Short-Acting Hormonal Methods

Short-acting hormonal methods are highly effective if used perfectly, but in typical use, they have a range of failure rates.

• Injectable birth control or “shot”
  • Depo-Provera® is injected into the arm or buttocks once every 3 months.
  • About 96% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Side Effects
    • Irregular bleeding in the first year
    • Weight gain in the first year
    • No period after a year
    • After you stop the shot, it may take several months before you are able to get pregnant
• Progestin-only pill (POP) – The Mini Pill
  • A pill with one hormone, progestin, that is taken daily to interfere with ovulation or sperm function by thickening cervical mucus, making it difficult for sperm to swim into the uterus or enter the fallopian tube.
  • About 91% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Side Effects
    • Irregular bleeding
    • Nausea
    • Breast tenderness
    • Headache
    • It is not common, but some women who take the pill develop high blood pressure

Combined Hormonal Methods

Combined hormonal methods contain a synthetic estrogen and work to by inhibiting ovulation and thickening cervical mucus.

• Combined oral contraceptives – The Pill
  • A pill taken daily that has two hormones (estrogen and a progestin) to stop ovulation by thickening the cervical mucus, keeping the sperm from fertilizing the egg
  • About 91% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Side Effects
    • Spotting or bleeding between periods
    • Nausea
    • Breast tenderness
    • Headache
    • It is not common, but some women who take the pill develop high blood pressure
    • It is rare, but some women will have blood clots, heart attacks, or strokes
• Vaginal Ring – NuvaRing®
  • A flexible 2-inch ring that releases two hormones, progestin and estrogen, to stop the ovaries from releasing eggs by thickening the cervical mucus to keep sperm from getting to the egg
  • You insert the ring into your vagina and keep it there for 3 weeks, then take it out for 1 week during your menstrual period
  • About 91% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Side Effects
    • Vaginal discharge, discomfort in the vagina, and mild irritation.
    • Headache
    • Mood changes
    • Nausea
    • Breast tenderness
    • It is not common, but some women who take the pill develop high blood pressure.
    • It is rare, but some women will have blood clots, heart attacks, or strokes.

Long-Acting Reversible Contraceptives (LARC) offer a birth control method that lasts for several years. If you are ready to get pregnant, you can stop using them at any time.

Intrauterine Methods

• Hormonal IUD or IUS
  • A T-shaped device that contain progestin and is inserted into the uterus by a healthcare provider. 
  • It thickens the mucus of the cervix, making it harder for sperm to get to the egg, and also thins the lining of the uterus
  • It can be used for up to 3 to 5 years, depending on the type
  • When it is removed, it is possible to get pregnant
  • About 99% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Common Side Effects
    • Irregular bleeding
    • No periods (amenorrhea)
    • Abdominal/pelvic pain
  • Less Common Side Effects
    • Pelvic inflammatory disease
    • Severe infection
    • Ectopic Pregnancy
    • Uterine perforation
    • Expulsion – the IUD is no longer in the uterus and therefore there is no pregnancy protection
    • Ovarian cysts
• Copper IUD
  • A T-shaped device containing copper that is inserted into the uterus by a healthcare provider. 
  • It prevents sperm from reaching the egg, from fertilizing the egg, and may prevent the egg from attaching in the womb (uterus)
  • It does not stop the ovaries from making an egg (ovulating) each month
  • It can be used for up to 10 years
  • When it is removed, it is possible to get pregnant
  • About 99% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Common Side Effects
    • Cramps
    • Heavier, longer periods or spotting between periods.
  • Less Common Side Effects
    • Pelvic inflammatory disease
    • Ectopic pregnancy (a pregnancy outside of the uterus) 
    • Uterine perforation
    • Expulsion – the IUD is no longer in the uterus and therefore there is no pregnancy protection

Implant Method

• Implantable Rod – Nexplanon®
  • A thin rod, the size of a matchstick, that contains progestin and is put under the skin on the inside of your upper arm by a healthcare provider
  • It stops the ovaries from releasing eggs (ovulation) and thickens the cervical mucus, which keeps sperm from getting to the egg
  • It can be used for up to 3 years
  • About 99% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Common Side Effects
    • Changes in menstrual bleeding patterns
    • Weight gain
    • Headache
    • Acne
  • Less Common Side Effects
    • Complication of insertion and removing including pain, bleeding, scarring, infection or movement of the implant to another part of the body.
    • Ectopic pregnancy
    • Ovarian cysts
    • It is rare but some women will have blood clots, heart attacks or strokes

Barrier methods block sperm from reaching the egg.

• Diaphragm with Spermicide
  • A dome-shaped flexible disk made of silicone that covers the cervix 
  • You add a spermicidal jelly, cream, or foam on the inside of the diaphragm and then insert it into the vagina before having sex (spermicide must be added to the diaphragm every time you have sex)
  • You must keep the diaphragm in place for at least 6 hours after having sex, and it can be left in place for up to 24 hours
  • There are varying sizes, so your healthcare provider will need to do an exam to determine the right size for you
  • If you have a child or lose more than 15 pounds, you may need a different size diaphragm
  • About 88% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Common Side Effects
    • Irritation
    • Allergic reactions
    • Urinary tract infection
    • Spermicides containing N9 (nonoxynol-9) can irritate the vagina and rectum
    • Spermicides containing N9 (nonoxynol-9) may increase the risk of getting HIV (the virus that causes AIDS) from an infected partner
  • Less Common Side Effects
    • If you keep it in place longer than 24 hours, there is a risk of toxic shock syndrome, a rare but serious infection
• Cervical Cap with Spermicide
  • A soft latex or silicone cup with a round rim that snugly fits around the cervix
  • You put spermicide inside the cap and then insert the cap into the vagina before having sex 
  • You do NOT need to use more spermicide each time you have sex
  • You must leave the cap in for at least 6 hours after having sex and you may leave it in for up to 48 hours
  • It comes in varying sizes so your healthcare provider will help determine the right size for you
  • It can be used for up to 2 years before needing replaced
• About 86% effective at preventing pregnancy for those who have never given birth; About 71% effective for those who have given birth
• Does not protect from STIs – consider adding a condom to prevent STIs
• Common Side Effects
  • Irritation
  • Allergic reactions
  • Abnormal Pap test
  • Spermicides containing N9 (nonoxynol-9) can irritate the vagina and rectum
  • Spermicides containing N9 (nonoxynol-9) may increase the risk of getting HIV (the virus that causes AIDS) from an infected partner
• Less Common Side Effects
  • If you keep it in place longer than 48 hours, there is a risk of toxic shock syndrome, a rare but serious infection
• Spermicides Alone
  • A foam, cream, jelly, film, or tablet that you insert into the vagina between 5 to 90 minutes before you have sex
  • It should be left in place for 6 to 8 hours after sex; do not douche or rinse the vagina for at least 6 hours after sex
  • Read the instructions on the label prior to use because they may vary for each type of spermicide
  • For better protection, use with a condom, diaphragm, or cervical cap
  • About 72% effective at preventing pregnancy
  • Does not protect from STIs – consider adding a condom to prevent STIs
  • Common Side Effects
    • Irritation
    • Allergic reactions
    • Urinary tract infection
    • If you are also using a medicine for a vaginal yeast infection, the spermicide might not work as well
    • Spermicides containing N9 (nonoxynol-9) can irritate the vagina and rectum
    • Spermicides containing N9 (nonoxynol-9) may increase the risk of getting HIV (the virus that causes AIDS) from an infected partner
• Male Condom (external condom)
  • A thin film sheath placed over the erect penis
  • Pull out before the penis softens and hold the condom against the base of the penis before pulling out
  • Use once and throw away after use
  • About 82% effective at preventing pregnancy
  • Consistent and correct use of the male latex condom reduces the risk of STIs
    • The condom cannot provide absolute protection against STIs
    • Use every time you have sex
    • Can be used with other forms of birth control
  • Common Side Effects
    • Irritation
    • Allergic reactions (If you are allergic to latex, you can try condoms made of polyurethane)

• Female Condom (internal condom)
  • A thin, lubricated pouch made with a nitrile (non-latex) sheath, a larger outer ring, and a polyurethane inner ring that you insert into the vagina before having sex
  • Follow directions carefully to be sure the penis stays within the condom and does not move outside the condom during sex
  • About 79% effective at preventing pregnancy
  • When used in the vagina, the female condom reduces the risks of STIs
    • The condom cannot provide absolute protection against STIs
  • Common Side Effects
    • Discomfort or pain during insertion or sex
    • Burning sensation, rash or itching

Emergency contraception can be used after unprotected intercourse or if a condom breaks.

• Copper IUD
  • This device can be inserted within 5 days of having unprotected sex
  • It is nearly 100% effective at preventing pregnancy
     
• Emergency Contraceptive Pills
  • A pill that blocks the hormone progesterone, working mainly by stopping or delaying the ovaries from releasing an egg, and also may change the lining of the womb (uterus) that may affect attachment
  • It can be taken up to 5 days after having unprotected sex (the sooner the pill is taken, the better it will work)
  • Around 57% to 94% effective at stopping pregnancy
  • Does not prevent STIs
  • Side effects
    • Headache
    • Nausea
    • Abdominal pain
    • Menstrual pain
    • Tiredness
    • Dizziness

There are other means for preventing pregnancy that do not involve taking medication or using devices. DHD#10 can provide more information and referrals.

• Abstinence – Not Right Now – Outercourse
  • You can choose not to have sex right now. This works 100% of the time to prevent unwanted pregnancies and STIs.
  • Outercourse is sexual activity that does not involve vaginal sex, thus preventing pregnancy by keeping semen away from the vagina so that it cannot get to an egg
• Withdrawal Method
  • When a person pulls their penis out of a vagina and ejaculates away from the vulva
  • About 78% effective at preventing pregnancy
• Fertility Awareness-Based Methods
  • Natural family planning that involves tracking your menstrual cycle to determine the days of ovulation when you can get pregnant
  • It involves planning, monitoring, and record-keeping
  • You must not have sex for at least a week during each menstrual cycle
  • Three main methods
    • Standard days: Tracking your periods
    • Cervical mucus: Observing your cervical mucus every day
    • Basal body temperature: Taking your temperature every day
  • About 77% to 98% effective at preventing pregnancy
• Sterilization Implant (not offered at DHD#10 – can refer)
  • A non-surgical method for permanently blocking the fallopian tubes
  • A healthcare provider threads a thin tube through the vagina and into the uterus to place a soft, flexible insert into each fallopian tube causing scar tissue to form around the inserts over the next 3 months
  • After 3 months, the healthcare provider will conduct a test to see that the scar tissue has fully blocked the fallopian tubes
  • Consider using a backup birth control method until tests show the tubes are fully blocked
• Female Sterilization—Tubal ligation or “tying tubes” (not offered at DHD#10 – can refer)
  • A surgery that involves a few different methods
    • Tying and cutting the fallopian tubes
    • Sealing them using an electric current
    • Closing them with clips, clamps or rings
    • Removing a small piece of the tube
  • About 99.5% effective – Out of 100 women, less than 1 may get pregnant
  • Side effects
    • Pain
    • Bleeding
    • Infection or other complications after surgery
• Male Sterilization–Vasectomy (not offered at DHD#10 – can refer)
  • A surgery that blocks a man’s vas deferens (the tubes that carry sperm from the testes) – after surgery, the semen has no sperm in it
  • It takes about 3 months to clear sperm from a man’s system so use another form of birth control until tests show there is no longer sperm in the seminal fluid
  • About 99.5% effective – Out of 100 women, less than 1 may get pregnant
    • The success of reversal surgery depends on:
      • The length of time since the vasectomy was performed
      • Whether or not antibodies to sperm have developed
      • The method used for vasectomy
      • Length and location of the segments of vas deferens that were removed or blocked
  • Some risks include:
    • Pain
    • Bleeding
    • Infection