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Sex & fertility

Birth control method comparison chart

The method of birth control you choose as a woman or together as a couple may vary over time, and it is critical for a sexually active woman to remain as well informed of her options as possible. The following table is a compilation of the choices currently available and can serve as a helpful guide to making this important decision.


Method Reliability* Protection against HIV/STD's? Pros & Cons
Intra-uterine Devices (IUD/IUS)
(All)
99%
No

Pros:
Longevity

Low side effect profile

High initial cost, but low when averaged out over lifespan of device

Cons:
Recommended principally for women in monogamous relationships

Can be expelled or become disloged

Not recommended for women with fibroids

• ParaGard (Copper T) IUD

   

ParaGard can remain in place for up to 10 yr

Fertility usually resumes immediately upon removal

Can be accompanied by increase in volume and duration of menstrual flow

• Mirena IUS     Mirena can remain in place for 5 yr

Possible delay in return of fertility once Mirena is removed

Releases levonorgestrel (LNg), a synthetic progestin, just in uterus. Reduces menstrual volume in time but spotting can occur in initial 6–12 months

May cause benign ovarian cysts

Can rarely cause hormonal side effects similar to those seen with oral birth control pills, such as mood swings, breast tenderness, headaches, and acne.
Sterilization
(All)


>99%
No
Pros/Cons:
Surgical risks

Permanence

Cost-effective over time

These methods can in some (few) cases be reversed, depending on method and individual
• Tubal ligation     Tubal ligation immediately effective
• Vasectomy     Vasectomy not immediately effective; it may take months before full sterility is achieved
Hormonal Methods
• Birth control pills (Oral contraceptive pills - BCP's/OCP's)

Options include:

-- 20–35-mcg combined pills

-- Regular or extended-cycle use pills

-- Pills with shortened pill-free interval option

-- Progestin-only ‘mini-pills'
95–99%
No

Pros:
High rate of efficacy

Relatively convenient

Multiple options available

Regulates menstrual cycle

Decreased risk of endometrial and ovarian cancer, endometriosis, PID

Cons:
Undesirable risk and side effect profile in some women

Not affordable for all women

Drug interactions

• Vaginal ring (NuvaRing)
~99%
No
Pros/Cons:
Same as w/BCP's, above

Other advantages:
Privacy

Use allows for more normal vaginal moisture and flora, reducing yeast infections for some women

Protection from pregnancy one month at a time

Other disadvantages:
Contraindicated with certain pelvic conditions, e.g., prolapse, endometriosis, susceptibility to irritation, etc.

• Transdermal birth control patch (Ortho Evra)

~99%
(less reliable for women >198 lb)
No
Pros/Cons:
Similar to those of BCP's, as above, except exposure to synthetic estrogen is ~60% higher, with resultant higher risk profile for thromboembolic events
• Depo-Provera injection

99.7%
No

Pros/Cons:
Same as w/BCP's, above

Other advantages:
Effective 24 hr following injection

Other disadvantages:
Side effects can be significant and long-lasting, including reduction in bone density, depression, and weight gain

• Contraceptive implants
99%
  Pros:
Longevity: Different systems last from 3-5 yr

Fertility returns relatively quickly

Cons:
Can be difficult to remove

Potential for scarring

Side effects can in some cases be significant and long-lasting
Barrier Methods
• Male condom
87–98%
Yes, except for STI's contracted from genital areas not covered*
Pros:
Convenience and availability

Multiple options

Inexpensive

Allows greater male partner participation

Cons:
Reduced spontaneity

Reduced sensation

Some users experience allergies
• Female condom
79–95%
Yes; only abstinence provides better protection*
Pros:
Can be placed up to 8 hr in advance

Good protection against STI’s

Does not require fitting by health care practitioner

Cons:
Only 1 style currently available

More costly than male condoms
• Female cervical cap
Varies: 68–91%
No
Pros:
Can be inserted up to 6 hr in advance

Very few side effects

Several designs on market

Cons:
Relatively low efficacy,* especially in women who have given birth

Some types require fitting by health care practitioner; limited to 4 sizes

Not widely available

Some users experience allergies
Spermicidal Methods
• Today Sponge
89–91**
No
Pros:
Immediate and continuous protection for 24-hr period

One size fits all and easy to insert

Cons:
Cost

Removal can be tricky for some
Some users experience sensitivities /allergies to spermicide
• Diaphragm with contraceptive jelly or foam
80–94%
Some*
Pros:
Few side effects

Can be inserted up to 6 hr in advance

Can be used for intercourse during menses to collect flow

Cons:
May reduce spontaneity

Requires fitting/periodic refitting

Some users experience allergies

Some consider method to be “messy”
• Vaginal contraceptive film, foam, inserts

74–94%;
efficacy maximal when used in conjunction with barrier method

No
Pros:
Readily available

Relatively inexpensive

Lubrication

Cons:
No protection from STI’s/HIV infection

Some users experience irritation and/or allergies

“Messiness” factor

Must be inserted within an hour before intercourse
Fertility Awareness Methods (FAM):
Examples:

• Basal Body Temperature (BBT)

• Sympto-thermal

• Billings Ovulation

• "Rhythm"
88–98%
No
Pros:
Zero health risks or side effects

Enhances body awareness and partner intimacy

Inexpensive

Cons:
Requires significant partner education, cooperation, and daily attention

Relatively high failure rate

Not ideal in perimenopause years or for women with otherwise irregular cycles

* Assumes perfect use. Actual effectiveness rates vary significantly. Statistics from Our Bodies, Ourselves (Boston Women’s Health Book Collective, 2005).

** McClure D., & D. Edelman. 1985. Worldwide method effectiveness of the Today vaginal contraceptive sponge. Adv. Contracept. 1: 305–11.

Return to Articles:

Birth control pills in perimenopause

Choosing a birth control method

Related to this article:

References & further reading on birth control

 

Last Modified Date: 04/19/2011
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician