Birth control is available in a variety of methods, from natural family planning to an intrauterine device, condoms, pills, rings and patches. Each method has advantages and disadvantages in terms of convenience, potential side effects and pregnancy prevention.
Birth Control Pills, Patches and Rings
Birth control pills are easy to use and have a low failure rate -- about 7 percent, according to the American College of Obstetricians and Gynecologists (ACOG). Other potential benefits include light, easy periods; less acne; fewer menstrual migraines; and decreased risk of uterine, ovarian and colorectal cancers. The most common disadvantage is irregular bleeding, which usually resolves in the first few months. Birth control pills are considered very safe for most women. The biggest risk is blood clots. However, this risk affects only 3 to 6 in 10,000 women taking birth control pills, according to ACOG. The patch and vaginal ring work just like the pill and have the same risks and benefits but are used less frequently -- weekly for the patch or every 3 weeks for the ring.
Depot medroxyprogesterone acetate (Depo-Provera) offers the convenience of 3 months of contraception with each injection and is at least as effective as birth control pills, patches and rings for preventing pregnancy. The depot shot often causes irregular bleeding in the first few months, but many women stop bleeding altogether with continued use. Fertility typically returns within 10 months of discontinuing use but may be delayed for up to 18 months. Weight gain has been associated with the injection, but research studies have not confirmed this link. The U.S. Food and Drug Administration added a black-box warning in 2004 due to concerns about increased bone loss. However, ACOG reports that bones appear to recover after stopping the injections and there is no increased incidence of fractures.
Implant and IUD
The etonogestrel implant (Nexplanon, Implanon) is placed under the skin of the upper arm. It is good for 3 years and is the most effective method of reversible contraception available with a failure rate of 0.05 percent, reports ACOG. Again, the most common side effect is irregular bleeding, which is generally light but is unpredictable and does not usually improve over time. Intrauterine devices (IUDs) have a 0.2 to 0.8 percent failure rate, according to ACOG. There are 2 types of IUDs available. One contains copper (ParaGard) and provides 10 years of birth control. The other releases a small amount of hormone (Mirena, Skyla) and works for 5 years. The copper IUD can be associated with heavier, more painful periods, while the hormonal IUD has the opposite effect. Many women have light periods or no periods at all.
The remaining methods of contraception are nonhormonal, which is an advantage for some women. Tubal ligation and vasectomy are permanent and have a failure rate of less than 0.5 percent, according to the Centers for Disease Control and Prevention. They do, however, involve surgery. Condoms, diaphragms, cervical caps, sponges and fertility awareness are other options. They have a relatively high failure rate -- typically 12 to 24 percent, reports CDC -- due to improper or inconsistent use. But for motivated individuals, these methods can be effective, and condoms have the added benefit of preventing sexually transmitted diseases.
- Obstetrics & Gynecology: Hormonal Contraception
- American College of Obstetricians and Gynecologists: Practice Bulletin Long-Acting Reversible Contraception: Implants and Intrauterine Devices
- American College of Obstetricians and Gynecologists: Practice Bulletin Noncontraceptive Uses of Hormonal Contraceptives
- National Health Statistics Reports: Current Contraceptive Use in the United States, 2006–2010, and Changes in Patterns of Use Since 1995
- U.S. Food and Drug Administration: Depo-Provera Prescribing Information
- American Family Physician: ACOG Guidelines on Noncontraceptive Uses of Hormonal Contraceptives
- American College of Obstetricians and Gynecologists: Committee Opinion, Depot Medroxyprogesterone Acetate and Bone Effects
- Centers for Disease Control and Prevention: Effectiveness of Family Planning Methods