Birth control methods are the methods used by a sexually active couple, to prevent an accidental or unplanned pregnancy. Nowadays, there are many good birth control methods available like barrier methods, oral contraceptive pills, injections, intrauterine devices, or surgery.
Birth control is also known as contraception or family planning and the methods used for birth control are called methods of contraception or family planning methods or birth control methods. Any sexually active couple who does not want a pregnancy should discuss the various methods of contraception with each other and with their doctor and opt for a birth control method, based on their requirement.
Table of Contents
What are the birth control options available?
Following is a brief overview of the various methods of birth control available:
- Barrier methods: These are the birth control methods that physically prevent a sperm from meeting the egg. These need to be worn by a man or a woman, just before intercourse. When used perfectly, they offer very effective contraception and are the only birth control method that prevents the transmission of sexually transmitted infections (STIs). However, to be effective, they need to be used correctly and regularly and a fresh condom has to be used each time. These include male condoms, female condoms, diaphragm, cervical cap, contraceptive sponge, and spermicide. (For more details, please see Barrier methods of contraception).
- Oral contraceptive pills: In this method, a woman takes hormonal pills regularly. These pills prevent pregnancy by preventing ovulation and also by thickening of the cervical mucus, and altering the inner lining of the uterus. This is a highly effective method for birth control and also regulates menstrual irregularities but it has certain downsides, like it needs very strict compliance (meaning that you cannot miss a dose) and it does not prevent transmission of sexually transmitted infections. Moreover, it has other systemic effects on the body. (For more information, please see Birth Control Pills I Oral Contraceptive Pills)
- Intrauterine device (IUD): In this method, your healthcare provider inserts a T-shaped device into the uterus. This device prevents pregnancy by impairing sperm viability and making the uterus unfavorable for the implantation of a fertilized egg. It is one of the most effective contraceptive methods providing long-term reversible contraception. Depending on the device used, it provides continuous protection for 5-10 years after insertion. It can be used both for regular contraception and for emergency contraception. (For more information, please see Copper containing Intrauterine device in Emergency Contraception)
- Contraceptive injections: These are progesterone hormone injections that are administered to women intramuscularly in the arm or buttock, every 3 months. They offer effective and long-acting contraception, without the need for any daily dosing, and can also be used during breastfeeding. However, you will need to visit your healthcare provider to get the injection every three months, and the contraceptive effects may last for up to one year after the last injection. So, if you wish to have the flexibility of immediate reversibility, this may not be the choice for you.
- Surgery: The surgical methods of contraception are vasectomy in males and tubectomy in females. Vasectomy involves cutting off a part of the vas deferens in the male so that sperms are absent in the semen and tubectomy involves cutting off a part of the fallopian tubes in the female so that eggs can’t reach the uterus. Both these methods cause permanent sterilization and reversibility, although possible, is difficult with uncertain results. So this method should only be considered by couples whose family is complete and do not have any plans to have a child in the future. (For more information, see Permanent birth control I Sterilization)
- Fertility awareness methods (FAMs): Fertility awareness methods are simple methods by which a woman can recognize her fertile days in the menstrual cycle. Commonly used fertility awareness methods include monitoring the basal body temperature, changes in cervical mucus, standard days method, and the calendar method. During the fertile days, pregnancy can be prevented by practicing sexual abstinence or using barrier methods of contraception. Even with perfect use, fertility awareness methods have a high rate of failure, resulting in many unwanted pregnancies.
- Sexual Abstinence: This simply means avoiding or refraining from sexual intercourse. This is the most impractical method of birth control for a sexually active individual.
- Emergency contraception: Emergency Contraception is used when there are concerns about the possibility of an unwanted pregnancy because of deliberate or accidental unprotected sexual intercourse or because of contraceptive failure. The methods used for emergency contraception are oral pills (ulipristal, levonorgestrel, or combined pills) or insertion of a copper-bearing intrauterine device. (For more information, please see Emergency Contraception)
How do contraceptives work?
Each of the contraceptive choices mentioned above help in birth control by different mechanisms. The various contraceptives may act in the following ways:
- Oral contraceptive pills prevent the release of an egg from the ovary, so that sperm is not able to fertilize it. They also thicken the cervical mucus which prevents the sperm from reaching the egg.
- Barrier methods physically block the sperm from reaching the egg.
- Intrauterine devices damage the sperm, thereby impairing sperm viability and make the inner wall of the uterus unfavorable for the implantation of the fertilized egg.
- Contraceptive injections prevent the release of egg from the ovary.
- Surgical methods like tubectomy and vasectomy offer permanent sterilization by blocking the natural path of eggs and sperm respectively.
- Fertility awareness methods involve recognizing your fertile days by various indicators like basal body temperature or changes in cervical mucus and avoiding intercourse during the fertile days.
How to choose the best birth control method?
Many different methods of birth control are available nowadays. Every method has certain advantages and disadvantages. So a method that may be best for a couple, may not be suitable for another couple. You should carefully consider your birth control options in consultation with your partner and your doctor and then choose the best option based on your needs and preferences. Following are the factors that you should consider while planning your contraception:
- Effectiveness of contraceptive method: This is the most important factor you should consider when deciding your contraceptive choice. A particular method however comfortable it might be, is not worth it if its efficacy is questionable. Some of the highly effective options include Intrauterine devices (IUD), Oral contraceptive pills (OCP), Contraceptive injections (Progestogen), and barrier methods like condoms when used correctly. Fertility awareness methods (FAM) and some barrier methods like cervical cap or diaphragm are less effective contraceptive choices.
- Number of sexual partners: Multiple sexual partners increases the risk of acquiring sexually transmitted infections (STIs). Most contraceptive methods do not offer any protection against STIs. Only the barrier contraceptive methods like condoms provide protection against the transmission of STIs. Both male and female condoms are effective.
- Reversibility: Some contraceptive methods like tubectomy and vasectomy are permanent methods and should only be considered if your family is complete and you do not plan to have any more children in the future. Contraceptive methods like oral contraceptive pills, intrauterine devices, and barrier methods offer very effective contraception and are immediately reversible as soon you stop using them or get them removed. Reversibility may be an issue with methods like contraceptive injections as they have long-lasting effects and the fertility may take up to one year to return after the last injection.
- Ease of use: Contraceptive methods like intrauterine devices offer the advantage of effective and long-lasting contraception as they provide continuous protection for 5-10 years after insertion. You do not need to use any other contraceptive method regularly during this time. Others like Birth Control Pills I Oral Contraceptive Pills need to be taken daily and lose their efficacy even if a single dose is missed. Barrier methods of contraception need to be used just before intercourse and hence you have to have them handy and also be disciplined for using them.
- Concurrent conditions: Your overall health, medical conditions, and/or menstrual abnormalities are also important factors while planning your contraception. For example, if you have heavy or irregular periods, oral contraceptive pills may help to regulate your cycles in addition to offering contraception. However, if you have conditions like high BMI, high blood pressure, diabetes, high cholesterol levels, heart disease, stroke, liver disease, deep vein thrombosis etc, then oral contraceptive pills may not be good choices or even may be contraindicated. A history of breast cancer or smoking also rules out the use of OCPs. (see Birth Control Pills I Oral Contraceptive Pills for more information)
- Occupation: You should also consider your occupation while planning your birth control so that you are able to use your contraception consistently, without having undue stress or missing on your contraception. This is especially true for working women for whom regular use of pills or barrier methods may be very impractical or cumbersome and may benefit more from long-acting methods like intrauterine devices.
- Reproductive goals: If your family is not complete or you are undecided about having a baby in the future, you should not go for permanent sterilization methods like tubectomy or vasectomy. If you do not want to have a baby right now but may plan in a couple of years, an intrauterine device may be your best bet as it provides long-term effective contraception, which is immediately reversible as soon as the device is removed. If you want to have the flexibility of planning a baby anytime, you should consider methods that can be reversed immediately and do not need a doctor’s assistance. For example oral contraceptive pills and barrier methods.
- Your age: Risks of having certain medical conditions like high blood pressure, diabetes, high cholesterol levels, heart disease, stroke, thrombosis, and some gynecological cancers like breast cancer increase with increasing age. The combined oral contraceptive pills increase the risks associated with all these conditions and so may are not good choices with advancing age.
- Cost: Cost is a very important factor to consider while planning long-term contraception. In some options, the cost justifies the benefits; in others, the benefits may not be worth the cost. For example, while selecting barrier contraceptives, male condoms are the least expensive option whereas female condoms, cervical caps and diaphragms are expensive while offering no additional benefit. Intrauterine devices provide effective long-term contraception at a minimal expense. Permanent methods like tubectomy and vasectomy, being surgical in nature, involve considerable expense.
- Breastfeeding: It is very important for breast feeding mothers to understand the safe contraceptive choices during breastfeeding. Barrier methods (condoms, diaphragms), Intrauterine devices and implants, contraceptive injections, progesterone-only pill (mini pill), or permanent sterilization (tubectomy, vasectomy) are safe during breastfeeding. Estrogen-containing contraceptive methods like Combined pill or vaginal ring are best avoided during breastfeeding as they reduce the supply of breast milk.
Which is the most effective birth control method?
Reversibility is an important consideration when deciding the most effective birth control method.
- Irreversible: If reversibility is not desired, permanent sterilization is the most effective method. It involves tubectomy in females or vasectomy in males. These surgical methods are almost 100% effective, with very low failure rates. Failure can sometimes occur due to spontaneous recanalization of the cut ends of fallopian tubes or vas deferens.
- Reversible: Among the reversible options, Intrauterine devices and implants are the most effective contraceptive choices, offering more than 99% efficacy, followed closely by oral contraceptive pills (98-99% efficacy). Barrier methods are also very effective, when used correctly.
Which birth control methods protect from sexually transmitted infections?
Barrier methods like male and female condoms are the only contraceptive methods that protect against the transmission of sexually transmitted infections. However, it is very important to use them correctly and to use a new condom every time.
Are there any side effects of birth control methods?
Each birth control method offers certain benefits and has certain disadvantages. These benefits and side effects are different for everyone, depending on your age, medical conditions, reproductive goals, choice of flexibility and ease of use.
The benefits and side effects of each contraceptive method have been discussed individually in detail in their respective sections. For details of the risks and benefits of individual methods, please see:
Barrier methods of contraception
Birth Control Pills I Oral Contraceptive Pills
Permanent birth control I Sterilization
Carry home message
Every sexually active couple must opt for a contraceptive method if they are not planning a pregnancy. There are many options available that are highly effective and easy to use with minimal side effects and easy reversibility. You can pick any of these contraceptive choices in discussion with your partner and doctor to suit your needs. Emergency contraception is also available and should be considered only in the event of failure of regular contraception and not as a substitute for regular contraception. Stay healthy!
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