Birth Control

There are many options when it comes to birth control. They all have their strong points and weak points and the decision on what to use is very personal. The following table is a brief summary of the methods available to help start the discussion of what method is best for you. Further discussion with a healthcare provider is encouraged to gain a better understanding of the options being considered.

Behavioral Methods
Method	Description	Strong Points	Weak Points
Abstinence	There is some variation on the definition of abstinence varying from no sexual contact to no intercourse only. It is the only method, if used in a stricter sense, that will prevent spread of STIs and pregnancy.	No pregnancy risk Little/no risk for STI No side effects/health risks Free	May experience difficulty resisting pressure to have sexual contact Requires self-discipline
Fertility awareness	This refers to a woman’s recognition of the fertile days of her cycle. This can be done by measuring body temperature, charting mucus changes, or the calendar method. Detailed discussion with a healthcare provider can help define these techniques.	No health risks/side effects Very low cost Helps a woman understand her body better	Typically, only 75% effective against pregnancy Difficult for women with irregular cycles

Hormonal Methods
Method	Description	Strong Points	Weak Points
Depo-Provera	Depo-Provera is an intramuscular shot of hormones given once every three months. It acts by stopping ovulation and thickening cervical mucus, making it harder for sperm to travel into the uterus. A prescription is required to get this medicine.	94-99+% effective against pregnancy Easy to use Does not interfere with sex May decrease menstrual cramps, bleeding, and PMS	No protection from STIs Requires shot (provider visit) every 3 months May take several months to leave system after stopping Long term use can decrease bone density (calcium supplements recommended) Possible side effects of weight gain, depression, headaches, or dizziness
Birth control pills	Birth control pills (BCPs) release hormones that halt ovulation, as well as thicken cervical mucus making it hard for sperm to get into the uterus. There are many different pills that vary with regard to the hormone(s) they contain and the length of time they allow between cycles. BCPs must be taken at the same time every day to be optimally effective. A prescription is required.	91-99+% effective Easy to use Does not interfere with sex May lighten periods and make them more regular May decrease menstrual cramp	No protection from STIs Must remember to take the pill at the same time every day Health side effects: very small chance of blood clots, heart attacks, strokes, HBP (esp. if smoker) May cause weight gain, spotting,headaches, nausea, depression, or moodiness Most side effects go away or lessen after 3 months
Vaginal ring	This is a soft flexible ring that a woman inserts in her vagina for three weeks, then removes it for the fourth week during which she has her menstrual period. The ring releases hormones that halt ovulation and thickens cervical mucus. A prescription is required to get this medicine.	91-99+% effective Easy to use Does not interfere with sex Lightens menstrual periods and cramps Helps prevent ovarian and endometrial cancer	No protection from STIs Must be worn whether having sex or not Health side effects: very small chance of blood clots, heart attack, stroke, and HBP (esp. if smoker) May cause weight gain, spotting, headaches, nausea, depression, moodiness, blurred vision, oily skin, or breast tenderness Most side effects go away or lessen after 3 months
Birth control patch	The birth control patch is a thin plastic square that is applied to the skin and works much like BCPs, releasing hormones that stop ovulation. The patch stays in place for 3 weeks, then is removed for the 4th week when menstruation takes place. A prescription is required to get the patch.	91-99+% effective Easy to use Does not interfere with sex Lightens menstrual periods and cramps	No protection from STIs Must be worn whether having sex or not Health side effects: very small chance of blood clots, heart attack, stroke, and HBP (esp. if smoker) May cause weight gain, spotting, headaches, nausea, depression, moodiness Reports of blurred vision, oily skin, and breast tenderness Most side effects go away or lessen after 3 months

Long Acting and Reversible
Method	Description	Strong Points	Weak Points
IUD	There are two types of intrauterine devices (IUDs), hormonal and copper. IUDs are small, T-shaped devices that are placed inside the uterus, and work to prevent sperm from reaching the uterus. The copper IUD can stay in place 10 years. The hormonal IUD releases a small amount of hormone daily and can stay in place 3-5 years. IUDs must be inserted and removed by a health care provider.	91-99+% effective Always in place Does not interfere with sex Long term protection Hormonal IUD may cause light/no periods Can be removed at any time by health care provider	No protection from STIs May cause menstrual changes or spotting between periods Copper IUD may cause increased menstrual bleeding/cramping Must be removed by health care provider
Implant	An implant is a tiny plastic rod that a health care provider inserts just under the skin, usually on the inner upper arm. It releases progestin, a hormone, which stops ovulation and thickens cervical mucus. The implant lasts for 3 years.	91-99+% effective Always in place, does not interfere with sex Can be removed at any time by health care provider	No protection from STIs Must be inserted and removed by health care provider May cause spotting, lighter periods, longer periods, or no period at all

Barrier Methods
Method	Description	Strong Points	Weak Points
Diaphragm	A diaphragm is a small, flexible latex or silicone cup that is placed over the cervix providing a block so sperm cannot get into the uterus. It can be inserted up to 6 hours prior to intercourse, and must be left in place 6 hours after. Spermicide is usually coated on the cup, and if intercourse is repeated, spermicide can be reapplied. A woman must be fitted for a diaphragm by a health care provider.	88-94% effective Can be inserted 6 hours prior to sex so will not interrupt Only used when needed	No protection from STIs Latex or spermicides can cause irritation or allergic reaction Some experience difficulty with insertion/removal Messy Must be left in place for 6 hours after intercourse
Male condom	A male condom fits over an erect penis and serves to prevent sperm from entering the vagina. If used properly, they help prevent the transfer of bodily fluids. Latex and plastic condoms protect against STIs, but are not 100%. Condoms cannot be re-used, a new one must be used each time.	82-98% effective Reduces the risk for STIs Readily available Easy to use/carry Used only when needed Can be used with other birth control methods as additional protection No prescription needed	Single use only, must use a new condom with every episode of intercourse Must be used properly for optimal effectiveness May interrupt sex Must plan ahead, make sure condoms are available
Female condom	The female condom is inserted into the vagina during sex, and prevents sperm from entering the vagina. They also reduce exchange of bodily fluids, thus reducing the risk for STIs. They cannot be used with a male condom as they will both break.	79-95% effective Reduces the risk for STIs Readily available Easy to use/carry Used only when needed Is not dependent on a male being erect to stay in place	May be awkward to insert May be distracting/noisy during intercourse Must be used properly for effectiveness Must plan ahead, make sure it’s available when needed

Other Methods
Method	Description	Strong Points	Weak Points
Spermicides	Spermicides are creams, films, foams, gels, or suppositories that contain chemicals that kill sperm. A woman inserts spermicides into her vagina prior to sex, and can be used alone or with other methods of birth control. They are available at most drug stores.	72-82% effective when used alone Readily available without a prescription Easy to use/carry Used only when needed	No protection for STIs May interrupt sex to insert right before intercourse Can be messy May cause irritation to either partner
Emergency contraception	Emergency contraception is used after unprotected sex. In most cases, it is a morning after pill (MAP) that contains hormones that prevent ovulation or implantation. It must be used within a few days. Some MAPs are available without a prescription. There is also an IUD (ParaGard IUD) available as emergency contraception, and must be inserted by a health care provider.	98% effective if used properly (3-5 days after unprotected sex) Some MAPs are available without a prescription	No protection for STIs Side effects: feeling sick/dizzy, headaches, or breast soreness