Unless you’re ready for maternity clothes and diaper bags, birth control is a non-negotiable part of your sex life. But which method is right for you? Check out these 5 ways to stay baby-free until the time is right. Plus, test your contraception IQ…
If you think “the talk” taught you everything you needed to know about birth control, think again. The latest and greatest a generation ago is old news compared to pregnancy prevention today.
From the pill to IUD, one size doesn’t fit all when it comes to contraception. Find out the best method for your body:
1.The Pill
The latest: These days, birth control pills come with an added bonus – shorter periods or none at all.
Yaz or Loestrin Fe 24 – both approved in 2006 – have 24 days of hormone pills, followed by four days of placebos, says Julie Tantibhedhyangkul, M.D., of the Cleveland Clinic OB/GYN & Women’s Health Institute. Regular birth control pills offer 21 days of hormones with seven days of placebos.
Why increase the number of hormone pills?
“To decrease the level of hormone fluctuation and hormone withdrawal symptoms – such as pelvic pain, headaches, bloating and breast tenderness – that some women have during the seven days of placebo pills,” she says.
Don’t want to deal with pads and tampons every month? Approved in 2006, Seasonique cuts periods down to just four a year. It provides women with a low dose of estrogen during their quarterly periods, which may lower the chances of breakthrough bleeding.
Lybrel – approved in 2007 – completely eliminates your monthly visitor with 365 days of low-dose hormones.
And rest easy about tampering with nature that way, Tantibhedhyangkul says: There’s no danger from having none or shorter periods while on birth control pills.
“The birth control pill is one of the most well-studied medications the FDA [Food and Drug Administration] has ever seen,” agrees Beth Jordan, M.D., medical director of the Association of Reproductive Health Professionals.
Approved in 2006, Femcon Fe is the newest generation of 21-day traditional birth control pill. The difference? It can be chewed or swallowed. But if you choose to chew it, you must drink 8 ounces of water immediately afterward to make sure the entire tablet is absorbed into your body.
How it works: All birth control pills are taken orally every day.
Just like traditional birth control pills, the newer versions offer pregnancy protection by preventing ovulation – or release of an egg from the ovaries.
The pill also inhibits egg development, thickens cervical mucus (making it harder for sperm to swim to the uterus) and makes the uterine lining unsuitable for implantation.
Reliability: Taken properly, the traditional and newer forms of the pill are at least 99% effective in preventing pregnancy. Be sure not to miss a dose and take it at the same time every day.
The good: Extended oral contraceptives offer a host of other benefits. They can:
Improve acne
Decrease facial hair
Decrease pain during your period
Reduce period bleeding, which lowers the chance of having iron deficiency anemia
Lower risk of ectopic pregnancy, benign breast disease and endometrial and ovarian cancers
Possibly decrease the incidence of ovarian cysts
Yaz is also approved for treatment of premenstrual dysphoric disorder (PMDD) – a severe form of PMS.
The bad: The progestin in Yaz can raise blood potassium levels (hyperkalemia), Tantibhedhyangkul says, which can cause several health issues, including heart disease. Women with kidney, liver or adrenal problems – all of which can also cause hyperkalemia – should choose different birth control.
Other side effects are the same as with the traditional pill and typically improve in 2-3 months:
Nausea
Breast tenderness
Bloating
Mood changes
Breakthrough bleeding
No version of the pill protects against sexually transmitted diseases.
Fertility usually returns as soon as the pill is stopped, Tantibhedhyangkul says.
Who it’s for: Extended oral contraceptives may help women with heavy periods, pelvic pain, PMS or hormone withdrawal symptoms while using traditional birth control pills.
Pills containing estrogen should be avoided by women with uncontrolled high blood pressure, a personal or family history of blood clots or stroke, or a history of estrogen-dependent tumors or active liver disease. Women older than 35 and who smoke should also stay away.
How to get it: All daily oral contraceptives are available by prescription only.
2. The Sponge
The latest: Yes, it’s back. Approved in the U.S. in 1983, the sponge was pulled from shelves in 1995 because of manufacturing problems.
Re-introduced in 2009, the Today Sponge (the only brand available in the U.S.) is a non-hormonal, barrier method.
How it works: It’s a disc-shaped polyurethane foam device containing nonoxynol-9, which kills sperm. It prevents pregnancy by covering the cervix and blocking semen from meeting up with an egg.
First, moisten the sponge with water to activate the spermicide. Fold it in half and insert it into your vagina, placing it firmly against your cervix. Finally, use one or two fingers to gently push the sponge up as far as it will go.
Reliability: “The sponge is a good barrier method, but it’s really not the most effective form of birth control,” Jordan says.
Even when used properly, about 9% of women will get pregnant in the first year of use, says Margaret Lewin, M.D., FACP, chief medical director of Cinergy Health in New York. With typical use – which includes slipups, like taking it out too soon or putting it in after intercourse – that number goes up to 16%.
The sponge is less effective in women who’ve had a baby, because it fits loosely: 20% will get pregnant in the first year with perfect use. With typical use, odds go up to 32%.
The good: Today’s Sponge can be inserted up to 24 hours before sex, so you don’t have to break the mood to prep. And women can have sex as many times as desired within that time-frame without changing the sponge or adding spermicide, Tantibhedhyangkul says.
But you must wait at least 6 hours after sex before removing it and you shouldn’t wear the sponge for more than 30 hours.
The bad: Its failure rate is high. And some women complain of vaginal dryness, soreness or itching after using it, Tantibhedhyangkul says.
The sponge won’t suit women allergic to polyurethane or spermicide. And the fit is a problem for women with abnormal anatomy in the vagina or cervix, she says.
It also doesn’t protect against STDs; in fact, it might raise your risk.
“The sponge might irritate the vaginal mucosa and increase the risk of HIV infection,” Tantibhedhyangkul says.
Who it’s for: The sponge may be a good option for women who want a non-hormonal option that won’t interfere with spontaneous sex – and for those who won’t be devastated by an accidental pregnancy.
How to get it: The Today Sponge is available over the counter and doesn’t require any special fitting. Plus, at $13.99 for a three-pack, it's an inexpensive way to stay baby-free.
3. The IUD
What’s new: “This isn’t your mother’s IUD,” says Nancy Stanwood, associate professor of obstetrics and gynecology at the University of Rochester School of Medicine. “They’re effective and great, and a lot of women in the U.S. are using them.”
About 1.8% of U.S. women using contraception choose the IUD, she says, and today they have two options: copper or hormone.
Approved in 1988, the copper IUD – called Paragard – has the metal wrapped around a T-shaped plastic frame.
The hormone IUD – Mirena – was approved in 2001 and also has a plastic frame, but features a reservoir containing progestin.
How they work:
Copper IUD (Paragard): After insertion by a doctor, “the copper repels sperm” by prompting the uterus to produce white blood cells, copper ions and other enzymes that kill sperm, Jordan says.
Paragard is effective for 10 years.
Hormone IUD (Mirena): This IUD releases progestin to change the chemistry in the cervix and uterus. Thick, sticky mucus prevents sperm from getting through. The hormone also keeps the lining of the uterus thin, creating an unsuitable environment for an egg to implant and grow.
Mirena is effective for five years.
Reliability:
Copper IUD (Paragard): “Over the first five years, the risk (of pregnancy) is 1%,” Stanwood says. “Over 10 years, it’s 2%.”
Hormone IUD (Mirena): It’s more than 99% effective at preventing pregnancy, Stanwood says.
The good: The copper IUD (Paragard) is the most commonly used reversible method of contraception around the world, hands down,” Stanwood says. “It just works so well and for so long, and it's so convenient.”
The hormone IUD (Mirena) relieves heavy and crampy periods, she says. And even women with normal periods will notice lighter, shorter flows. After a year, 50% stop having periods, and that’s not something to worry about.
“Periods stopping with the hormone IUD isn’t a problem at all and many women like it,” Stanwood says.
The bad: Paragard (the copper IUD) can exacerbate problems for women with heavy, crampy periods.
Neither IUD will properly fit a woman with an abnormally shaped uterus or whose uterus has changed because of fibroids, Stanwood says.
All IUDs come with small risks:
About 5% of the time, they fall out. They can be re-inserted, but the risk of a second one falling out increases to 30%.
About 3 in 1,000 women develop infections, which can be treated with antibiotics.
In 1 out of 1,000 women, the IUD will be inserted too deep into the uterine wall, causing pain or migration into the abdomen, Stanwood says. It can be repositioned or removed and re-inserted.
IUDs don’t protect against STDs, so it’s not for women with multiple partners.
Who it’s for: Women who want long-term pregnancy protection or simply wish to space out pregnancies, Stanwood says. It can be removed at any time (with no effect on fertility) if a woman wants to get pregnant.
How to get it: Both IUDs require a doctor’s visit. The device is inserted into the uterus during a 10-minute procedure, usually without anesthesia, Stanwood says. Brief cramping is common.
4. Implanon
The latest: Approved in 2006, the hormone-based Implanon is a single flexible, plastic rod inserted in the upper arm. More than 4.5 million rods have been sold worldwide since 1998.
“It's the only implant contraceptive system available in the U.S.,” Tantibhedhyangkul says. (Another, Norplant, was taken off the market in 2002 because of problems with removing its six rods.)
How it works: The rod contains a progestin-like hormone called etonorgestrel, which is slowly released into the body to prevent ovulation and, therefore, pregnancy for three years.
The device also thins the uterine lining and thickens, and decreases cervical mucus, making it harder for sperm to swim inside the uterus.
Reliability: Implanon is more than 99% effective – even better than the pill, Tantibhedhyangkul says.
The good: Most women experience lighter periods on Implanon, she says. And many have no periods at all after the first year of use.
Plus, women are almost immediately fertile after the rod is removed, Lewin says.
The bad: Many women have spotting. It’s the main reason that about 15% of women in the U.S. and Europe discontinue it, Tantibhedhyangkul says.
Implanon also:
Can trigger acne and breast pain.
Can trigger adverse drug interactions with anti-seizure medications, anti-fungals, St. John’s wort and other herbal medication.
Doesn’t protect against STDs.
Who it’s for: Women who want long-term pregnancy protection without the bother of taking a daily pill.
It's also a safe, effective birth-control option for breast-feeding women.
How to get it: Implanon is surgically inserted under the skin at your doctor’s office. The procedure takes 2-3 minutes.
5. Emergency Contraception (Plan B)
The latest: A birth-control mishap doesn’t have to equal mommyhood. Approved in July 2009, Plan B One-Step is a single-dose backup method for preventing pregnancy when taken within 72 hours of having unprotected sex or contraceptive failure.
It’s an improvement on the first generation of Plan B, which required women to take two doses 12 hours apart, Stanwood says.
But don’t confuse Plan B with Mifepristone (or RU486), which terminates a pregnancy.
“If a woman takes Plan B when she’s pregnant and doesn’t know it, it won’t cause a miscarriage and birth defects,” she says.
How it works: Plan B One-Step is a progestin-only pill that delays ovulation.
“Sperm can make a woman pregnant for three days after sex, so if you can postpone the egg from being released for at least three days, it works as a contraceptive,” Stanwood explains.
Reliability: According to the manufacturer, Plan B One-Step prevents pregnancy in 7 out of 8 women who take the emergency contraception. It’s most effective if taken within 24 hours of having unprotected sex or contraception failure.
The good: Plan B One-Step is as safe and effective as the original Plan B, Stanwood says. Women with medical conditions – such as heart disease, diabetes or history of blood clots – that prevent them from using standard birth-control pills can take Plan B because it doesn’t contain estrogen.
The bad: About 25% of women taking Plan B One-Step feel nauseous and 6% vomit.
Plan B One-Step doesn’t protect against STDs.
Who it’s for: Any woman worried about pregnancy due to contraceptive failure or unprotected sex. But it shouldn’t be used as a regular birth control method.
How to get it: Plan B One-Step is available at drugstores without a prescription to women age 17 and older. Men may also buy it for their partners. Those younger than 17 need a prescription.
Not-2-late.com – operated by the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals – helps women find doctors who will prescribe Plan B in a timely manner without an office visit, Stanwood says. The website also instructs women how to use their brand of birth control pill as emergency contraception.
Freelance writer Shanna Thompson Zareski contributed to this article.
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