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Birth control options for women - Introduction

Description

An in-depth report on the birth control options available to women.

Alternative Names

Contraception

Introduction:

Contraceptives are devices or methods for preventing pregnancy, either by preventing the fertilization of the female egg by the male sperm or by preventing implantation of the fertilized egg.

Contraceptive Options

Choosing the appropriate contraceptive is a personal decision that varies from individual to individual. Contraceptive options include:

Hormonal contraceptives (oral contraceptives, skin patch, vaginal ring, implant, injection)
Intrauterine devices (IUDs), which contain either a hormone or copper
Barrier devices with or without spermicides (diaphragm, cervical cap, sponge, condom)
Fertility awareness methods (temperature, cervical mucus, calendar, symptothermal)
Female sterilization (tubal ligation, Essure)
Vasectomy [For more information, see In-Depth Report #37: Vasectomy and vasectomy reversal .]

The condom is the only birth control method that provides protection against sexually transmitted diseases (STDs).

The pill works in several ways to prevent pregnancy. The pill suppresses ovulation so that an egg is not released from the ovaries, and changes the cervical mucus, causing it to become thicker and making it more difficult for sperm to swim into the womb. The pill also does not allow the lining of the womb to develop enough to receive and nurture a fertilized egg. This method of birth control offers no protection against sexually-transmitted diseases.

Determining Effectiveness

Contraceptive effectiveness is characterized by "typical use" and "perfect use":

Typical use refers to real-life conditions, in which mistakes (such as forgetting to take a birth control pill at the right time) sometimes happen.
Perfect use refers to contraceptives that are used correctly each time intercourse occurs.

The most effective standard female contraceptives are surgical sterilization, intrauterine devices (IUDs), and the implant. They all have an estimated failure rate of 1% or less during the first year of normal (typical) use. Vasectomy (male surgical sterilization) is the only male contraceptive that is equally effective. By comparison, the estimated failure rate of the male latex condom is 17% with typical use and 2% with perfect use. To put these rates into perspective, a sexually active woman of reproductive age who does not use contraception faces an 85% likelihood of becoming pregnant in the course of a year.

Resources

www.nichd.nih.gov -- National Institute of Child Health and Human Development
www.plannedparenthood.org -- Planned Parenthood
http://ec.princeton.edu -- Emergency Contraception Website
www.acog.org -- American College of Obstetricians and Gynecologists
www.guttmacher.org -- The Alan Guttmacher Institute
www.arhp.org -- Association of Reproductive Health Professionals

References

Blythe MJ and Diaz A. Contraception and adolescents. Pediatrics. 2007; 120(5): 1135-48.

Cheng L, Gulmezoglu AM, Piaggio G, Ezcurra E and Van Look PF. Interventions for emergency contraception. Cochrane Database Syst Rev. 2008;(2): CD001324.

Cole JA, Norman H, Doherty M, Walker AM. Venous thromboembolism, myocardial infarction, and stroke among transdermal contraceptive system users. Obstet Gynecol. 2007 Feb;109(2 Pt 1): 339-46.

Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, DollR, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008 Jan 26;371(9609): 303-14.

Creinin MD, Meyn LA, Borgatta L, Barnhart K, Jensen J, Burke AE, et al. Multicenter comparison of the contraceptive ring and patch: a randomized controlled trial. Obstet Gynecol.2008;111(2 Pt 1): 267-77.

Erkkola R. Recent advances in hormonal contraception. Curr Opin Obstet Gynecol. 2007;19(6): 547-53.

Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ. 2007;335(7621): 651.

Hov GG, Skjeldestad FE and Hilstad T. Use of IUD and subsequent fertility--follow-up after participation in a randomized clinical trial. Contraception. 2007;75(2): 88-92.

Inki P. Long-term use of the levonorgestrel-releasing intrauterine system. Contraception. 2007;75(6 Suppl): S161-6.

Jick S, Kaye JA, Li L, Jick H. Further results on the risk of nonfatal venous thromboembolism in users of the contraceptive transdermal patch compared to users of oral contraceptives containing norgestimate and 35 microg of ethinyl estradiol. Contraception. 2007 Jul;76(1): 4-7.

Kaunitz AM. Clinical practice. Hormonal contraception in women of older reproductive age. N Engl J Med. 2008;358(12): 1262-70.

Kaunitz AM, Arias R and McClung M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception. 2008;77(2): 67-76.

Kulier R, O'Brien PA, Helmerhorst FM, Usher-Patel M and D'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev. 2007;(4): CD005347.

Lopez LM, Grimes DA, Gallo MF and Schulz KF. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2008;(1): CD003552.

Margolis KL, Adami HO, Luo J, Ye W, Weiderpass E. A prospective study of oral contraceptive use and risk of myocardial infarction among Swedish women. Fertil Steril. 2007 Aug;88(2):310-6.

Meirik O. Intrauterine devices - upper and lower genital tract infections. Contraception. 2007;75(6 Suppl): S41-7.

Nelson AL. Contraindications to IUD and IUS use. Contraception. 2007;75(6 Suppl): S76-81.

O'Brien PA, Kulier R, Helmerhorst FM, Usher-Patel M and d'Arcangues C. Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception. 2008;77(5): 318-27.

Peterson HB. Sterilization. Obstet Gynecol, 2008;111(1): 189-203.

Polis CB, Schaffer K, Blanchard K, Glasier A, Harper CC and Grimes DA. Advance provision of emergency contraception for pregnancy prevention (full review). Cochrane Database Syst Rev. 2007;(2): CD005497.

Power J, French R and Cowan F. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database Syst Rev. 2007;(3): CD001326.

Prager S and Darney PD. The levonorgestrel intrauterine system in nulliparous women. Contraception. 2007;75(6 Suppl): S12-5.

Roumen FJ. The contraceptive vaginal ring compared with the combined oral contraceptive pill: a comprehensive review of randomized controlled trials. Contraception. 2007;75(6): 420-9.

Rosenberg L, Zhang Y, Constant D, Cooper D, Kalla AA, Micklesfield L, et al. Bone status after cessation of use of injectable progestin contraceptives. Contraception. 2007;76(6): 425-31.

Tolaymat LL and Kaunitz AM. Long-acting contraceptives in adolescents. Curr Opin Obstet Gynecol. 2007;19(5): 453-60.

Reviewed last on: 11/11/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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