There are a variety of mechanisms to prevent pregnancy, otherwise known as contraception. Birth control pills are popular in the United States, while intrauterine devices (IUD) are most common worldwide. Birth control pills or oral contraceptives (OCPs) are very effective, safe, and reversible. One advantage of OCPs is the ability to manipulate the onset of bleeding or suppress it entirely while on vacation or for special events. Unfortunately, there are many myths associated with OCPs and their side effects, but overall they can be used to safely prevent pregnancy and even treat some conditions, such as polycystic ovarian syndrome (PCOS).
Types of birth control
Condoms prevent sperm from accessing the egg as do diaphragms, whereas copper IUDs prevent act as a spermicide. Progestin-containing IUDs act by making the lining of the uterus unfavorable for fertilization, and hormonal contraceptives such as the Nuva ring, an intravaginal insert, birth control pills, depo-provera, and implantable hormones act to stop ovulation or egg release, alter tubal motility and make the lining of the uterus unfavorable for implantation should an egg get released accidentally. The low levels of hormone release act on the hypothalamus/pituitary to trick the glands into thinking the ovary is not ready to release an egg due to a steady, low level of hormone circulating in the blood.
Phexxi is a new non-hormonal contraceptive that acts as a spermicide by keeping the vagina acidic even in the face of alkaline semen. Tubal ligation blocks the tubes to prevent sperm and egg from meeting. There are testosterone injections for men and vasectomies.
A list of contraceptive options includes:
- Periodic abstinence
- Natural family planning
- Pulling out before ejaculation
- Barrier Forms of Contraception
- Male condom
- Female condom
- Cervical cap
- Hormonal Forms of Contraception
- Hormone implants-Implanon and Nexplanon
- Injectable hormones-Depo-provera
- Progestin-only pills
- Combination OCPs
- Hormone patch
- Hormone vaginal ring
- Intrauterine devices (IUDs)
- Female sterilization
- Vasectomy-male sterilization
- Hormones and implants to prevent sperm growth-reversible
- Emergency Contraception
- Emergency contraceptive pills (ECP) (eg, Plan B One-Step OTC, an enteric-coated levonorgestrel ECP that dissolves and is absorbed in the intestine), inhibit ovulation inhibition if given before the LH surge.
- Ulipristal acetate (eg, Ella), available by prescription, progesterone-receptor modulator effective in ovulation inhibition through the LH surge.
- Copper T380 IUD, foreign body effect creates toxic environment preventing implantation.
- Progesterone agonist/antagonist
Guidelines and benefits
The CDC, adapted from the World Health Organization, suggests the following guidelines for contraceptive use:
- No blood or lab tests are necessary before starting a form of birth control.
- Before beginning a contraceptive, no physical examination is needed, but blood pressure should be checked.
- Cervical cancer screening is not needed before intrauterine device (IUD) placement.
- IUD removal is unnecessary in the face of pelvic inflammatory disease (PID). Only antibiotics are needed unless an abscess is suspected.
In addition to protecting against pregnancy, there are many benefits to taking the pill. They include:
- Lighter periods
- Regular periods
- Ability to stop the period altogether
- Improved complexion or reduced acne
- Less painful periods
- Reduced hair growth, which can counter the effects of increased hair growth that sometimes occurs with PCOS
- Reduce the symptoms of endometriosis
- Possibly prevent ovarian cyst formation
- No increased risk of cancer and decrease in ovarian and uterine cancer.
Which contraceptive is right for you?
When determining the contraceptive that is best for you, consider the following:
- Prior pregnancies
- Planning to get pregnant soon
- Risk of unintended pregnancy
- Underlying medical conditions, such as propensity to form blood clots or smoking status
- Ability to comply with daily ingestion of birth control pills.
If someone has acne or PCOS, doctors may recommend oral contraceptives. Long-acting reversible contraception (LARC) consists of many types of IUDs. IUDs can last up to 10 years, although most last 3 or 5 years. You can have them removed at any time, and fertility returns almost immediately. If they contain hormones, your periods will likely get lighter.
What are the common side effects of hormonal birth control?
If birth control contains estrogen, breast tenderness, nausea, increased appetite, headaches, a potential increase in PMS, and lighter and irregular bleeding in the first 3 months may occur. Otherwise, the progestin-only pills could cause a lack of bleeding over time, possible weight gain, and acne. Blood clots and high blood pressure are two more serious consequences of oral contraceptive pills.
There are estrogen/progestin combination pills, progestin-only pills, 21-day, and 28-day cycles, and there is a 91-day combination oral contraceptive with 12 weeks of active pills and one week of placebo pills. Low-dose estrogen pills (20 mcg) are more common than the higher doses of 30-35 mcg.
Does age have any effect on birth control side effects or effectiveness?
Age doesn't impact the effectiveness of contraceptives; however, side effects or risks may increase if you are over the age of 35, especially if underlying conditions such as high blood pressure, diabetes, or heart disease are present.
What are the non-hormonal contraceptive options?
The following options are non-hormonal:
- Copper IUD
- Tubal ligation
RISUG and Vasalgel are two new types of male contraceptives. RISUG is reversible and has no side effects. It involves injecting a gel into the vas deferens (two tubes that carry sperm from the testicles to the urethra). It works by attracting sperm and damaging their heads and tails so that they cannot swim or penetrate the egg.
DMAU or Dimenthandrolone Undecanoate and Nesterone are two other types of male contraception, which lower testosterone levels and decrease sperm count.
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