If you’re sexually active and don’t want to get pregnant right now, you’re going to need birth control. Understanding what your options are, and how to access them, can help you lead the life you want with less risk of unintended pregnancy or sexually transmitted infections.
There are a lot of options on the table for preventing pregnancy these days. Finding the right one means taking some time to learn about your options.
Lizette Caldera, the health promotion and outreach manager for women’s health with AltaMed Health Services in Los Angeles, says that a lot of different factors can influence your choice of the right birth control method for you. “Knowing how the methods work, their efficacy and talking to a primary care provider can help individuals choose the right birth control method for them.”
[READ: 7 Things to Know About Home Pregnancy Testing.]
Common Forms Reversible of Birth Control
Dr. Meera Shah, the chief medical officer of Planned Parenthood Hudson Peconic in New York, says that “birth control is not one-size-fits-all. There are many contraceptive options and their effectiveness rate depends on use and if it’s used correctly.”
Commonly available contraceptives can be sorted into several types:
— Long-acting reversible contraceptives.
— Hormonal contraceptives.
— Barrier methods.
— Behavioral methods.
— Sterilization.
[READ: What Is TFMR? Termination of Pregnancy for Medical Reasons.]
Long-Acting Reversible Contraceptives
Also called LARCS, these options include implanted devices such as Nexplanon, as well as hormonal or nonhormonal intrauterine devices, or IUDs. The Nexplanon implant “is a small rod that’s inserted under the skin of the upper arm,” Caldera explains. It’s 99% effective at preventing pregnancy and lasts up to three years, according to Nexplanon’s site.
An IUD, is a “T-shaped device that’s placed inside the uterus.” It’s also 99% effective and can last between three and 12 years, depending on the type. Both IUDs and birth control implant devices must be inserted by a medical professional.
Both hormonal IUDs and implants release hormones that prevent your from becoming pregnant, Caldera explains. “These hormones can help prevent a pregnancy by thickening the cervical mucus to stop sperm from reaching an egg, and can help prevent the release of eggs cells from leaving the ovaries,” — a process knowns as ovulation.
But not all IUDs contain hormones. Some devices, like the nonhormonal copper IUD Paragard, “work by creating a hostile environment for sperm inside the uterus.” The copper in the device causes an inflammatory response that’s toxic to sperm, disrupting its ability to fertilize an egg.
Shah notes that IUDs are “one of the most effective methods available, with a 99% effectiveness rate.”
Both IUDs and the implant provide long-term protection from pregnancy — up to 10 years depending on the device. “However, a health care provider can remove these birth control methods sooner if a person wishes to do so,” Caldera says. One reason these methods are so effective is that IUDs and implants are not user dependent meaning you do not need to remember to do anything once it is in place.
[Read: Top Pharmacist-Recommended Women’s Health Medicines]
Hormonal Contraceptives
While some IUDs contain hormones, generally speaking, hormonal contraceptives typically refers to:
— Birth control pills.
— Patches.
— Shots.
— Vaginal ring.
Birth Control Pills
Birth control pills are about 91% effective and are taken daily.
Patches
Transdermal patches release hormones via the skin to prevent pregnancy. This method is 91% effective and must be replaced weekly.
Shots
Depo-Provera is an injected form of hormones that prevent pregnancy. The birth control shot is 94% effective and has to be administered every three months.
Vaginal ring.
The birth control vaginal ring is 91% effective, and it has to be replaced — removed and put in a new one — once a month.
In all of these methods, hormones cause a number of changes to the body, including:
— Thickening the lining of the uterus, which prevents the implantation of a fertilized egg.
— Stopping or reducing ovulation, which is the release of an egg from an ovary.
— Encouraging thickening of cervical mucus to prevent sperm from entering the uterus.
“These hormonal methods of birth control must be used consistently and repeatedly, and require a prescription from a health care provider,” Caldera explains.
Hormonal contraceptives range in efficacy from 91% to 99% depending on the type and how well their users follow the instructions.
Barrier Methods
If you’re not too keen on using hormones or having a semi-permanent device implanted in the body, there are some less-permanent barrier methods that can help prevent pregnancy. These include:
— Condoms.
— Diaphragm.
— Sponge.
— Cervical cap.
— Phexxi.
Condoms
Condoms are thin sheaths of rubber that slide over the penis prior to penetrative sex. There is also an internal condom, or a female condom, that can be used by women. The internal condom goes inside the vagina and prevents sperm from accessing the cervix.
Traditional condoms catch the male ejaculate, preventing sperm from getting into the vagina and cervix. Male and female condoms are the only method of birth control that can also help prevent sexually transmitted infections, such as HIV.
Shah notes that condoms are “98% effective at preventing pregnancy if used perfectly every time you have sex.” However, “people don’t always use them correctly, so with ‘typical use,’ they’re really about 85% effective. That means about 15 out of 100 people who use condoms as their only form of birth control will get pregnant each year.”
That being said, “even if your partner is on another form of birth control, condoms are essential because they are the only method of birth control that protects against STIs.”
Diaphragm
A diaphragm is a shallow, flexible cup that’s bent in half and inserted into the vagina. Inside, it opens up and covers the cervix, blocking entry for sperm. They’re typically used with spermicide and they’re 88% effective when used correctly. They need to be used every time you have intercourse.
Sponge
Birth control sponges are also inserted into the vagina before sex. They’re loaded with spermicide, which slows down or kills sperm. The sponge covers the cervix to prevent entry. When used correctly, they’re 79% to 88% effective. They have to be used every time.
Cervical Cap
Cervical caps are similar to diaphragms, in that it’s a bowl-shaped piece of soft silicone that’s inserted deep into the vagina to cover the cervix. They’re between 71% and 86% effective and must be used every time.
Phexxi
Caldera notes that the newest form of birth control, which the Food and Drug Administration approved for the prevention of pregnancy in 2020, is a nonhormonal birth control gel called Phexxi.. It’s used like a spermicide and is inserted into the vagina up to an hour before sex. “The gel works by maintaining an acidic pH level in the vagina and creating an inhospitable environment for sperm.” It’s 93% effective when used correctly.
Behavioral Methods
Changing when, how or whether you have sex to prevent pregnancy are considered behavioral methods of birth control. These include:
— Withdrawal.
— Fertility awareness.
— Abstinence.
Withdrawal
Also called the pull-out method, this approach means removing the penis from the vagina before ejaculation to prevent sperm from reaching an egg. It’s considered 78% effective when done correctly. It has to be repeated every time to prevent pregnancy.
Fertility Awareness Method
Also called natural family planning or the rhythm method, FAM means tracking your menstrual cycle so you know when you’re ovulating. If you’re not ovulating, an egg will not be available to be fertilized during sex. FAMs are 76% to 88% effective when done correctly.
Abstinence
Abstinence, or the act of not having intercourse, is the only 100% effective way of preventing pregnancy.
Sterilization
Sterilization, which means tubal ligation for women or a vasectomy for men, is a permanent form of birth control that’s over 99% effective. Such procedures are not intended to be reversed, but reversal procedures do exist. However, Caldera notes that sterilization reversal procedures “can be complicated, and fertility is not guaranteed.”
Emergency Contraception
In some instances, such as when a birth control method fails, emergency contraception may be an option for preventing pregnancy. These methods are offered as pills, sometimes called the “morning-after pill,” and they “help prevent pregnancy before it begins,” Caldera says.
Sperm can live inside the vagina for up to six days after sex. If you ovulate during that time period, it’s possible for the sperm that’s hanging around to fertilize the newly released egg. Emergency contraceptives derail that possibility by using either hormonal or nonhormonal means.
Hormone-based emergency contraceptive pills contain a hormonal medication called levonorgestrel, which prevents the release of an egg during ovulation. Brands include Plan B One-Step, Preventeza, My Way, Take Action, Option 2, AfterPill, My Choice, EContra and Aftera.
These are available over-the-counter at many pharmacies and drug stores. They work best when taken within 72 hours (three days) of unprotected sex, but the sooner you take them, the better they work. These pills may not be effective in people who weigh more than 165 pounds.
Ella is a type of nonhormonal emergency contraceptive pill. It contains ulipristal acetate, a drug that prevents ovulation. It’s a prescription-only drug and must be taken within five days to work. It may not work well if you weigh more than 195 pounds.
Both hormonal and non-hormonal of IUDs can also be used as an emergency contraceptive if they’re inserted within 120 hours (five days) of unprotected sex.
The sooner after sex these means can be used, the more effective they are. It’s important to note that if you’re already pregnant, emergency contraception won’t work. And it’s also worth pointing out that the morning-after pill is not the same thing as the abortion pill called mifepristone (formerly called RU-486), which induces a medication abortion.
Which One Is Best?
Determining which method of birth control is right for you depends on your lifestyle and preferences. “The best birth control option for users is one that they feel comfortable using consistently and correctly, in consultation with their health care provider,” Caldera says.
Things you should consider when choosing a birth control method include:
Motivation
Shah says it’s important to think about why you’ll be using birth control in the first place. “Is your priority pregnancy prevention, STI prevention, regulating your menstrual cycle, treating a health issue or something else altogether? You might have many reasons for starting birth control. Once you know what your goals are, you and your doctor can use that information to narrow down your options to birth control types that can meet your needs.”
Effectiveness
Some methods are more effective at preventing pregnancy than others and for some people, that’s critically important. For example, if you’re in a place in your life where becoming pregnant wouldn’t be totally unwelcome, you may be able to use a birth control method that’s less effective. If you live in a state where pregnancy termination is not an option, you should choose a method that is most effective.
Side Effects
Some forms of birth control have side effects. For example, some can change your menstrual periods, making them heavier or stopping them altogether. “Certain hormonal contraceptive methods can also have different side effects, including nausea and headaches,” Caldera says.
Websites such as Bedsider.org, the FDA and the Centers for Disease Control and Prevention offer detailed information about the efficacy and side effects of each method of birth control.
Preexisting Health Conditions
“If you are over a certain age and smoke or you have a history of blood clots, birth control with estrogen isn’t safe for you,” Shah notes. “Your doctor can help you figure out whether you have any habits or conditions that could make estrogen-containing birth control products — or any other forms of birth control — less than ideal options for you.”
Some hormonal methods of contraception, such as the hormonal IUD or implant, do not contain estrogen and may be used by women who are not able to use an option with estrogen.
Length of Use
“Considering whether or not you might want to get pregnant in the future might help you narrow down your options,” Shah explains. “A shorter-acting birth control method that’s easy to stop using — like the pill, patch or ring — might be a good fit if you’re considering getting pregnant in the near future. But if you want to wait a while (for example, several years), or if you never want to get pregnant, a longer-acting method — like an IUD or the implant — might be more appealing. These options last from three to 12 years, but aren’t permanent. When they’re removed, your fertility goes back to what it was, and you can have them removed at any time for any reason.”
Privacy
Some forms of birth control are less visible than others, which may be important for some users. For example, an IUD won’t be visible to your sexual partner while a condom will be.
Lifestyle
“Someone with an extremely busy schedule may have a hard time remembering to take their daily birth control pill every day,” Caldera says. Similarly, if you just prefer the idea of one type of birth control over another, that’s OK. “Some types of birth control require more work than others. Your preferences are valid because you want to be comfortable with the birth control method you choose.”
In all cases, Caldera recommends working with your health care provider to find the right fit. “Your health care provider can help determine the best birth control method based on the health history and your unique needs.”
How to Access Birth Control
If you’re looking to prevent pregnancy, there are a range of places you can go to get the help and information you need to make the right choice for you. “Local community clinics can be a great resource to learn more about contraception,” Caldera says.
Shah recommends visiting your nearest Planned Parenthood health center to speak with a provider. Planned Parenthood offers online resources that provide lots of information about the various types of birth control and a birth control quiz that can help you get started narrowing down your options. “Our health educators are also available via Chat/Text to help you think through your birth control options,” she says.
Planned Parenthood clinics offer a variety of reproductive health care services in addition to access to birth control, such as getting tested for an STI, finding an abortion provider or accessing routine health screenings such as a Pap smear.
While the recent Supreme Court decision that overturned Roe v. Wade was not specifically directed at birth control methods, “many professional and advocacy groups are concerned about the future of access to contraceptives, including emergency contraception and other types of restrictions on reproductive health care,” Caldera says.
She adds that in states where abortion is now or will likely become illegal “family planning providers are being forced to close their doors, limiting access to reproductive health care. These states may also face a shortage of physicians and other medical professionals who offer family planning services due to restrictions.” Low-income communities and communities of color are most likely to be impacted by these closures, she notes.
Shah adds that birth control isn’t “‘nice to have,’ it’s necessary. Nearly 9 in 10 women of reproductive age have used contraception, and nearly 9 in 10 adults agree that everyone deserves access to the full range of birth control methods — no matter who they are, where they live or what their economic status is. Right now, people are genuinely concerned about their sexual and reproductive health and their agency over their own bodies — and rightfully so.”
Not Just for Preventing Pregnancy
While birth control methods are usually used to prevent pregnancy, some of them have additional uses that may improve health or well-being for certain users. For example, some hormonal birth control methods can help regulate heavy or painful menstrual periods or prevent ovarian cysts. Some methods can help relieve symptoms of conditions like endometriosis, and some might even reduce the risk of developing certain kinds of cancer later in life, such as uterine, breast or ovarian cancer.
Birth control is also not just for cisgender, heterosexual couples. Members of the LGBTQ community may also experience benefits from using birth control even if they aren’t at risk of becoming pregnant. For example, some hormonal birth control methods can stop periods altogether, which could reduce gender dysmorphia for some trans men.
“Furthermore, latex condoms can also help protect users against sexually transmitted infections,” Caldera says, adding that no other birth control method offers this potential benefit. Preventing STIs is important no matter who your sexual partner is or the genders involved in the partnership.
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How to Get the Birth Control That’s Right for You originally appeared on usnews.com
Update 10/20/22: This story was previously published at an earlier date and has been updated with new information.
