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Which birth control is right for me?
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:
- 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).
- 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).
Hormonal methods1. 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
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).
- 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.
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.
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.
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!
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.
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.
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.
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).
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.
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
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.
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.
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!
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.
- Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept Reprod Med. 2018;3:9-.
- Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health. 2010;2:211-20.
- O'Brien PA, Kulier R, Helmerhorst FM, Usher-Patel M, d'Arcangues C. Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception. 2008;77(5):318-27.
- Mishell DR, Jr. Intrauterine devices: mechanisms of action, safety, and efficacy. Contraception. 1998;58(3 Suppl):45S-53S; quiz 70S.
- Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009;79(5):356-62.
- Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception. 2007;75(6 Suppl):S16-30.
- Diedrich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction. American journal of obstetrics and gynecology. 2015;212(1):50.e1-.e508.
- Johnston-Robledo I, Barnack J, Wares S. “Kiss Your Period Good-Bye”: Menstrual Suppression in the Popular Press. Sex Roles. 2006;54(5):353.
- Hillard PA. Menstrual suppression: current perspectives. Int J Womens Health. 2014;6:631-7.
- Trussell J, Guthrie K. Choosing a contraceptive: Efficacy, safety, and personal considerations. Contraceptive Technology. 2007:45-74.
- Bahamondes L, Fernandes A, Monteiro I, Bahamondes MV. Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol. 2020;66:28-40.
- Bhatia P, Nangia S, Aggarwal S, Tewari C. Implanon: subdermal single rod contraceptive implant. J Obstet Gynaecol India. 2011;61(4):422-5.
- Bigrigg A, Evans M, Gbolade B, Newton J, Pollard L, Szarewski A, et al. Depo Provera. Position paper on clinical use, effectiveness and side effects. Br J Fam Plann. 1999;25(2):69-76.
- Berenson AB, Rahman M. Changes in weight, total fat, percent body fat, and central-to-peripheral fat ratio associated with injectable and oral contraceptive use. American journal of obstetrics and gynecology. 2009;200(3):329.e1-.e3298.
- Walsh JS, Eastell R, Peel NFA. Effects of Depot Medroxyprogesterone Acetate on Bone Density and Bone Metabolism before and after Peak Bone Mass: A Case-Control Study. The Journal of Clinical Endocrinology & Metabolism. 2008;93(4):1317-23.
- Stoddard A, McNicholas C, Peipert J. Efficacy and Safety of Long-Acting Reversible Contraception. Drugs. 2011;71:969-80.
- Population NRCUCo. Contraception and reproduction health consequences for women and children in the developing world. Washington, D.C.: National Academy Press; 1989.
- Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;2(2):CD000154-CD.
- Gebel Berg E. The Chemistry of the Pill. ACS Cent Sci. 2015;1(1):5-7.
- Tepper NK, Whiteman MK, Marchbanks PA, James AH, Curtis KM. Progestin-only contraception and thromboembolism: A systematic review. Contraception. 2016;94(6):678-700.
- Galzote RM, Rafie S, Teal R, Mody SK. Transdermal delivery of combined hormonal contraception: a review of the current literature. Int J Womens Health. 2017;9:315-21.
- Roumen FJ. Review of the combined contraceptive vaginal ring, NuvaRing. Ther Clin Risk Manag. 2008;4(2):441-51.
- Steiner M, Piedrahita C, Glover L, Joanis C, Spruyt A, Foldesy R. The Impact of Lubricants on Latex Condoms during Vaginal Intercourse. International Journal of STD & AIDS. 1994;5(1):29-36.
- Sanders S, Yarber W, Kaufman E, Crosby R, Graham C, Milhausen R. Condom use errors and problems: A global view. Sexual health. 2012;9:81-95.
- Marfatia YS, Pandya I, Mehta K. Condoms: Past, present, and future. Indian journal of sexually transmitted diseases and AIDS. 2015;36(2):133-9.
- Sundaram A, Vaughan B, Kost K, Bankole A, Finer L, Singh S, et al. Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth. Perspect Sex Reprod Health. 2017;49(1):7-16.
- Gallo MF, Norris AH, Turner AN. Female condoms: new choices, old questions. Lancet Glob Health. 2013;1(3):e119-e20.
- Shoupe D, Kjos SL. The handbook of contraception : a guide for practical management. Totowa, N.J.: Humana Press; 2006.
- Teal S, Edelman A. Contraception Selection, Effectiveness, and Adverse Effects: A Review. JAMA. 2021;326(24):2507-18.
- Mosher WD JJ. Use of contraception in the United States: 1982–2008. Vital Health Statistics: National Center for Health Statistics; 2010.
- Killick SR, Leary C, Trussell J, Guthrie KA. Sperm content of pre-ejaculatory fluid. Hum Fertil (Camb). 2011;14(1):48-52.
- Frank-Herrmann P, Heil J, Gnoth C, Toledo E, Baur S, Pyper C, et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study. Human Reproduction. 2007;22(5):1310-9.
- Simmons RG, Jennings V. Fertility awareness-based methods of family planning. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020;66:68-82.
- Vekemans M. Postpartum contraception: the lactational amenorrhea method. Eur J Contracept Reprod Health Care. 1997;2(2):105-11.
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