Contraception: How to decide

With so many options, choosing a form of birth control can be daunting. Begin with a few questions: Do you need to protect against STIs? How important is convenience? What about effectiveness? Only abstinence is 100% effective, but other methods come close. Review this slideshow, then ask your doctor, nurse, or family planning specialist which options are best for you.

Fertility awareness

Also called natural family planning, fertility awareness means avoiding sex when the woman is most fertile. The most reliable way to do this is to watch for changes in cervical mucous and body temperature. To use this method correctly, it’s best to get training from a health care professional.

Pros: No medications or devices.

Cons: Limits spontaneous sex, less reliable than pill or sterilisation.

Spermicide

Spermicide contains a chemical that kills sperm. It comes in the form of foam, jelly, cream, film, sponge or pessary that is placed inside the vagina before sex. Some types must be put in place 30 minutes ahead of time. Frequent use may cause tissue irritation, increasing the risk of infections and STIs. Spermicides are most often used along with other birth control methods.

Pros: Easy to use.

Cons: May increase the risk of STIs, best used with backup method.

Male condom

The latex condom is the classic barrier method. It prevents sperm from entering the woman’s body protecting against pregnancy and against STIs. Condoms are about 85% effective and can be up to 99% effective with proper use.

Pros: Widely available, protects against STIs.

Cons: Only effective if used correctly every time. Can’t be reused.

Female condom

The female condom is a thin plastic pouch that lines the vagina and can be put in place any time before sex but before the penis comes into contact with the vagina or genital area. Users grasp a flexible, plastic ring at the closed end to guide it into position. It's somewhat less effective than the male condom.

Pros: Widely available, some protection against STIs, conducts body heat better than a male condom.

Cons: Can be noisy, five out of 100 users get pregnant, not reusable. Should not be used with a male condom, to avoid breakage.

Diaphragm

The diaphragm is a rubber dome that is placed over the cervix before sex. It is used with a spermicide. If used correctly, they are estimated to be 92-96% effective in preventing pregnancy.

Pros: One device can last two years.

Cons: Must be fitted by a doctor, no STI protection. Can’t be used during your period due to a risk of toxic shock syndrome.

Cervical cap

A cervical cap is similar to a diaphragm, but smaller. The cap slips into place over the cervix, blocking entry into the uterus. It is used with spermicide. The success rate is similar to that of the diaphragm.

Pros: Can stay in place for up to 48 hours.

Cons: Initially must be fitted by a doctor, no protection against STIs. Can’t be used during your period.

Contraceptive sponge

The contraceptive sponge is made of foam and contains spermicide. It is placed against the cervix up to 24 hours before sex. The sponge is around 90% effective, but unlike the diaphragm or cervical cap, no fitting by a doctor is required.

Pros: No prescription, effective immediately.

Cons: Difficult to insert correctly, no STI protection. Can’t be used during your period.

Contraceptive pill

The most common type of contraceptive pill uses the hormones oestrogen and progestogen to prevent ovulation. When taken on schedule, the pill is over 99% effective at preventing pregnancy.

Pros: More regular, lighter periods or no periods, depending on the type of pill. Less period pain.

Cons: No STI protection. May cause side effects, including breast tenderness, spotting, serious blood clots and raised blood pressure. Some women should not use contraceptive pills.

Birth control patch

Women who have trouble remembering a daily pill could consider the birth control patch. The patch is worn on the skin and changed only once a week for three weeks with a fourth week that is patch-free. The patch releases the same types of hormones as the birth control pill and is just as effective.

Pros: More regular, lighter periods with less period pain, no need to remember a daily pill.

Cons: May cause skin irritation or other side effects similar to birth control pills. Doesn’t protect against STIs.

Vaginal ring

The vaginal ring is a soft plastic ring that is worn inside the vagina. The ring releases the same hormones as the pill and patch and is just as effective It is removed every 21 days and replaced a week later following a "ring-free" week.

Pros: Lighter, more regular periods, only replaced every month.

Cons: May cause vaginal irritation or other side effects similar to pills and the patch. Doesn’t protect against STIs.

Contraceptive injection

The contraceptive injections, known as Depo-Provera and Noristerat, are hormonal injections. Depo-Provera protect against pregnancy for up to 12 weeks, and Noristerat protects against pregnancy for up to eight weeks. Both Noristerat and Depo-Provera are 99% effective in preventing pregnancy.

Pros: Only injected a few times a year, highly effective.

Cons: May cause spotting and other side effects. Doesn’t protect against STIs. Prolonged use may increase risk of osteoporosis.

Contraceptive implant

The contraceptive implant is a matchstick-sized rod that is placed under the skin of the upper arm. It releases the same hormone that’s in the contraceptive injection, but the implant protects against pregnancy for three years. It is highly effective.

Pros: Lasts three years, highly effective.

Cons: May cause side effects, including irregular bleeding. Doesn’t protect against STIs.

IUDs and IUSs

IUD stands for intrauterine device, a T-shaped piece of plastic that is placed inside the uterus by a doctor. IUDs contain copper and can remain in the uterus for five to 10 years. An IUS, or interuterine system, is a similar T-shaped device that contains the hormone progestogen. It can remain in place for up to five years. Both types make it more difficult for sperm to fertilise the egg. And are 99% effective.

Pros: Long-lasting, low-maintenance.

Cons: Side effects can include painful or heavy periods.

Tubal ligation

If you're sure you won’t want biological children in the future, you may be ready for permanent birth control. The traditional method for women is called tubal ligation or “having your tubes tied.” A surgeon closes off the fallopian tubes, preventing eggs from making their journey out of the ovaries. (The banding method is shown here.)

Pros: Permanent, nearly 100% effective.

Cons: Requires surgery, may not be reversible. Doesn’t protect against STIs.

Tubal implants

A newer procedure makes it possible to block the fallopian tubes without surgery. Small implants of metal or silicone are placed inside each tube. Scar tissue eventually grows around the implants and blocks the tubes. Once an X-ray confirms the tubes are blocked, no other form of birth control is needed.

Pros: Permanent, no surgery, almost 100% effective.

Cons: Takes a few months to become effective. May raise the risk of pelvic infections, irreversible.

Vasectomy

Besides condoms, a vasectomy is the only birth control option available to men. It involves surgically closing the vasdeferens – the tubes that carry sperm from the testes, through the reproductive system. This prevents the release of sperm but doesn’t interfere with ejaculation.
Pros: Permanent, almost 100% effective.
Cons: Requires surgery, not effective immediately, may not be reversible.

Emergency contraception

Emergency contraception works after unprotected sex to help avoid pregnancy. This is an option if a woman has had unprotected sex or suspects her usual method failed. Though it is often called the "morning after pill", the Levonelle (prescription-only) or Levonelle One Step (over the counter levonorgestrel) pill can be taken within 72 hours (up to three days) and the ellaOne pill (prescription –only) within 120 hours (up to 5 days). The IUD (coil) can be fitted up to five days later as emergency contraception.

Options for older women

Age and lifestyle are important factors in choosing a form of birth control. If you’re over age 35 and smoke or are obese, the combination birth control pill, patch, and ring are not recommended. It’s best to consult your doctor, nurse or family planning specialist about safe alternatives. If you’re approaching the age of menopause, the contraceptive injection has an added benefit: it may relieve some of the symptoms of perimenopause.

Withdrawal

Pulling out before the man ejaculates, known as the withdrawal method, is not a foolproof method of birth control. Some ejaculate (fluid that contains sperm) may be released before the man actually begins to climax. In addition, some men may not have the willpower to withdraw in time.

Pros: Free, no need for devices or hormones.

Cons: Hard to do correctly. No protection against STIs.

Related reading

• Myths about contraception
• Safe sex or Russian roulette?
• Contraception: The facts
• Not your mother’s contraception
• The morning after pill
• Which contraceptive pills?
• Modern rhythm: Is it safe?
• Men & contraception