CONTRACEPTION

Hormonal birth control is any pill, injection, device, or treatment that uses hormones to prevent pregnancy. There are a few different kinds of hormonal birth control. Some contain the hormones estrogen and progestin. Others contain only progestin.
While no birth control works 100 percent perfectly all the time, hormonal methods work very well to prevent pregnancy. The methods differ in how easy they are to use and their side effects (table 1):

• Pills – If you choose to take birth control pills, you will need to take a pill every day. Skipping pills can increase the chance of getting pregnant. Birth control pill packets usually include 4 to 7 days of hormone-free pills each month. It is during these hormone-free days that you get your period. If you prefer not to get a period, you can skip the hormone-free pills and take a hormone pill every day instead. This is called “continuous dosing.” Most birth control pills contain estrogen and progestin but some contain only progestin.
• Skin patches – There are two different patches available (brand names: Xulane, Twirla). You can wear the patch on your shoulder, back, belly, or hip (figure 1). One of them (Xulane) can also be worn on the upper arm. The patch must be changed once a week, and you put it in a new place each time. You typically wear a new patch each week for 3 weeks and then leave the patch off during week 4. Week 4 is when you have your period. Skin patches for birth control contain both estrogen and progestin.
• Vaginal rings – This is a flexible ring that you put in your vagina (brand names: Annovera, EluRyng, NuvaRing). It can stay in place for 3 weeks at a time (figure 2). The ring releases hormones in the vagina. It should not be removed when you have sex. You will need to check before and after sex to make sure the ring is in place.
  If the ring is removed or falls out, it can stay out for up to 3 hours. You typically use the ring for 3 weeks. Then, depending on which ring you have, you either throw it away or clean it and store it to put back in later. You do not use the ring during week 4, which is when you have your period.
  If you choose, you can continue using a ring for longer than 3 weeks. If you do this you will not have a regular period, although you might have some light bleeding or “spotting.” Vaginal rings for birth control contain both estrogen and progestin.
• Injections – If you use hormone injections, you will get a shot in the arm or butt every 3 months. Injections for birth control (brand name: Depo-Provera) contain only progestin.
• Implants – A birth control implant is a tiny rod that releases hormones in the arm (figure 3). It must be implanted by a doctor or nurse and can stay in the arm for up to 3 years. Implants for birth control (brand name: Nexplanon) contain only progestin.
• Hormone-releasing IUD – IUD stands for “intrauterine device.” This is a device that is placed inside the uterus to prevent pregnancy (figure 4). Some IUDs work by releasing hormones into the body (brand names: Kyleena, Liletta, Mirena, Skyla). Depending on which hormone-releasing IUD you get and your age, it can stay in place for 3 to 6 years. The hormone-releasing IUDs contain the hormone levonorgestrel, which is a progestin.

Hormonal birth control is a safe and reliable way to prevent pregnancy for most people. But it does not protect you from infections that spread through sex (called “sexually transmitted infections” or “sexually transmitted diseases”).

Hormonal birth control has other benefits besides preventing pregnancy. It can make your periods lighter or more regular. For this reason, it is also often used in the treatment of certain health conditions, including:

• Heavy, irregular, or painful periods – Different things can affect your monthly period. Some people also get painful cramps or other symptoms.
• Polycystic ovary syndrome (PCOS) – This is a condition that can cause irregular periods, acne, extra facial hair, or hair loss from the head.
• Menstrual migraines – These are migraine headaches that are triggered by hormone changes around the monthly period. Hormonal birth control might be an option for treatment, as long as you do not get migraines with “aura.” An aura is a symptom or feeling that happens before or during the headache. For example, some people see flashing lights, bright spots, or zig-zag lines, or lose part of their vision.

If you have any of these conditions, your doctor or nurse might suggest the pill or another form of hormonal birth control. Do not try using birth control to treat a health condition without talking to your doctor or nurse first.

Work with your doctor or nurse to choose the best option for you. As you think about your decision, think about how likely you are to use each method the right way. Can you remember to take a pill every day? Can you remember to change a patch once a week? Long-acting methods (IUD, implant) are the most convenient because they work for 3 to 10 years, depending on the method. The injection, which works for 3 months, might be more convenient than the pill, patch, or ring. Also, ask your doctor how the method you are thinking about will affect your period. The table has a list of side effects and risks for each of the different forms (table 1).

No. Some people should not use estrogen-containing hormonal birth control. This includes those who:

• Are age 35 or older and smoke cigarettes – These things increase your risk for heart attacks and strokes.
• Could possibly be pregnant – Before prescribing hormonal birth control, your doctor or nurse will ask questions to make sure that you are not pregnant. You might need to take a pregnancy test to confirm this.
• Have had blood clots or a stroke in the past
• Are being treated for breast cancer, or have had breast cancer before
• Have some types of liver disease – Hormonal birth control can make some types of liver disease worse.
• Have some types of heart disease
• Get the type of migraine headaches that cause vision or hearing problems

If you have high blood pressure, you can still use hormonal birth control. But your blood pressure needs to be well controlled and regularly checked by a doctor.

Many people who can’t take estrogen-containing hormonal birth control can take other kinds of hormonal birth control that contain only progestin. Or they can use methods that do not contain hormones.

Some medicines can affect how well hormonal birth control works. These include:

• Some medicines used to prevent seizures (called “anticonvulsants”)
• Certain antibiotics used to treat tuberculosis (rifampin and rifabutin)
• St. John’s Wort (an herbal medicine for depression)

If you take any of these medicines, talk to your doctor about how to handle birth control. Also, if you already take hormonal birth control, mention it to any doctor or nurse who might be prescribing medicines for you.

If you have sex and forgot to use your birth control, you can take emergency contraception to reduce your risk of pregnancy. Some forms of emergency contraception require a prescription, but others you can buy in a pharmacy. The IUD is the most effective method of emergency contraception, but requires a doctor or nurse to insert it. If you need to use emergency contraception, do it as soon as possible after sex.

Birth control is a term used to describe ways to prevent pregnancy. Another word for birth control is “contraception.”

Different types of birth control include medicines, devices, and procedures. Some types need to be used every time you have sex. Other types can prevent pregnancy for long periods of time. Some types need a prescription, and others do not.

There are many different types of birth control, and this is a personal decision. Your doctor or nurse can work with you to choose the type that is right for you. To help you make a decision, think about:

• How well it prevents pregnancy – No birth control works 100 percent perfectly all the time. But some prevent pregnancy better than others.
• How often you have to use it – For example, if you choose to take birth control pills, you must take them every day. There are other types, like condoms, that you use only when you have sex.
• How easy it is to get – For some types of birth control, you need to see a doctor or nurse. You can get other types at the drug store, or at a health clinic like Planned Parenthood.
• How easy it is to use
• Whether it has benefits besides preventing pregnancy – For example, some types of birth control help make your periods lighter or more regular, or reduce period cramps.
• Its side effects or downsides
• How much it costs
• If you think you might want to get pregnant in the future – Some types of birth control are permanent, meaning they prevent you from ever getting pregnant. Other types of birth control prevent pregnancy only for a limited amount of time. After that time, you can still get pregnant.
• How soon you might want to get pregnant in the future – Some types of birth control can be started and stopped quickly. Other types can prevent pregnancy for several years.
• Whether it protects you from infection – Condoms are the only form of birth control that can reduce your chance of getting certain sexually transmitted infections (“STIs”).

Different types of birth control prevent pregnancy in different ways. Some work better than others. But they are different in other ways, too.

The main types of birth control include:

• Long-acting methods – These are forms of birth control that can prevent pregnancy for years at a time. They include intrauterine devices (“IUDs”) and the implant. Some IUDs as well as the implant use hormones to prevent pregnancy.
• Permanent procedures – These make a person permanently unable to get pregnant, or get a partner pregnant. They include tubal ligation (having your “tubes tied”) and vasectomy.
• Hormonal birth control – These methods use hormones to prevent pregnancy. They include pills, injections, patches, and vaginal rings.
• Condoms – These are also called a “barrier” method. They prevent sperm from getting into the uterus and reaching an egg.
• “Pericoital” methods – This refers to birth control you use at the time of sex, such as diaphragms, sponges, and spermicides. Condoms are also a type of pericoital birth control.

There are a few forms of “natural” birth control. This means they require no medicines or devices. They include:

• Withdrawal – This is when the male partner pulls out before ejaculating.
• Fertility awareness – This involves keeping track of your monthly periods so you can predict when you are most likely to get pregnant each month. Then, you can avoid sex during that time, or use some form of birth control then, such as condoms. There are smartphone apps that can help you with tracking.
• Breastfeeding – Breastfeeding can decrease a person’s ability to get pregnant. Some people use it as a form of birth control for the first few weeks after having a baby. But for it to work, breast milk should be the baby’s only food. The medical term for using breastfeeding as birth control is “lactational amenorrhea method,” or “LAM.” If you want to try this method, discuss it with your doctor or nurse.

These forms of birth control are less reliable than other methods. If you feel strongly that you do not want to get pregnant, or get a partner pregnant, you might want to consider other methods instead.

Tell your doctor or nurse if you have any side effects or problems with your birth control. Sometimes, side effects will go away after a few months. If they don’t, you might want to switch to a different type. Your doctor or nurse can talk with you about your options.

For a person to get pregnant through sex, an egg must be fertilized by a partner’s sperm. “Barrier” methods of birth control prevent pregnancy by keeping sperm from getting to an egg. Condoms are the most commonly used type of barrier birth control.

Doctors use the term “pericoital birth control” to refer to any birth control that you use at the time of sex. This includes condoms as well as other methods like diaphragms, sponges, and spermicides. These other methods work similarly to condoms in preventing sperm from reaching an egg. They are often referred to as barrier methods for this reason, although they do not physically block sperm in the same way that condoms do.

They include:

• Condoms – There are 2 types of condoms, external (male) and internal (female):
• External condoms are placed over the erect penis before sex. This prevents semen (the fluid that contains sperm) from getting into the partner’s body during sex.
• Internal condoms work in a similar way, but are worn inside the vagina to keep semen from entering the body.
  Condoms are the only form of birth control that can also protect against infections you can get through sex. (These are called sexually transmitted infections or “STIs.”) They are a good choice if you don’t know your partner’s sexual history or if you or a partner already has an STI. Some people use condoms in addition to another type of birth control, such as the pill.
• Diaphragm and cervical cap – A diaphragm is a flexible device that is inserted through the vagina and placed over the cervix before sex (picture 2). It is used along with foam, gel, or cream that contains spermicide, which kills sperm. The diaphragm keeps the spermicide in place around the cervix, which prevents sperm from getting into the uterus. If sperm cannot travel through the cervix, they cannot fertilize an egg.
  A cervical cap is similar to a diaphragm, but smaller. It is typically not recommended for people who have given birth before. This is because pregnancy and childbirth change the size of the cervix, which makes a cervical cap fit less well.
• Sponge – The birth control sponge is a soft, disk-shaped device that contains spermicide. It is inserted through the vagina before sex. It works by preventing sperm from getting into the uterus.
• Spermicides – Spermicides are chemicals that kill sperm. They come in different forms, including foam, gel, cream, film, and tablets. Spermicide can be used by itself, but works better if used with another method such as a condom or diaphragm.
• Vaginal “pH regulator” gel – This gel is inserted into the vagina like spermicide, but works in a different way. Instead of killing sperm, it changes the level of acid in the vagina, which makes sperm unable to move. It is less likely than spermicide to irritate the vagina or the partner’s penis.
  Vaginal pH regular gel can be used with another method such as a condom or diaphragm. It should not be used with a type of birth control called the “vaginal ring,” which contains hormones.

It depends on which type you use. The table shows the average chances of pregnancy for people who use each type. In general, barrier methods do not prevent pregnancy as well as some of the other available methods. Other methods include hormonal methods, such as birth control pills, and long-term methods such as the intrauterine device (IUD).

Barrier methods of birth control work best if they are used correctly. This means using your method of birth control every time you have sex. It’s also important to follow the instructions about how and when to use the method.

Combining more than 1 type of birth control will further lower the risk of pregnancy. For example, using spermicide along with a condom is more effective than using spermicide alone.

In general, these methods have the following benefits:

• They are safe to use
• They do not contain hormones
• They will not affect your monthly period
• Many can be bought without a prescription, and some (like condoms) might be free at some health centers
• They do not affect fertility after you stop using them, so if you or your partner want to get pregnant, you can start trying right away
• Condoms also protect against sexually transmitted infections

Possible downsides include:

• They do not work as well as other birth control methods to prevent pregnancy
• You must remember to use them every time you have sex
• Some methods, like spermicide, can cause irritation of the vagina or penis
• Some people do not like how sex feels with a condom

This is a personal decision. When choosing birth control, you will need to think about what is most important to you. You should also think about how likely you are to use each method the right way. For example, can you remember to use your birth control every time you have sex? Do you also want protection from sexually transmitted infections? Are you planning to try to get pregnant in the near future?

Your doctor or nurse can also talk to you about the different options and help you make the decision that is best for you.

If you have sex and forgot to use your birth control, you can take emergency contraception to reduce your risk of pregnancy. Some forms of emergency contraception require a prescription, but others you can buy in a pharmacy. If you need to use emergency contraception, do it as soon as possible after sex.

If you are worried that could you have a sexually transmitted infection, talk to your doctor or nurse. They can tell you about your risk and your options for testing or treatment.