Birth Control
Learn what contraceptives are available in the U.S.,
their risks and their benefits
The following contains a brief explanation of various forms of contraceptives available for use in this country. Should you have any specific questions, please call our office for an appointment to review in further detail which contraceptive choice would be right for you. Listed are a brief description of the device with risks and benefits. Also included is information about the failure rate of each method. This rate represents the number of pregnancies that occur when 100 women use the method for a full year.
ALL ABOUT INTRAUTERINE DEVICES FOR CONTRACEPTION (IUDs)
WHAT TO DO IF YOU'VE MISSED TAKING YOUR PILLS
Male Condom
Latex/Polyurethane
Description: A sheath placed over the erect penis blocking the passage of sperm.
Failure Rate: (number of pregnancies expected
per 100 women per year): 11
Some Risks: Irritation and allergic reactions (less likely with polyurethane)
Protection from Sexually Transmitted Diseases (STDs): Except for abstinence, latex condoms are the best protection against STDs, including gonorrhea and AIDS.
Convenience: Applied immediately before intercourse; used only once and discarded. Polyurethane condoms are available
for those with latex sensitivity.
Female Condom
FDA Approval Date: 1993
Description: A lubricated polyurethane sheath
shaped similarly to the male condom. The closed end has a flexible ring that is inserted into the vagina.
Failure Rate: (number of pregnancies expected
per 100 women per year): 21
Some Risks: Irritation and allergic reactions
Protection from Sexually Transmitted Diseases (STDs): May give some STD protection; not as effective as latex condom
Convenience: Applied immediately before intercourse; used only once and discarded.
Diaphragm with Spermicide
Description: A dome-shaped rubber disk with a flexible rim that covers the cervix so that sperm cannot reach the uterus. A spermicide is applied to the diaphragm before insertion.
Failure Rate: (number of pregnancies expected
per 100 women per year): 17
Some Risks: Irritation and allergic reactions, urinary tract infection. Risk of toxic shock syndrome, a rare but serious infection, when kept in place longer than recommended.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted before intercourse and left in place at least six hours after; can be left in place for 24 hours, with additional spermicide for repeated intercourse.
Availability: Prescription
Cervical Cap with Spermicide
FDA Approval Date: 1988
Description: A soft rubber cup with a round rim, which fits snugly around the cervix.
Failure Rate: (number of pregnancies expected
per 100 women per year): Prentiff Cap–17; FemCap–23
Some Risks: Irritation and allergic reactions,
abnormal Pap test. Risk of toxic shock syndrome, a rare
but serious infection, when kept in place longer than recommended.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: May be difficult to insert; can remain in place for 48 hours without reapplying spermicide for
repeated intercourse.
Availability: Prescription
Sponge with Spermicide
Received FDA approval in 1983
Description: A disk-shaped polyurethane device
containing the spermicide nonoxynol-9.
Failure Rate: (number of pregnancies expected
per 100 women per year):
14-28
Some Risks: Irritation and allergic reactions, difficulty in removal. Risk of toxic shock syndrome, a rare but serious infection, when kept in place longer than recommended.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted before intercourse and protects for repeated acts of intercourse for 24 hours without additional spermicide; must be left in place for at least six hours after intercourse; must be removed within 30 hours of insertion. Is discarded after use.
Availability: Nonprescription; not currently marketed
Spermicide Alone
Description: A foam, cream, jelly, film, suppository,
or tablet that contains nonoxynol-9, a sperm-killing chemical
Failure Rate: (number of pregnancies expected
per 100 women per year):
20-50 (studies have shown varying effectiveness rates)
Some Risks: Irritation and allergic reactions,
urinary tract infections
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Instructions vary; check the labeling.
Inserted between 5 and 90 minutes before intercourse and usually left in place at least six to eight hours after.
Availability: Nonprescription
Oral Contraceptives combined pill
FDA Approval Date: 1960; most recently in 2003
Description: A pill that suppresses ovulation by the combined actions of the hormones estrogen and progestin. A chewable form was approved in November 2003.
Failure Rate: (number of pregnancies expected
per 100 women per year): 1-2
Some Risks: Dizziness; nausea; changes in menstruation,
mood, and weight; rarely, cardiovascular disease, including high blood pressure, blood clots, heart attack, and strokes
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken on daily schedule, regardless of frequency of intercourse. Women using the chewable tablet must drink 8 oz. of liquid immediately after taking.
Availability: Prescription
Oral Contraceptives progestin-only
mini-pill
FDA Approval Date: 1973
Description: A pill containing only the hormone progestin that reduces and thickens cervical mucus to prevent
the sperm from reaching the egg.
Failure Rate: (number of pregnancies expected
per 100 women per year): 2
Some Risks: Irregular bleeding, weight gain,
breast tenderness, less protection against ectopic pregnancy
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken on daily schedule, regardless of frequency of intercourse.
Availability: Prescription
Oral Contraceptives
91-day regimen (Seasonale)
FDA Approval Date: 2003
Description: A pill containing estrogen and progestin, taken in 3-month cycles of 12 weeks of active pills followed by one week of inactive pills. Menstrual periods occur
during the 13th week of the cycle.
Failure Rate: (number of pregnancies expected
per 100 women per year): 1-2
Some Risks: Similar to oral contraceptives–combined pill
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken on daily schedule, regardless of frequency of intercourse. Since users will have
fewer periods, they should consider the possibility that they might be pregnant if they miss scheduled periods. May have more unplanned bleeding and spotting between periods than with
28-day oral contraceptives.
Availability: Prescription
Patch
(Ortho-Evra)
FDA Approval Date: 2001
Description: Skin patch worn on the lower abdomen,
buttocks, or upper body that releases the hormones progestin and estrogen into the bloodstream.
Failure Rate: (number of pregnancies expected
per 100 women per year): 1-2 (Appears to be less effective in
women weighing more than 198 pounds.)
Some Risks: Similar to oral contraceptives–combined pill
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: New patch is applied once a week
for three weeks. Patch is not worn during the fourth week, and woman has a menstrual period.
Availability: Prescription
Vaginal Contraveptive Ring (Nuvaring)
FDA Approval Date: 2001
Description: A flexible ring about 2 inches in diameter that is inserted into the vagina and releases the hormones progestin and estrogen.
Failure Rate: (number of pregnancies expected
per 100 women per year): 1-2
Some Risks: Vaginal discharge, vaginitis, irritation.
Similar to oral contraceptives–combined pill
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted by the woman; remains in the vagina for 3 weeks, then is removed for 1 week. If ring is expelled and remains out for more than 3 hours, another birth control method must be used until ring has been used continuously
for 7 days.
Availability: Prescription
Injection
(Depo-Provera)
FDA Approval Date: 1992
Description: An injectable progestin that inhibits
ovulation, prevents sperm from reaching the egg, and prevents the fertilized egg from implanting in the uterus.
Failure Rate: (number of pregnancies expected
per 100 women per year):
less than 1
Some Risks: (serious medical risks from contraceptives
are rare): Irregular bleeding, weight gain, breast tenderness,
headaches
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: One injection every three months.
Availability: Prescription
Injection
(Lunelle)
FDA Approval Date: 2000
Description: An injectable form of progestin and estrogen
Failure Rate: (number of pregnancies expected
per 100 women per year):
less than 1
Some Risks: Changes in menstrual cycle, weight
gain. Similar to oral contraceptives–combined.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Injection given once a month.
Availability: Prescription
IUD
(Intrauterine Device)
FDA Approval Date: 1976
Description: A T-shaped device inserted into the uterus by a health professional.
Failure Rate: (number of pregnancies expected
per 100 women per year):
less than 1
Some Risks: Cramps, bleeding, pelvic inflammatory disease, infertility, perforation of uterus.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: After insertion by physician, can remain in place for up to one or 10 years, depending on type
(Up to 5 years for Mirena and 10 years for Paraguard).
Availability: Office Procedure
Male Vasectomy
Description: Sealing, tying, or cutting a man’s vas deferens so that the sperm can’t travel from the testicles
to the penis.
Failure Rate: (number of pregnancies expected
per 100 women per year):
less than 1
Some Risks: (serious medical risks from contraceptives
are rare) Pain, bleeding, infection, other minor post-surgical complications
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: One-time surgical procedure.
Availability: Office Procedure
Periodic Abstinence
Description: To deliberately refrain from having sexual intercourse during times when pregnancy is more likely.
Failure Rate: (number of pregnancies expected
per 100 women per year): 20
Some Risks: None
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Requires frequent monitoring of
body functions (for example, body temperature for one method).
Availability: Instructions from health-care provider
Laparoscopic
Tubal Sterilization
Description: The woman’s fallopian tubes are blocked so the egg and sperm can’t meet in the fallopian tube, preventing conception.
Failure Rate: (number of pregnancies expected
per 100 women per year):
less than 1
Some Risks: Pain, bleeding, infection, other post-surgical complications, ectopic (tubal) pregnancy.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: One-time surgical procedure that
requires an abdominal incision.
Availability: Surgery
IUDs
The IUD procedure is common and done frequently by all of our practitioners
IUDs are now more commonly used and are generally well tolerated. We insert the IUDs with or without local anesthetic after cleansing the cervix (to reduce the chance of infection) with an Iodine based solution. Most women who have had vaginal deliveries tolerate the insertion very well even without local anesthetic because the cervix is slightly more dilated compared to women who have had cesarean sections or no prior deliveries at all. The actual insertion takes less than 15 seconds, and removal of the device when pregnancy is desired takes 1 second. You may experience some mild cramping following the procedure that Advil should treat very effectively.
Following are comments I’ve heard from many patients, and facts that will hopefully make you feel more comfortable with choosing an IUD for contraception:
I HEARD IUD’s WERE DANGEROUS!
As you consider the possibility of choosing the intrauterine device for contraception, you should understand its history as well. The rise in popularity of the IUD has occurred in the face of great conflict. There have been many myths and misconceptions associated with today’s IUD. In the 1970s, an IUD called the Dalkon shield was manufactured and subsequently taken off the market due to its contribution to a huge increase in pelvic infections that sometimes resulted in permanent infertility. As it turned out, a manufacturing flaw caused these infections.
The Dalkon shield consisted of main circular part that rested in the uterus. Like most other IUD’s, a thread was attached to this main part. This “tail” ran through the cervix and protruded slightly into the vagina. The purpose of this thread was simply to provide a means of confirming its presence and to facilitate an easy removal. For this particular IUD, however, a braided multi-filament thread was used. This gave bacteria in the vagina an opportunity to “wick” (climb) up the thread in all of its cracks and crevices into the uterus. After this was discovered, the Dalkon shield was taken off the market, and all subsequent IUDs were manufactured with a monofilament thread. The monofilament tail prevents bacteria from gaining access into the intrauterine cavity, thus virtually eliminating the opportunity for developing an infection.
DOESN'T IT WORK BY CAUSING ABORTION?
Previously it had been thought that the IUD worked by preventing implantation of fertilized eggs. Having studied this issue in depth, we now know that the mechanism of action of an IUD is almost completely spermicidal. The way this was discovered is very interesting. Researchers took a group of women desiring permanent sterilization by tubal ligation, and divided them into two groups. In one group, IUD’s were placed for a time prior to the surgical sterilization procedure. On the morning of their tubal ligation procedure, the women in both groups had “unprotected” intercourse. During the actual sterilization procedure, physicians irrigated the intrauterine cavity and the contents of the irrigant were studied microscopically. In addition, the contents within the resected segments of fallopian tubes were inspected microscopically, as well. What they discovered was interesting. In the group that did not have the IUD, they found living, motile (moving) sperm in both the uterine cavity irrigant and the fallopian tube segment, just as one would expect. In the group that did have the IUD, they found dead sperm in the uterine cavity irrigant, and NO sperm in the fallopian tube segment. Upon further research, they discovered that the device causes swelling in the endometrial cells lining the uterus. This sterile inflammatory reaction causes these cells to burst and release lysozymes, a spermicidal substance.
WHAT ABOUT THE RISK OF INFECTION?
The risk of infection related to IUD use is most prominent within the first 20 days and usually associated with contamination during the insertion process. Following the first twenty days, the risk of infection is limited so long as patients who utilize this form of contraception are monogamous. In women with multiple sexual partners, it has been found that there is an increased risk of infection . As a result, we typically reserve the IUDs for women in stable, monogamous relationships.
WHAT ARE SIDE EFFECTS OF THE TWO DIFFERENT IUDS?
Some side effects associated with the IUD depend on what type is used. There are currently two different IUD devices marketed in the U.S. One is made of inert copper and plastic, and the other is made of plastic and a silastic capsule containing a progesterone hormone called levonorgestrel. Both types of IUDs may cause cramping for a variable amount of time. The biggest distinction between the two is regarding the impact on menstrual bleeding. The copper & plastic IUD, or Paraguard device is associated with heavier bleeding during menstrual cycles. However, this should be put into perspective. If a woman has previously been on birth control pills (which generally lighten flow) and then uses the Paraguard IUD, she may note that her periods are heavier. In women who use other non-hormonal types of contraception, they may not notice such a dramatic increase in flow. The bleeding side effects may be offset, somewhat, by knowing that the Paraguard device may be used for up to 10 years. The Mirena IUD in contrast, is associated with up to a 90% reduction in menstrual flow. In fact, 20% of users will completely stop having periods. We now know that having menses very light or absent in this situation is not harmful. The Mirena, unlike the Paraguard, is effective for 5 years, at which time it should be replaced.
HOW EFFECTIVE IS THE IUD IN PREVENTING PREGNANCY?
The IUD method of birth control is as effective in preventing pregnancy as birth control pills when used correctly, or tubal ligation, or vasectomy. The Paraguard IUD is FDA-approved to remain in the uterus for up to ten years before removal is mandated. The Mirena is FDA-approved for 5 years before removal is recommended. As soon as the device is removed, conception can take place as soon as the sterile inflammatory response resolves which is usually very quickly (a few days to weeks).
The one drawback to the IUD is its expense. Insurance companies oftentimes will cover either the device or the insertion, although sometimes they cover both the device and the insertion and sometimes they cover neither one. The fee for both the device and insertion can range from $450.00 to $500.00. Compared to the cost of birth control pills, the IUD would pay for itself in approximately 13 to 14 months. We have found more recently that most insurance companies are paying for the device and insertion. Nevertheless, please call your insurance company and inquire whether they reimburse for this service. If you have any questions regarding the IUD, please call our office.
Missed Pills
A step-by-step plan on what to do
IF YOU MISS 1 ACTIVE PILL:
-
Take it as soon as you remember. Take the next pill at your regular time. This means you may take 2 pills in
1 day. -
You do not need to use a backup birth control method if you have sex.
IF YOU MISS 2 ACTIVE PILLS IN A ROW IN WEEK 1
OR WEEK 2:
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Take 2 pills on the day you remember and 2 pills the next day.
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Then take 1 pill a day until you finish the pack.
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You COULD BECOME PREGNANT if you have sex in the 7 days after you miss pills. You must use another birth control method (such as condoms or spermicide) as a back-up method for those 7 days.
IF YOU MISS 2 ACTIVE PILLS IN A ROW IN THE 3RD WEEK:
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If you are a Sunday starter, keep taking 1 pill every day until Sunday. On Sunday, THROW OUT the rest of the pack and start a new pack of pills that same day.
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If you are a Day 1 starter, THROW OUT the rest of the pill pack and start a new pack that same day.
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You may not have your period this month but this is expected. However, if you miss your period 2 months in a row, call the office because you may be pregnant.
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You COULD BECOME PREGNANT if you have sex in the 7 days after you miss pills. You MUST use another birth control method (such as condoms or spermicide) as a back-up method for those 7 days.
IF YOU MISS 3 OR MORE ACTIVE PILLS IN A ROW DURING
THE FIRST 3 WEEKS:
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If you are a Sunday starter, keep taking 1 pill every day until Sunday. On Sunday, THROW OUT the rest of the pack and start a new pack of pills that same day.
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If you are a Day 1 starter, THROW OUT the rest of the pill pack and start a new pack that same day.
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You may not have your period this month but this is expected. However, if you miss your period 2 months in a row, call the office because you may be pregnant.
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You COULD BECOME PREGNANT if you have sex in the 7 days after you miss pills. You MUST use another birth control method (such as condoms or spermicide) as a back-up method for those 7 days.
IF YOU FORGET ANY OF THE 7 PLACEBO PILLS IN WEEK 4:
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THROW AWAY the pills you missed.
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Keep taking 1 pill each day until the pack is empty.
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You do not need to use a back-up method.
If you’re having an urgent issue, please call us.
Call Main Office