Basic Information |
|
here
to view table version Choosing a method of birth control is a
highly personal decision, based on individual preferences, medical
history, lifestyle, and other factors. Each method carries with
it a number of risks and benefits of which the user should be
aware. Each method of birth control has a failure rate-an inability
to prevent pregnancy over a one-year period. Sometimes the failure
rate is due to the method and sometimes it is due to human error,
such as incorrect use or not using it at all. Each method has
possible side effects, some minor and some serious. Some methods
require lifestyle modifications, such as remembering to use the
method with each and every sexual intercourse. Some cannot be
used by individuals with certain medical problems. (The following
information is adapted in part from the FDA Consumer, the magazine
of the U.S. Food & Drug Administration.)
|
|
Spermicides Used Alone
Spermicides, which come in many forms foams, jellies, gels,
and suppositories-work by forming a physical and chemical barrier
to sperm. They should be inserted into the vagina within an
hour before intercourse. If intercourse is repeated, more spermicide
should be inserted. The active ingredient in most spermicides
is the chemical nonoxynol 9. The failure rate for spermicides
in preventing pregnancy when used alone is from 20 to 30 percent.
Spermicides are available without a prescription. People who
experience burning or irritation with these products should
not use them.
|
Barrier Methods |
There are five barrier methods of contraception: male condoms,
female condoms, sponge, diaphragm, and cervical cap. In each instance,
the method works by keeping the sperm and egg apart. Usually,
these methods have only minor side effects. The main possible
side effect is an allergic reaction either to the material of
the barrier or the spermicides that should be used with them.
Using the methods correctly for each and every sexual intercourse
gives the best protection.
|
|
1) Male Condom
A male condom is a sheath that covers the penis during sex.
Condoms are made of either latex rubber or natural skin (also
called "lambskin" but actually made from sheep intestines).
Only latex condoms have been shown to be highly effective in
helping to prevent sexually transmitted diseases (STDs). Latex
provides a good barrier to even small viruses such as the human
immunodeficiency virus (HIV) and hepatitis B. Each condom can
only be used once. Condoms have a birth control failure rate
of about 15 percent. Most of the failures can be traced to improper
use. Some condoms have spermicide added. This may give some
additional contraceptive protection. Vaginal spermicides may
also be added before sexual intercourse. Some condoms have lubricants
added. These do not improve birth control or STD protection.
Non-oil-based lubricants can also be used with condoms. However,
oil-based lubricants such as petroleum jelly (Vaseline) should
not be used because they weaken the latex. Condoms are available
without a prescription.
|
|
2) Female Condom
The Reality Female Condom was approved for use in the United
States in 1993. It consists of a lubricated polyurethane sheath
with a flexible polyurethane ring on each end. One ring is inserted
into the vagina much like a diaphragm, while the other remains
outside, partially covering the labia. The female condom may
offer some protection against STDs, but for highly effective
protection, male latex condoms must be used. In a six-month
trial, the pregnancy rate for the Reality Female Condom was
about 13 percent. The estimated yearly failure rate ranges from
21 to 26 percent. This means that about 1 in 4 women who use
Reality may become pregnant during a year.
|
|
3) Sponge
The contraceptive sponge was approved in 1983. In 1995, the
only company in the U.S. manufacturing the sponge discontinued
its production. It may become available again at some future
date. The sponge is made of white polyurethane foam. It is shaped
like a small doughnut and contains the spermicide nonoxynol
9. Like the diaphragm, it is inserted into the vagina to cover
the cervix during and after intercourse. It does not require
fitting by a health professional and is available without prescription.
It is to be used only once and then discarded. The failure rate
is between 18 and 28 percent. An extremely rare side effect
is toxic shock syndrome(TSS), a potentially fatal infection
caused by a strain of the bacterium Slaphylococcus aureus and
more commonly associated with tampon use.
|
|
4) Diaphragm
The diaphragm is a flexible rubber disk with a rigid rim. Diaphragms
range in size from 2 to 4 inches in diameter and are designed
to cover the cervix during and after intercourse so that sperm
cannot reach the uterus. Spermicidal jelly or cream must be
placed inside the diaphragm for it to be effective.
The diaphragm must be fitted by a health professional and the
correct size prescribed to ensure a snug seal with the vaginal
wall. If intercourse is repeated, additional spermicide should
be added with the diaphragm still in place. The diaphragm should
be left in place for at least six hours after intercourse. The
diaphragm used with spermicide has a failure rate of from 6
to 18 percent.
|
In addition to the possible allergic reactions or irritation
common to all barrier methods, there have been some reports
of bladder infections with this method. As with the contraceptive
sponge, toxic shock syndrome (TSS) is an extremely rare side
effect.
|
|
5) Cervical Cap
The cervical cap, approved for contraceptive use in the United
States in 1988, is a dome-shaped rubber cap in various sizes
that fits snugly over the cervix. Like the diaphragm, it is
used with a spermicide and must be fitted by a health professional.
It is more difficult to insert than the diaphragm, but may be
left in place for up to 48 hours. In addition to the allergic
reactions that can occur with any barrier method, 5.2 to 27
percent of users in various studies have reported an unpleasant
odor and/or discharge. There also appears to be an increased
incidence of irregular Pap tests in the first six months of
using the cap, and TSS is an extremely rare side effect. The
cap has a failure rate of about 18 percent.
|
|
Hormonal Contraception |
Hormonal contraception involves ways of delivering forms of two
female reproductive hormones estrogen and progestogen-that help
regulate ovulation (release of an egg), the condition of the uterine
lining, and other parts of the menstrual cycle. Unlike barrier
methods, hormones are not inert, do interact with the body, and
have the potential for serious side effects, though this is rare.
When properly used, hormonal methods are also extremely effective.
Hormonal methods are available only by prescription.
|
|
1) Birth Control Pills
- There are two types of birth control pills: combination
pills, which contain both estrogen and a progestin (a natural
or synthetic progesterone), and "mini-pills," which contain
only progestin. The combination pill prevents ovulation, while
the mini-pill reduces cervical mucus and causes it to thicken.
This prevents sperm from reaching the egg. Also, progestins
stop the uterine lining (endometrium) from thickening. This
prevents the fertilized egg from implanting in the uterus.
The failure rate for the mini-pill is 1 to 3 percent; for
the combination pill its 1 to 2 percent.
- Combination oral contraceptives offer significant protection
against ovarian cancer, endometrial cancer, iron deficiency
anemia, pelvic inflammatory disease (PID), and fibrocystic
breast disease. Women who take combination pills have a lower
risk of functional ovarian cysts.
- The decision about whether to take an oral contraceptive
should be made only after consultation with a health professional.
Smokers and women with certain medical conditions should not
take the pill. These conditions include:
- A history of blood clots
- Heart attacks, strokes, or angina
- Cancer of the breast, vagina, cervix, or uterus
- Any undiagnosed, abnormal vaginal bleeding
- Liver tumors
- Jaundice due to pregnancy or use of birth control pills
- Women with the following conditions should discuss with
a health professional whether the benefits of the pill outweigh
its risks for them:
- High blood pressure
- Heart, kidney or gallbladder disease
- A family history of heart attack or stroke
- Severe headaches or depression
- Elevated cholesterol or triglycerides
- Epilepsy
- Diabetes
- Serious side effects of the pill include blood clots that
can lead to stroke, heart attack, pulmonary embolism, or death.
A clot may, on rare occasions, occur in the blood vessel of
the eye, causing impaired vision or even blindness. The pills
may also cause high blood pressure that returns to normal
after oral contraceptives are stopped. Minor side effects,
which usually subside after a few months' use, include: nausea,
headaches, breast swelling, fluid retention, weight gain,
irregular bleeding, and depression. Sometimes taking a pill
with a lower dose of hormones can reduce these effects.
- The effectiveness of birth control pills may be reduced
by a few other medications, including some antibiotics, barbiturates,
and antifungal medications. On the other hand, birth control
pills may prolong the effects of theophylline and caffeine.
They also may prolong the effects of benzadiazepines such
as Librium (chlordiazepoxide), Valium (diazepam), and Xanax
(alprazolam). Because of the variety of these drug interactions,
women should always tell their health professionals when they
are taking birth control pills.
|
2)Norplant
- Norplant-the first contraceptive implant-was approved by
FDA in 1990. In a minor surgical procedure, six matchstick-sized
capsules containing progestin are placed just underneath the
skin of the upper arm. The implant is effective within 24
hours and provides progestin for up to five years or until
it is removed. Both the insertion and the removal must be
performed by a qualified professional.
- Because contraception is automatic and does not depend
on the user, the failure rate for Norplant is less than 1
percent for women who weigh less than 150 pounds. Women who
weigh more have a higher pregnancy rate after the first two
years.
- Women who cannot take birth control pills for medical reasons
should not consider Norplant a contraceptive option. The potential
side effects of the implant include: irregular menstrual bleeding,
headaches, nervousness, depression, nausea, dizziness, skin
rash, acne, change of appetite, breast tenderness, weight
gain, enlargement of the ovaries or fallopian tubes, and excessive
growth of body and facial hair. These side effects may subside
after the first year.
|
3)Depo-Provera
- Depo-Provera is an injectable form of a progestin. It was
approved by FDA in 1992 for contraceptive use. Previously,
it was approved for treating endometrial and renal cancers.
Depo-Provera has a failure rate of only 1 percent. Each injection
provides contraceptive protection for 14 weeks. It is injected
every three months into a muscle in the buttocks or arm by
a trained professional.
- The side effects are similar to those for Norplant listed
above. In addition, there may be irregular bleeding and spotting
during the first months followed by episodes of amenorrhea
(no menstrual period). About 50 percent of the women who use
Depo-Provera for one year or longer report amenorrhea. Side
effects, such as weight gain and others described for Norplant,
may occur.
|
Other Temporary Contraceptive Methods |
Intrauterine Device (IUD)
- IUDs are small, plastic, flexible devices that are inserted
into the uterus through the cervix by a trained clinician. Only
two IUDs are presently marketed in the United States: ParaGard
T380A, a T-shaped device partially covered by copper and effective
for eight years; and Progestasert, which is also T-shaped but
contains a progestin released over a one-year period. After
that time, the IUD should be replaced. Both IUDs have a 4 to
5 percent failure rate. It is not known exactly how IUDs work.
At one time it was thought that the IUD affected the uterus
so that it would be inhospitable to implantation. New evidence,
however, suggests that uterine and tubal fluids are altered,
particularly in the case of copper-bearing IUDs, inhibiting
the transport of sperm through the cervical mucus and uterus.
- The risk of pelvic inflammatory disease (PID) with IUD use
is highest in those with multiple sex partners or with a history
of previous PID. Therefore, the IUD is recommended primarily
for women in mutually monogamous relationships. In addition
to PID, other complications include perforation of the uterus
(usually at the time of insertion), septic abortion, or ectopic
(tubal) pregnancy. Women may also experience some short-term
side effects-cramping and dizziness at the time of insertion;
bleeding, cramps and backache that may continue for a few days
after the insertion; spotting between periods; and longer and
heavier menstruation during the first few periods after insertion.
|
Periodic Abstinence
- Periodic abstinence entails not having sexual intercourse
during the woman's fertile period. Sometimes this method is
called natural family planning (NFP) or "rhythm." Using periodic
abstinence is dependent on the ability to identify the approximately
10 days in each menstrual cycle that a woman is fertile. Methods
to help determine this include: The basal body temperature method
is based on the knowledge that just before ovulation a woman's
basal body temperature drops several tenths of a degree and
after ovulation it returns to normal. The method requires that
the woman take her temperature each morning before she gets
out of bed.
- The cervical mucus method, also called the Billings method,
depends on a woman recognizing the changes in cervical mucus
that indicate ovulation is occurring or has occurred. There
are now electronic thermometers with memories and electrical
resistance meters that can more accurately pinpoint a woman's
fertile period. Maintaining a calendar record of menstrual cycles
is an additional step women can take to help determine ovulation.
- The periodic abstinence method has a failure rate of 14 to
47 percent. It has none of the side effects of artificial methods
of contraception.
|
Surgical Sterilization
- Surgical sterilization must be considered permanent. Tubal
ligation seals a woman's fallopian tubes so that an egg cannot
travel to the uterus. Vasectomy involves closing off a man's
vas deferens so that sperm will not be carried to the penis.
- Vasectomy is considered safer than female sterilization.
It is a minor surgical procedure, most often performed in a
doctor's office under local anesthesia. The procedure usually
takes less than 30 minutes. Minor post-surgical complications
may occur.
- Tubal ligation is an operating-room procedure performed under
general anesthesia. The fallopian tubes can be reached by a
number of surgical techniques, and, depending on the technique,
the operation is sometimes an outpatient procedure or requires
only an overnight stay. Following vaginal delivery, patients
often choose to have their tubal ligation performed as a minilaparotomy.
A 2-inch incision is made in the abdomen. The surgeon, using
special instruments, lifts the fallopian tubes and, using clips,
a plastic ring, an electric current or sutures, seals the tubes.
Another method, laparoscopy, involves making a small incision
above the navel, and distending the abdominal cavity so that
the intestine separates from the uterus and fallopian tubes.
Then a laparoscope-a miniaturized, flexible telescope-is used
to visualize the fallopian tubes while closing them off.
- Both of these methods are replacing the traditional laparotomy.
Major complications, which are rare in female sterilization,
include: infection, hemorrhage, and problems associated with
the use of general anesthesia. It is estimated that major complications
occur in 1.7 percent of the cases, while the overall complication
rate has been reported to be between 0.1 and 15.3 percent.
- The failure rate of laparoscopy and minilaparotomy procedures,
as well as vasectomy, is less than 1 percent. Although there
has been some success in reopening the fallopian tubes or the
vas deferens, the success rate is low, and sterilization should
be considered irreversible.
|
Note: For many people, the prevention of sexually
transmitted diseases (STDs), including HIV (human immunodefieieney
virus), which leads to AIDS, is a factor in choosing a contraceptive.
Only one form of birth control-the latex condom, worn by the
man-is highly effective in helping protect against HIV and
other STDs). The female condom, made of polyurethane, may
give limited protection against STDs but has not been proven
as effective as male latex condoms. People who use another
form of birth control but who also want a highly effective
way to reduce their STD risks, should also use a latex condom
for every sex act from start to finish.
|
Notify Your Healthcare Provider If |
You want additional information on contraception.
|
|
|