Birth control methods fact sheet

This method is when you do not have sex or use a barrier method on the days you are most fertile (most likely to become pregnant). You can read about barrier methods in the following chart.

A woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. These fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation.

To have success with this method, you need to learn about your menstrual cycle. Then you can learn to predict which days you are fertile or "unsafe." To learn about your cycle, keep a written record of:

• When you get your period
• What it is like (heavy or light blood flow)
• How you feel (sore breasts, cramps)

This method also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it in a chart. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.

Contraceptive sponge

This barrier method is a soft, disk-shaped device with a loop for taking it out. It is made out of polyurethane (pah-lee-YUR-uh-thayn) foam and contains the spermicide (SPUR-muh-syd) nonoxynol-9. Spermicide kills sperm.

Before having sex, you wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24 hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must then be taken out within 30 hours after it is inserted.

Only one kind of contraceptive sponge is sold in the United States. It is called the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.

Diaphragm, cervical cap, and cervical shield

These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg.

• The diaphragm is a shallow latex cup.
• The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap.
• The cervical shield is a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix. It often is called by its brand name, Lea's Shield.

The diaphragm and cervical cap come in different sizes, and you need a doctor to "fit" you for one. The cervical shield comes in one size, and you will not need a fitting.

Before having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store.

All three of these barrier methods must be left in place for 6 to 8 hours after having sex to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield should be taken out within 48 hours.

Female condom

This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex.  Use a new condom each time you have intercourse. And don't use it and a male condom at the same time.

Male condom

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. And you need to use a new condom with each sex act.

Condoms are either:

• Lubricated, which can make sexual intercourse more comfortable
• Non-lubricated, which can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you use them for vaginal or anal sex. You can use a water-based lubricant, such as K-Y jelly. You can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break.

Keep condoms in a cool, dry place. If you keep them in a hot place (like a wallet or glove compartment), the latex breaks down. Then the condom can tear or break.

Oral contraceptives — combined pill ("The pill")

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the "extended cycle" pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don't contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.

Your doctor may advise you not to take the pill if you:

• Are older than 35 and smoke
• Have a history of blood clots
• Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

The patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Shot/injection

The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.  

Vaginal ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.

It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Implantable rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Intrauterine devices or IUDs

An IUD is a small device shaped like a "T" that goes in your uterus. There are two types:

• Copper IUD — The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.

• Hormonal IUD — The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.

Sterilization implant (essure)

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining.

It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.

Surgical sterilization

For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.

For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis.

Emergency contraception (Plan B One-Step or Next Choice. It is also called the "morning after pill.")

Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but it was used incorrectly, or did not work (like a condom breaking). Or, a woman may have forgotten to take her birth control pills. She also may have been abused or forced to have sex. These are just some of the reasons women may need emergency contraception.

Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within 72 hours after having unprotected sex.

A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages 17 and older.

Sterilization surgery for women

Less than 1 pregnancy

• Pain
• Bleeding
• Complications from surgery
• Ectopic (tubal) pregnancy

Sterilization implant for women
(Essure)

Less than 1 pregnancy

• Pain
• Ectopic (tubal) pregnancy

Sterilization surgery for men

Less than 1 pregnancy

• Pain
• Bleeding
• Complications from surgery

Implantable rod
(Implanon)

Less than 1 pregnancy

Might not work as well for women who are overweight or obese.

• Acne
• Weight gain
• Ovarian cysts
• Mood changes
• Depression
• Hair loss
• Headache
• Upset stomach
• Dizziness
• Sore breasts
• Changes in period
• Lower interest in sex

Intrauterine device
(ParaGard, Mirena)

Less than 1 pregnancy

• Cramps
• Bleeding between periods
• Pelvic inflammatory disease
• Infertility
• Tear or hole in the uterus

Shot/injection
(Depo-Provera)

Less than 1 pregnancy

• Bleeding between periods
• Weight gain
• Sore breasts
• Headaches
• Bone loss with long-term use

Oral contraceptives (combination pill, or "the pill") 

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.

• Dizziness
• Upset stomach
• Changes in your period
• Changes in mood
• Weight gain
• High blood pressure
• Blood clots
• Heart attack
• Stroke
• New vision problems

Oral contraceptives (continuous/extended use, or "no-period pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.

• Same as combination pill
• Spotting or bleeding between periods
• Hard to know if pregnant

Oral contraceptives (progestin-only pill, or "mini-pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.

• Spotting or bleeding between periods
• Weight gain
• Sore breasts

Skin patch
(Ortho Evra)

5 pregnancies

May not work as well in women weighing more than 198 pounds.

• Similar to side effects for the combination pill
• Greater exposure to estrogen than with other methods

Vaginal ring (NuvaRing)

5 pregnancies

• Similar to side effects for the combination pill
• Swelling of the vagina
• Irritation
• Vaginal discharge

Male condom

11-16 pregnancies

• Allergic reactions

Diaphragm with spermicide

15 pregnancies

• Irritation
• Allergic reactions
• Urinary tract infection
• Toxic shock if left in too long

Sponge with spermicide (Today Sponge)

16-32 pregnancies

• Irritation
• Allergic reactions
• Hard time taking it out
• Toxic shock if left in too long

Cervical cap with spermicide

17-23 pregnancies

• Irritation
• Allergic reactions
• Abnormal Pap smear
• Toxic shock if left in too long

Female condom

20 pregnancies

• Irritation
• Allergic reactions

Natural family planning (rhythm method)

25 pregnancies

None

Spermicide alone

30 pregnancies

It works best if used along with a barrier method, such as a condom.

• Irritation
• Allergic reactions
• Urinary tract infection

Emergency contraception ("morning-after pill," "Plan B One-Step," "Next Choice")

1 pregnancy

It must be used within 72 hours of having unprotected sex.

Should not be used as regular birth control; only in emergencies.

• Upset stomach
• Vomiting
• Lower stomach pain
• Fatigue
• Headache and dizziness
• Irregular bleeding
• Breast tenderness