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
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%).
- 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