Birth control methods (contraception)

Birth control methodsBirth control methods include various devices or medicines to avoid pregnancy. There is no ideal contraception method, each method has its advantages and disadvantages. However, only abstinence may guarantee that you will not conceive.

Barrier methods prevent the fertilization of the oocyte. Contraceptive pills interferes with the ovulation (the release of the egg by the ovary), whereas other methods help to prevent the attachment of the zygote to the lining of the uterus.

Unlike other methods of birth control, the barrier method has a significant benefit – it provides a protection against sexually-transmitted diseases.  

Pearl Index

In clinical trials to estimate the efficacy of the birth control method the Pearl Index is measured. This index is usually calculated for typical and perfect use, as the adherence to the right contraception use provides better effectiveness of the birth control method.

Abstinence

Abstinence is the most effective method (100% efficacy) to prevent unplanned pregnancy and avoid sexually transmitted diseases.

Hormonal methods

Hormonal contraceptives are available only for women. These methods include:

 

  • Combined oral contraceptive pills (Loestrin, Lutera, Trivora) and progestogen-only pills (Camila, Errin, Micronor, Ovrette)
  • Hormonal implants (Implanon, Nexplanon)
  • Hormonal patches (Estraderm)
  • Vaginal rings (NuvaRing)
  • Injections (DepoProvera)

 

All these pills and devices contain hormones – progestin and estrogen. Hormones prevent the ovulation, thicken the mucus (prevent the entering of the sperm into the uterus), thin the lining of the uterus (and prevent the attachment of the fertilized egg to the uterus).
Combined pills contain both estrogens and progestins, whereas progestogen-only pills comprise of only synthetic progesgestogens.
Before using hormonal method of birth control a woman should consult with her doctor as hormona methods have various side effects and contraindications. However, hormones have also some benefits especially when a woman has menstrual disorders or polycystic ovary syndrome.

Homonal methods are highly effective with approximately 99% efficacy.

Barrier methods

 

  • Male condom
    Male condom is made of latex or plastic and should be worn on the penis during the sexual intercourse. The main benefit of male condom is the protection from sexually transmitted diseases, which no other method except abstinence can provide. When used correctly their effectiveness is about 98%. Disadvantages of male condom include possible latex allegy and the unpleasant feeling while using it.
  • Female condom
    Female condom is a little pouch placed into the vagina and provides protection from pregnancy and sexually transmitted diseases. Female condoms provide 95% effectiveness when used perfectly and approximately 79% effectiveness when used typically.
    Female condom and male condom shouldn’t be used at once.
    Unlike male condoms female condoms ae latex-free and therefore may be used by those who have latex allergy.
  • Diaphragm
    Diaphragm is a silicone cup placed into the vagina. It is recommended to use diaphragm along with spermicides for higher efficacy. Diaphragm itself does not provide protection against sexually transmitted diseases, but luckily male condom may be used with diaphragm at once. The effectiveness of diaphragm when used typically is about 88%.
  • Cervical cap
    Cervical caps from silicone are produced under the brand name FemCap. Cervical caps are less effective (approximately 71-86%) than diaphragms and may remain in the vagina up to 2 days. They don’t provide protection from sexually transmitted diseases and should be used along with other birth control methods.

 

Intrauterine devices (IUDs)

IUD is a T-shaped device inserted into the uterus and provides long-term birth control. The effect of this method is reversible, it means that when the device is removed the fertility is restored.  

    • Copper IUD (ParaGard)
      Copper has spermicide feautes, so the copper-containing IUD damages the sperm and therefore pevents the fertilization of the egg. A failure rate for copper IUD was estimates as 0,1-2,2%. Side effects of copper IUD include heavy menstrual bleeding and cramping.    

 

  • Hormonal IUD (Mirena, Skyla)
    Hormonal IUD contains progestin and releases it in small amounts resulting in the ovulation impairment and thinning of the uterus lining. The IUD may remain in the uterus up to 5 years. Unlike copper-containing IUDs hormonal IUD lessens the menstrual bleeding and doesn’t cause cramping. Hormones released by the IUD thicken the mucus and provide protection against bacteria and therefore prevent the pelvic inflammatory disease.
    There are numerous contraindication to hormonal IUDs, so before using this birth control method a woman should consult with her GP.
    Effectiveness of hormonal IUDs is about 99%.

 

Spermicide

Spermicides are placed in the vagina before the intercourse. These chemicals affect the sperm motility and block the cervix. Spermicides are produced in forms of creams, ges, foams and suppositories under the brand names Advantage-S, Conceptrol, Crinone, Delfen Foam, Emko, Prochieve etc. When used solely spermicides provide approximately 72% effective protection, so usually it is recommended to combine spermicides with other birth control methods.

Some spermicides may irritate the reproductive system, especially when used often. This method do not provide the protection from sexually transmitted diseases. It is also not so easy to use spermicides, as in general the substantion should be placed into the vagina 10-15 minutes before the intercourse and every time before having sex a person should use it again.

Pregnancy test

Pregnancy test combo, 2 tests

Sterilization

Sterilization is the most effective birth control method and it is considered permanent, so it’s almost impossible to reverse it.

 

  • Tubal ligation for women
    During the sugery the Fallopian tubes are cut or blocked.
  • Vasectomy for men
    The vas deferens is cut or blocked. This method is almost `100% effective and usually non-reversible.

 

Coitus interruptus (withdrawal or pull-out  method)

Coitus interruptus is a method when the penis is withdrawn from the female internal reproductive organs before the ejaculation – the release of the sperm. However, this method is not able to provide high effective protection from unplanned pregnancy and requires self-control. Though this method is very common, as it’s free and doesn’t affect the feelings and doesn’t have the side effects as hormona contraceptives.

Natural methods

  • Ovulation test kits
    To determine the ovulation a woman may record information about her menstrual cycle, chart the monthly cycles of the basal body temperature, or mark the changes in the cervical mucus. Sometimes these methods are not enough to predict the ovulation period accurately, and then an ovulation home test is recommended.

The test detects the increased level of luteinizing hormone (LH) in the urine, which signals the ovary to release the egg.

Usually the test is performed on the 11th day of the cycle. A positive result indicates the possible ovulation in the following 24 – 36 hours.

    • Cervical mucus examination
      Salivary ferning kits are also available. They allow to test saliva with a pocket-sized portable microscope. As the levels of estrogen rise, the salt content of the mucus increases. The drying of the saliva leaves a fern-like pattern of salt crystals. Ferning occurs in the few days prior to ovulation.

 

  • Tracking menstrual cycles (rhythm method) also known as fertility awareness method
    When a woman uses this method she should record her periods and based on that data calculate the days when the fetility is the highest. Ovulation usually occur about 12 to 16 days after the periods. The egg may be fertilized 1-2 days after the ovulation, whereas the sperm remains viable up to 5 days. In these days periodic abstinence from sex should be obtained to prevent pregnancy or other birth control methods may be used as a backup.
    This method cannot be used when a woman has irregular menstrual cycle.  

 

Lactational amenorrhea method

The stimulation of the nipple during breastfeeding causes the release of prolactin, which inhibits production of gonadotropin-releasing hormone (GnRH)  by the hypothalamus and the luteinizing hormone (LH) by the pituitary gland. Low levels of progesterone in the blood denote the absence of ovulation – the oocyte doesn’t maturate and is not released from the ovary. Respectively, menstruation doesn’t occur. Therefore the condition is called the lactational amenorrhea. “Lactational” refers to the breastfeeding and “amenorrhea” indicates the absence of the periods.

When a woman is aware of the characteristics of this method its effectiveness reaches 98-99,5%. According to the Bellagio Consensus, LAM may be used effectively only when the following 3 criteria are met:

 

  • Amenorrhea – the periods are still absent;
  • The baby was born less than 6 months old;
  • The baby is fully or nearly fully breastfed (full and high partial breastfeeding) and the feeding is frequent (the interval between the breastfeeds is not longer than 4 during the day and 6 hours at night);

 

Emergency contraception

Emergency contraceprion should be used duing the first 5 days after the intercourse to be effective.

  • Copper-bearing intrauterine devices (IUDs)
    Copper IUD may prevent the fertilisetion of the egg and the attachment of the zygote to the ining of the uterus. It is effective up to 5 days after the intercourse. Once the implantation has occurred, IUD is no more effective.  
  • Emergency contraceprive pills (ECPs) are also known as “morning-after-pills” prevent the pregnancy, as they are able to interfere the ovulation and conception. These tablets such as levonorgestrel and ulipristal acetate contain high doses of hormones. When taken within 120 hours after the intercourse it provides approximately 80-85% effective protection from unplanned pregnancy depending on the pill.