- Birth Control Pills
- IUD (intrauterine device)
- Emergency contraceptive pill
- Sterilization (tubal ligation or vasectomy)
- Termination of pregnancy
(abortion and other methods)
Birth Control Pills (Only about 0.1 to 3% of users will become pregnant in one year)
Birth control pills or oral contraceptives are highly effective at preventing pregnancy. They inhibit ovulation, change the cervical mucus making it harder for sperm to enter the uterus, and they cause the lining of the uterus to be less hospitable to a fertilized egg. The modern birth control pill is easy to use and has few serious side effects. It is known to reduce the duration and discomfort associated with menstrual bleeding so is sometimes prescribed to help regulate and ease long, painful periods. It may reduce the risk of ovarian and endometrial cancer. There are some women who should not use birth control pills. These include people with high blood pressure, clotting problems (history of blood clots in the leg, strokes etc), people with certain types of cancer and pregnant women. If you think you may be pregnant, don’t start on the pill! Smokers are also at increased risk of heart and vascular problems when they are on the pill. If you are on the pill, you should not smoke.
If you decide to take the pill, you must get a prescription from a doctor. You can take the pill in 2 different ways. One way is to take an “active” pill for 21 days and then no pill for 7 days. Another way is to take an “active” pill for 21 days and then 7 “dummy” pills. The benefit of the latter method is that you take a pill every day and get into a regular habit. You are less likely to forget to take pills. Most women who get pregnant when taking the pill, forget to take a pill! Some women experience a little nausea and spotting between periods when they first start the pill. Occasional women also have trouble wearing contact lenses. In most individuals these symptoms subside within a few months. When you first start the pill, you must use another birth control method for the first cycle. You must also use a back-up method for 7 days if you forget a pill, vomit up a pill etc.
There are certain medications that interfere with the action of the pill so always tell your doctor you are on the pill and ask if a prescribed drug will affect birth control.
Although serious side effects are rare, if you have any of the following while on the pill, contact a doctor immediately: severe headache, severe chest pain, severe abdominal pain, severe eye pain or vision loss, severe leg pain. One other drawback of the pill is that it does nothing to prevent sexually transmitted diseases. If you are not in a monogamous relationship with a partner you know well and plan to have sex, USE A CONDOM!
Condoms are not the most effective birth control method but do help protect against sexually transmitted diseases. Drawbacks are that they decrease spontaneity and the woman must depend on the man to agree to use the condom. Although some men complain that condoms decrease sensitivity of the penis, it is not a valid excuse to risk pregnancy and transmission of disease. There are many kinds of condoms now available that can actually add to sexual enjoyment. (Visit Condomania web site). Using a condom and contraceptive foam can increase the contraceptive effect and at the same time protect against disease.
Female condoms are made of plastic with a ring at both ends to help hold it in place. Like the male condom it is helpful in preventing sexually transmitted diseases; however pregnancy occurs in 5% to 20% of users often because it is used incorrectly. It does provide the woman with a way to protect herself and can be bought without a prescription from a doctor. Some people say that its ability to conduct heat makes sex even more enjoyable. Others find it clumsy and hard to use. It can be inserted several hours before intercourse and is sold with lubricant. Unfortunately it is sometimes difficult to find at local drugstores and is more expensive than the male condom.
Depo-Provera (About 0.3% of users will become pregnant in one year)
Depo-provera is a very effective birth control method. It is given as an injection 4 times a year. It is basically modified progesterone which prevents ovulation and thins the lining of the uterus. Although it is very good at preventing pregnancy, many women have problems with continual vaginal bleeding for several months after they start the injections. About half of the users will stop bleeding completely (no periods) after one year. Other women continue to bleed irregularly. The latter individuals are probably better off choosing another method of contraception. Other people that should not use Depo-Provera include those with breast cancer, clotting problems, liver disease or current pregnancy. Like the pill, Depo does nothing to prevent sexually transmitted diseases.
Diaphragm (About 6 to 18% of users will become pregnant in one year)
The diaphragm is a rubber cup shaped device that is inserted into the vagina to cover the cervix. Spermicidal cream or jelly is placed in the cup and it is inserted before having intercourse. It is left in for 6 hours after intercourse and is then removed. Taking the diaphragm out before 6 hours has elapsed may increase the chance of pregnancy. Wearing the diaphragm for more than 24 hours is also not advised because of the risk of build up of bacteria that cause toxic shock syndrome. Toxic shock syndrome is a serious illness characterized by fever, rash, vomiting. If you have these symptoms while wearing a diaphragm, you should remove it and consult your doctor.
You must see your doctor to be fitted for a diaphragm. A diaphragm is a good method of birth control for women who are comfortable and knowledgeable about their bodies. If it is not inserted and used properly, it will not be an effective contraceptive.
Intrauterine Device-IUD (About 0.6 to 0.8% of users will become pregnant in one year)
An IUD or intrauterine device is made of plastic and metal (especially copper) and is inserted into the uterus by a doctor. The most common type in use today is “T shaped” and made of plastic and copper. The presence of the device and the metallic copper in the uterus interferes with fertilization of the egg and implantation. Although the IUD is a very effective birth control device that can be left in the uterus for up to 10 years, it should only be used by a woman in a monogamous relationship. The main reason for this is that the risk of infection and pelvic inflammatory disease is increased with the use of an IUD. Pelvic inflammatory disease is caused by a variety of bacteria including some that are sexually transmitted. It is an inflammation of the internal reproductive organs of the female. Occasionally it is severe enough to cause sterility and to warrant removal of the uterus and tubes. Rarely an IUD will also perforate through the uterus causing inflammation and infection in the abdominal cavity. Some patients also report more severe menstrual bleeding and cramping with an IUD but this varies among individuals.
Emergency Contraceptive Pill (for use within 72 hours of unprotected intercourse)
Emergency contraceptive pills can be used in a situation where you had sex and were either unprotected or your method of contraception failed (for example broken condom). These pills may be taken within 72 hours of intercourse. They are basically the same as birth control pills but taken in 2 larger doses. Disadvantages include frequent nausea and occasional vomiting. They are also not as effective as regular birth control pills. If you need emergency contraception call your doctor or a family planning clinic.
Norplant (About 0.09% of users will become pregnant in one year)
Norplant is an extremely effective reversible contraceptive that is implanted under the skin and lasts for 5 years. Its active ingredient is a synthetic progesterone which prevents ovulation. Unfortunately there have been complaints of many side effects, the most frequent of which is prolonged vaginal bleeding or spotting. Headaches are another commonly mentioned side effect. Difficulty removing the implants has also been reported in about 6% of patients. Currently there are several liability lawsuits pending concerning Norplant. Until the dust settles it may be wise to choose another form of contraception.
Rhythm (Effectiveness varies greatly with skill and determination of user).
The rhythm method of birth control may be used by some couples who do not wish to use alternative forms of contraception due to religious or other reasons. This method depends on the woman knowing her menstrual cycle very well and the day she is most likely to ovulate. A woman is most fertile and most likely to get pregnant around the time of ovulation. She should be aware of the length of her cycle and her cycle should be very regular. Most women ovulate day 10 to 18 of the menstrual cycle depending on the overall length of their cycle. Sperm can live for 2 to 3 days in the female reproductive tract so intercourse even 3 days prior to ovulation can result in pregnancy. Their are certain physical signs that occur just prior to and at ovulation and indicate a woman’s most fertile time. These include
1. Change in cervical/vaginal mucus from dry to more watery and abundant.
2. Body temperature increase at ovulation.
If a woman methodically charts her cycle including her peak body temperature, she should be able to predict ovulation. She should not have intercourse 5 days prior to ovulation and at least 3 days after ovulation. Her body temperature rise should occur at ovulation.
This method is not recommended for young women/girls who have not settled into regular cycles (see menstruation). It also takes maturity and an ability not to have sex at a time when your hormones and body make sex seem most appealing.
Sterilization (0.2 to 0.4 % of users will become pregnant in one year)
Female sterilization is called tubal ligation and involves a surgical procedure where the fallopian tubes are clipped or closed in some way. This prevents the sperm from reaching the egg. For tubal ligation a small hole is made in the woman’s abdomen and the procedure is performed through an instrument called a laparoscope.
Male sterilization is called a vasectomy and is done by cutting the vas deferens which are the tubes that take the sperm from the testis to the penis. It is a very minor operation that costs less and has fewer complications than a tubal ligation done on a female.
Sterilization is the perfect contraception choice for a man or woman who does not want any more children. It should be considered a permanent form of birth control since reversals are very difficult and often unsuccessful. Although tubal ligation and vasectomy are highly effective forms of contraception, rarely pregnancy will occur. If a woman who has had a tubal ligation believes she may be pregnant, she should contact her doctor since ectopic pregnancy (a tubal pregnancy or pregnancy outside the uterus) can occur in this instance. An ectopic or tubal pregnancy can be dangerous if not removed.
Sponge (10 to 15% of users will become pregnant in one year)
The “Today Sponge” was removed from the market in 1995 not because it was dangerous but simply because the company that was currently manufacturing the sponge could not afford to improve its plant to meet FDA guidelines for manufacturing. Another New Jersey company is planning to remarket the sponge in 2000 so this non-prescription form of birth control will again be available to women in the USA. Currently sponges can be purchased on-line from birthcontrol.com. The contraceptive sponge is a device made with foam like material that contains a spermicide. It has been popular with women because it can be inserted several hours before sex and is available without a prescription. It also offers some protection against venereal disease, but is not as effective in preventing disease as the condom. The user must be comfortable with her body and able to properly insert the sponge. If you have ever had toxic shock syndrome, you should not use the sponge.
Termination of pregnancy (abortion)
Abortion is the removal of an embryo or fetus from the uterus. This can be done either surgically by dilating the cervix and evacuating the contents of the uterus or it can be done medically by using a combination of drugs to expel the embryo or fetus from the uterus. Abortion is legal and state laws may not interfere with a woman’s right to have an abortion up to about 13 weeks of pregnancy. From 14 to 24 weeks states may regulate abortion procedures to ensure that safe medical practice is followed. Abortion after 24 weeks is usually not allowed because this is the time when the fetus may survive outside the mother’s womb. Rarely an abortion may be done in this instance to save the life of the mother.
Abortion was legal in this country until about the mid 1800’s when many states began to pass laws prohibiting the procedure. The Roe vs Wade decision which again made abortion legal was passed in 1973. The morality of abortion is a personal decision based often on religious views.
Surgical abortion up to 14 weeks is a safe and fairly simple procedure. The cervix is dilated gradually using rods of different widths or a material that slowly expands (laminaria). After dilation the doctor uses suction to aspirate the contents of the uterus. He then gently scrapes the lining of the uterus to ensure the pregnancy is completely removed. After 14 weeks abortion is less simple because the fetus is larger. There are basically 2 methods used. The first is dilation and evacuation which is similar to the above procedure but the cervix must be more widely dilated and the doctor must often use forceps to remove some fetal parts. The second method for later abortions is to induce labor by injecting a medication into the uterus. Contractions will ensue and the fetus will be expelled. This latter method is most often done in a hospital.
Medical abortion involves using drugs to cause the body to expel the pregnancy. Medical abortion can be done as soon as pregnancy is confirmed, in fact the earlier the better. Medical abortion is not reliable after 7 weeks. To induce medical abortion a doctor first prescribes either Methotrexate, which inhibits the growth of fetal tissues or Mifepristone (RU-486), which blocks the hormone progesterone. (RU-486 is still not approved in this country for medical abortion as of 2/2000.) A few days after taking the first drug, the woman uses a second drug, Misoprostol, which will cause the uterus to contract and expel its contents. Medical abortion can take from a few days to 2 weeks to complete. A woman must return to the clinic or doctor after she feels she has expelled the pregnancy so that the clinic or doctor can confirm she is no longer pregnant.
Abortion is generally a very safe procedure when done by licensed doctors, nurses or clinics. Bleeding and cramping are common after both a medical or surgical abortion. Such symptoms tend to be more severe with medical abortion because contraction of the uterus is necessary to expel the pregnancy. Severe complications such as infection, perforation of the uterus, or severe hemorrhage are uncommon with legal abortion.
Abortion is a divisive issue in this country primarily because people disagree as to when “human life” begins. For a discussion on the philosophical aspects of abortion click here
Check out the FWHC’s convenient table with birth control information
Locations of clinics for emergency birth control, routine birth control, abortion etc.