a year, about 14 to 20 will become pregnant. Other methods of birth control, such as spermicide alone, female condoms, and natural family planning, don't work as well.

Birth Control You Can Get Without a Prescription

Some types of birth control are available without a doctor's prescription. They have no side effects for most people. But some people may be allergic to them and get rashes if they use them.

Condoms for Men

People sometimes call condoms for men rubbers, safes, or prophylactics. You can buy condoms without a prescription at drugstores, supermarkets, and many other places.

To use, put the condom on the erect penis before having sex. Use each condom only once. Most condoms are made from latex rubber. Others are made from lamb intestines and are often called lambskins. Some condoms are made from polyurethane. If you aren't allergic to latex, you should use latex condoms because they are best at preventing pregnancy and they also protect best against AIDS, herpes, and other sexually transmitted diseases (STDs). Condoms shouldn't be used with Vaseline or other brands of petroleum jelly, lotions, or oils. But they can be used with lubricants that don't have oil, such as K-Y jelly.

Female Condom

The Reality Female Condom is made of polyurethane. You can buy female condoms at drugstores without a prescription. To use, insert the condom into the vagina right before sex and use each only once. Don't use it at the same time as a male condom. If you have a choice, it's better for the man to use a latex condom because it's better than the female condom at preventing pregnancy and protecting you against STDs.

Spermicide Alone

Spermicides are available without a prescription in drugstores and some other stores. They contain a chemical that kills sperm. Spermicides are sold in several forms including foam, cream and jelly.

To use, put the spermicide into the vagina at least 10 minutes before having sex. One dose of spermicide usually works for one hour, but you must use another dose every time you have intercourse even if less than an hour has passed. You should not douche or rinse your vagina for at least 6 to 8 hours after having sex.

Birth Control You Need to See Your Doctor For

The risks and benefits of different forms of birth control are different for each person. So it's best to decide with your doctor which form of birth control is best for you.

Diaphragm

The diaphragm with spermicide is put into the vagina before sex so that it covers the cervix, or neck of the womb. Put the spermicide into the dome of the diaphragm before inserting it. You must be fitted for a diaphragm at a doctor's office or clinic because diaphragms come in several different sizes. The diaphragm must stay in place at least 6 hours after intercourse, but not for more than 24 hours. If you have sex more than once while wearing the diaphragm, you must add more spermicide without taking the diaphragm out. Spermicide is available without a prescription at drugstores.

Cervical Cap

The cervical cap is a soft rubber cup with a round rim that is put into the vagina to fit over the cervix, or neck of the womb. The cap is smaller than the diaphragm, but sometimes more difficult to insert. You must go to your doctor or clinic to be fitted for the cervical cap. It comes in several different sizes. The cervical cap must be used with spermicide, which is available in drugstores without a prescription. You can leave it in place for 72 hours.

Birth Control Pills

You need a doctor's prescription to get birth control pills, also called oral contraceptives. There are two types of birth control pills: "combined oral contraceptives" and "minipills."

Combined oral contraceptives have a combination of two hormones-estrogen and progestin. They work by keeping the ovaries from releasing an egg. The pill must be taken every day.

Minipills contain only one hormone, progestin. They work by thickening the cervical mucus to keep sperm from reaching the egg.

Sometimes they also keep the ovaries from releasing an egg. You must take one pill every day. Minipills are slightly less effective than combined oral contraceptives.

Depo-Provera

Depo-Provera is a form of progestin, similar to the hormone in the minipill. Depo-Provera must be injected with a needle into the woman's buttocks or arm muscle by a doctor. You must get an injection every three months for the birth control to continue to work.

NuvaRing©

NuvaRing© is as effective as the Pill when used as directed, but you don't have to take it every day. You leave NuvaRing© in place for 3 weeks, then remove it for a 1-week ring-free period. You should get your period during this "week off." (Using NuvaRing© as prescribed, you will continue to be protected from pregnancy during the ring-free week.) Exactly 1 week after you take NuvaRing© out, you insert a new one.

Implanon™

IMPLANONis a type of birth control for women. It is a flexible plastic rod the size of a matchstick that is put under the skin of your arm. IMPLANON™ contains a hormone called etonogestrel. You can use a single IMPLANON™ rod for up to three years. Because IMPLANON™ does not contain estrogen, your healthcare provider may recommend IMPLANON™ even if you cannot use estrogen.

IUDs

An IUD (Intra-Uterine Device) is inserted into the womb by a doctor. Two types of IUDs are now used in the United States: the Paragard Copper T 380A, which releases copper, and the Mirena (new progestin IUD}, which releases progesterone, a form of progestin. The Paragard IUD can stay in place for 10 years. The Mirena (new progestin IUD} must be replaced every year. A doctor must remove it.

Male Sterilization (Vasectomy)

Outpatient surgery is necessary to make a man sterile, or unable to produce enough sperm to make a woman pregnant. This is done by sealing, tying or cutting the tube through which sperm travel to the penis from the testicles. The operation usually takes less than 30 minutes and is done under local anesthesia. Men who have vasectomies must be sure they will never want to father children in the future.

Female Sterilization

Female sterilization is usually a longer operation than a vasectomy, though it may sometimes be done as outpatient surgery. It is usually done under general anesthesia. The surgery involves tying, cutting or blocking the fallopian tubes so eggs can't reach the womb. Women who have this surgery must be sure they will never want to have a baby in the future.

Natural Family Planning

This is also known as fertility awareness or periodic abstinence. For this method to work, a man and woman cannot have sex on the days the woman can become pregnant unless using another form of birth control. These days usually include from seven days before the woman ovulates (releases an egg) to three days after she ovulates. A woman can ask her doctor how to tell when she ovulates. This is done by taking into account when the last menstrual period began, changes in body temperature, and changes in vaginal mucus.

Preventing Sexually Transmitted Diseases

The only kind of birth control that is also highly effective in preventing AIDS and other sexually transmitted diseases is the latex condom worn by the man. The female condom can also give some protection, but it's not as good as the latex condom for men. If you use other forms of birth control but also want protection against AIDS and other sexually transmitted diseases, the man should also use a latex condom.

What to do about missed or skipped birth control pills

Birth control methods have high rates of effectiveness if they are used consistently. Follow your health professional's instructions on what to do if you miss or skip your birth control pills. Some general guidelines are listed here.

Combination (estrogen plus progestin) birth control pills

The greatest risk for pregnancy occurs if you start taking combination (estrogen plus progestin) pills late or stop too early (that is, you don't finish the month's worth of pills). If you use a 21-pill pack, you take 3 weeks of hormone pills and go 1 week without pills. If your pills come in packs of 28, the last 7 pills usually do not have hormones.

If you miss even one hormone pill in the first week of your pack, or if you are late to start your new pack, use emergency contraception (special hormone pills). And then start taking your pills on schedule the next day. That first week of the pill pack is when there is a greater chance that your body will release an egg (ovulate) and you can become pregnant.

After missing one or more pills, be sure to follow these instructions:

  • If you miss 1 pill during week 2 or 3 of your pack, take it as soon as you remember. Take your next pill at the regular time.
  • If you miss 2 pills, take 1 of the forgotten pills every 12 hours until you have caught up, then continue taking the rest of the pill pack. Use backup contraception, like a condom or diaphragm, over the next 7 days.
  • If you miss more than 2 pills and have had sex in the last 5 days, use emergency contraception. Then start taking your daily pills the next day. Use a backup method, like a condom or diaphragm, over the next 7 days. If you have had sex and decide not to use emergency contraception, skip the missed pills and complete the rest of the pill pack. Use backup contraception, like a condom or diaphragm, until your next menstrual period. Taking the rest of the pill pack does not protect you from pregnancy but will control your cycle.
  • If you miss more than 2 pills and have not sex in the last 5 days, take 2 pills at once, then start taking your daily pills the next day. Use a backup method, like a condom or diaphragm, over the next 7 days.

Emergency contraception

If you had unprotected sex during the time that you missed taking pills, you can use emergency contraception to help prevent pregnancy. You can buy the emergency contraceptive Plan B (sometimes called the "morning-after pill") in most drugstores.

  • If you are 18 or older, you can get Plan B from a pharmacist, without a prescription. Bring proof of your age.
  • If you are younger than 18, you can get Plan B with a prescription from a doctor.

Illness

Vomiting and diarrhea can decrease the effectiveness of birth control pills. It is recommended that another method of birth control be used for 7 days after you have had the flu, even if you did not miss any pills.

Talk to your health professional if you are taking medications for epilepsy (phenytoin and barbiturates) or tuberculosis (rifampin). These medications may interfere with how well your birth control pills work.

Progestin-only pills

Progestin-only pills must be taken at the same time each day. If a pill is taken more than 3 hours late, another method of birth control should be used for the next 48 hours to prevent pregnancy. If you forget to take a pill for even one day, you must use a second method of birth control until your next period to prevent pregnancy.2 You can't take extra pills as with combination pills to make up for a missed day. Progestin-only pills cannot be used vaginally if you are vomiting because the dose is too low to be effective this way.

sources:
http://www.nlm.nih.gov
http://www.webmd.com
http://www.fda.gov
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