Which birth control is right for me?

 There are numerous factors to consider when choosing a birth control method. They are certainly worth learning about if want to avoid pregnancy or contracting a sexually transmitted infection (STI). Out of every 100 couples who have regular sex for one year (without using birth control), an estimated 84 will become pregnant (1). With an abundance of options available, making a choice can be slightly overwhelming. You have likely heard stories from friends, sisters or online about experiences using different methods (cue some horror stories). Questions often arise such as, “which is right for me?”, “how effective are they?” and “are they safe?”. We are here to help!

There is no simple answer to what birth control option you should choose since each has its own downsides. There really is no “perfect” option or one-size-fits-all. It is about finding a good fit for you and your lifestyle. Making a birth control choice can be difficult, so speak with your healthcare provider to get personalised advice about which might be right for you. 

 

 

Intrauterine devices (IUDs) 

These are small T-shaped devices inserted into the uterus through the vagina by a trained healthcare professional. Generally, they last between three and ten years and can be removed at any time (2). They come in two forms: 

  1. Copper IUDs: this is the only non-hormonal IUD. A copper coil is wrapped around the plastic T-shaped device which works to prevent pregnancy by repelling sperm and making the lining of the uterus (endometrium) less hospitable (3, 4). Cool right! They may make bleeding heavier and more painful, however, this has been found to decrease over time (5). As Copper IUDs are non-hormonal, they won’t suppress ovulation – meaning you will continue to get your period (2).
  2. Hormone-releasing IUD: releases a small amount of progestin each day. It may prevent ovulation from occurring (meaning no egg is released from the ovary) and pregnancy is not possible (2). If an egg is released, it prevents pregnancy by 1) thickening the cervical mucus which blocks and traps sperm and 2) thinning the uterine lining, making it a poor environment for an egg to be fertilized and grow (6). The thin lining means periods get much lighter, with 20% having no periods at all by 12 months, and 50% at two years (7).

There can be some confusion about whether suppressing a period due to birth control is unhealthy (8). Let’s set the record straight: There is currently no evidence to support this. If there is no lining to shed, then it is not unhealthy not to be having a period (9). 

Am I protected from STIs?
IUDs do not protect you from sexually transmitted infections
What is the failure rate?
Typical use failure rate: Copper IUD 0.8% and Hormonal IUD 0.1-0.4% (10).

Hormonal methods 

1. The Implant - The implant is a thin, single rod about the size of a matchstick that is inserted under the skin of the upper arm and releases progestin (no need to stress, it won’t be seen or felt – unless you poke around) (11). The implants generally last for 3 years, and they function similarly to hormonal IUDs in that they can inhibit ovulation, thicken cervical mucus, and thin the uterine lining (12). This latter mechanism is the reason why many users report stopping their periods
    Am I protected from STIs?
    The implant will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 0.01% (REF)

     

    2. Birth control “shot” - Depo-Provera, also known as the birth control “shot”, contains a high dose of progestin that prevents ovulation (meaning no egg is released from the ovary) and makes cervical mucus thicker and more difficult for sperm to travel (13). It is given generally into the buttocks or arm every 12 weeks. Compared to other forms of contraception, there is the most evidence that the birth control shot is linked to weight gain (14). It is not recommended for use for greater than 2 years as it can cause other side effects such as bone thinning and osteopenia (which decrease once you stop receiving the shot) (15). 

    Am I protected from STIs?
    The birth control “shot” will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 6% (16).
     
    3. The pill - The pill is heavily criticised by the media, often unfairly so, which has led to some decreases in the number of pill users. The pill can have significant protective benefits (for example against bowel, endometrial and ovarian cancer) and has improved the quality of life for many people who previously struggled with heavy and painful periods (17, 18). In saying this, it is certainly not for everybody and there are some side effects. There are two types: 
    • Combined oral contraceptives (COC): This is one of the most used forms of contraception. It contains two active ingredients, the hormones estrogen and progestin (19). Its main method of preventing pregnancy is to suppress ovulation, which means no egg = no fertilization = no pregnancy but also by thinning the lining of the uterus (18). This needs to be taken daily. 
    • Progestin-only pill (POP): Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin. This pill works primarily by thickening the cervical mucus, inhibiting sperm. It doesn’t increase the risk of blood clots and could be a more suitable option if you cannot tolerate the COC for other reasons (20). It needs to be taken daily.  
    Am I protected from STIs?
    The pill and mini pill will not protect you from sexually transmitted infections
    What is the failure rate?
    Combined oral contraceptive: Typical use failure rate: 7%.
    Progestin-only pill: Typical use failure rate: 7%.

     

    4. Patch - This skin patch may be worn on the lower abdomen, buttocks, or upper body and releases progestin and estrogen (21). You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. It can also be used to “skip” a period if a new patch is placed during the fourth week. 

    Am I protected from STIs?
    The patch will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 7%

     

    5. Hormonal vaginal contraceptive ring - This is a thin ring that sits at the top of the vagina (don’t worry, you shouldn’t be able to feel it once inserted). It slowly releases the hormones progestin and estrogen (22). You certainly don’t want to be shy about inserting your fingers into your vagina if you have the ring, as this is the way that you will manually take it in and out. You wear the ring for three weeks, after which you leave it out for 7 days when you have a withdrawal bleed (22). It works in a similar manner to the pill, although has lower levels of hormones. 

    Am I protected from STIs?
    The contraceptive ring will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 7% 

    Barrier Methods

    Condom for penis owners 

    A condom is a thin tube that is used to cover the penis and prevent sperm from entering a partner. Oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly should not be used with latex condoms as they may cause them to tear or break (23). Condoms are all about how you use them, with the most common errors involving putting a condom on inside out, then flipping it over or putting it on too late in the game (24). What many people don’t know is that pre-ejaculatory fluid from the penis (which you may not even notice) can contain sperm – so don’t forget to put them on early! 


    Am I protected from STIs? 
    Condoms can greatly reduce, but not entirely eliminate the risks of contracting a sexually transmitted infection (25). 
    What is the failure rate?
    Typical use failure rate: 13% (26)

     

    Condom for vulva owners

    This is an internal condom that is inserted and worn inside the vagina to prevent sperm from entering (27). They seem to be slightly more difficult to find and less used as a result. They are more likely to fail than the external male condom, probably due to the fact that they don’t have a tight fit, so there is a risk of the penis slipping down the side between the condom and vaginal wall, rather than into the condom itself. 

    Am I protected from STIs? 
    Condoms can greatly reduce, but not entirely eliminate the risks of contracting a sexually transmitted infection  
    What is the failure rate?
    Typical use failure rate: 21%

    Spermicides

    These come in a variety of forms such as foam, gel, cream, film suppository or tablet and are placed into the vagina no more than one hour prior to sex (28). They work by killing the sperm. 


    Am I protected from STIs? 
    Spermicides will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 21% 

    Diaphragm or cervical cap

    These are reusable barriers that are placed inside the vagina and cover the cervix (29). They are placed with a spermicide and work by killing and blocking sperm from reaching the upper reproductive tract (28). These should be left inside the body for 6 hours after sex and should not be used with oil-based lubricants, as this can cause them to break down. You should also be properly fitted for a diaphragm or cervical cap by your doctor as these vary in size. 

    Am I protected from STIs? 
    Diaphragms or cervical caps will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 17% (10)

    Exit methods 

    Pull-out method 

    The withdrawal method, also known as coitus interruptus, has been used by at least 60% of women wanting to avoid pregnancy at some point in time (30). As Dr. Anita Mitra (AKA the Gynae Geek) states, the withdrawal method is like “playing Russian roulette, this time with a penis instead of a gun”. One study showed that 34% of pre-ejaculatory fluid contains healthy motile sperm - meaning that pregnancy certainly is possible (31).  

    Am I protected from STIs? 
    The pull-out method will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: Up to 24%

    Fertility Awareness-Based Methods

    Understanding your monthly fertility pattern can help you prevent getting pregnant (32). These methods are based on predicting when you will be ovulating, and fertilization is possible. If you are using this method and want to avoid pregnancy, you will need to avoid sex or use a barrier method on the days when you are in your fertile window (33). This method may be suitable for you if you have a very regular menstrual cycle. Many people determine their ovulation by menstrual tracking apps or charting their cycle – although these are not foolproof. 

    Am I protected from STIs? 
    Fertility awareness-based methods will not protect you from sexually transmitted infections.
    What is the failure rate?
    Typical use failure rates range from 2-23%.

     

    Lactational Amenorrhea Method (LAM)

    If you have recently had a baby, LAM may be used as a temporary birth control method if you are exclusively breastfeeding (34). It should be mentioned that there is still a chance of pregnancy. If you are wanting to learn more, check out https://www.plannedparenthood.org/learn/birth-control/breastfeeding  

    Am I protected from STIs? 
    LAM will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate is 2%. 

    Permanent Methods

    Female Sterilization

    Tubal ligation or “tying tubes” involves undergoing a surgical procedure where the fallopian tubes are tied (or closed) so that sperm and eggs cannot meet for fertilization. This method is effective immediately. 

    Am I protected from STIs? 
    Tubal ligation will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 0.5%.

     

    Male Sterilization – Vasectomy

    This is a reversible (although its reversal is not always successful) operation that prevents sperm from reaching the penis. Meaning that the ejaculate does not contain any sperm that could fertilize an egg. 

    Am I protected from STIs? 
    A vasectomy will not protect you from sexually transmitted infections
    What is the failure rate?
    Typical use failure rate: 0.15%.

    Future contraceptives 

    In exciting news, new forms of contraception are arising for penis owners! The main forms include a non-hormonal pill and a gel. It's time we shared the burden and responsibility of birth control! 

    Summary 

    Clearly, there is a multitude of birth control options! There really is no one-size-fits-all. It is best to speak with your healthcare provider about which option may be right for you. If you don’t yet feel comfortable speaking with your provider but are wanting to find the right fit, consider Reya Health, a birth control matching platform or the Planned Parenthood resources

     

    Zoe Sever is Unfabled's Clinical Lead. Zoe brings a wealth of knowledge from her broad spanning background, having started her career in Nursing and transitioning to Sexology and Research. She holds a Master’s in Sexual and Reproductive Health and is currently pursuing a PhD in Women’s and Reproductive Health at Oxford University. On a mission to empower individuals with cycles to better understand their bodies, Zoe is helping us to banish shame, stigma and demystify reproductive health.

     

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