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Choosing Contraception: A Beginner's Guide

49% of pregnancies in the US are unintended. This staggering statistic sheds light on the importance of education regarding family planning and contraceptive options.
The good news is that we have a multitude of safe and effective birth control methods available.

The choice of method is a personal decision based on many factors, such as a person’s lifestyle and medical history. Other considerations include risks and benefits of a method, sexually-transmitted infection (STI) prevention, how the method is administered, and whether it requires a health care provider. According to a recent survey, the most important attributes of birth control identified by women were efficacy and side effects.

The leading method of contraception in the US is the oral contraceptive pill (OCP). Most OCPs fall under the category of “combination hormonal” methods, which deliver a combination of estrogen and progestin. OCPs must be taken daily at the same time and are 99%* effective with ideal use. Other combination hormonal options with similar efficacy to the pill but different modes of delivery include the vaginal ring and the patch.

The intrauterine device (IUD) is the most common form of contraception used worldwide, as well as the most cost-effective in the long-run. It is a small, T-shaped device that is inserted into the uterus and left in place for a number of years, depending on the type used. Its efficacy is >99% and it lacks the risk of user error.

There are also progestin-only forms of birth control available for women who cannot take estrogen or are breastfeeding. These include the Mirena IUD, progestin-only pills, implants (matchstick-sized rods inserted into the arm for up to 3 years), and shots (hormones administered every 3 months).

There has been recent concern regarding the risk of blood clots associated with certain hormonal birth control methods. This risk is mainly related to the dosage of estrogen, as well as to the newer types of progestins (desogestrel and drospirenone). However, the absolute risk of blood clot is still extremely low while on a hormonal OCP. If you have a genetic predisposition to blood clots or are a smoker over the age of 35, you may be at increased risk of blood clot and should consider a progestin-only or non-hormonal birth control method.

Another common form of birth control in the US is female sterilization. This is a minor surgical procedure that permanently closes the fallopian tubes, thereby preventing sperm access to the eggs. Vasectomy, or male sterilization, is also a minor surgical procedure which involves permanently sealing the vas deferens, or the tube which allows ejection of sperm.

Barrier methods, such as condoms, are effective when used correctly, especially in combination with spermicide, and provide the additional benefit of protecting against STIs. Barrier methods are generally less reliable forms of birth control due to the risk of incorrect and inconsistent use.

You can visit the Planned Parenthood website listed below to learn more about your birth control options. If you are interested in initiating or changing your method of contraception, feel free to discuss your options with your doctor.

*Efficacy numbers cited are per year (e.g., 99% efficacy signifies 1 pregnancy per 100 users per year of use). Ideal use refers to use as directed, while typical use efficacy is generally lower for methods that require adherence such as OCPs or condoms (e.g., for OCPs, typical use efficacy is 92%).

Resources:

  • Centers for Disease Control and Prevention: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/
  • Guttmacher Institute: http://www.guttmacher.org/pubs/fb_contr_use.html
  • Planned Parenthood: http://www.plannedparenthood.org/health-topics/birth-control-4211.htm
  • Rott H. Contraception, venous thrombosis and biological plausability. Minerva Med. 2013 Apr;104(2):161-7.
  • Wyatt KD et al. Women's values in contraceptive choice: a systematic review of relevant attributes included in decision aids. BMC Womens Health. 2014 Feb 13;14(1):28

Meet the Author

Aditi (Asha) Springstubb, M.D.

Specialty: Internal Medicine
Areas of Interest: Reproductive Healthcare & Weight Management

Dr. Springstubb is an internist at Hoag Medical Group. By nature, she is enthusiastic and compassionate, which is evident in her approach to practicing medicine. She is located at the Hoag Health Center in Newport Beach. View Bio [+]