In the blur of sleepless nights and diaper changes, it’s easy to forget about birth control. But the fact is, even before you experience your first menstrual period after childbirth, there may be a chance that you could become pregnant again if you have unprotected sex. Conceiving again within 24 months of your delivery may carry certain health risks for you and your baby — possibly including an increased risk of autism — not to mention the stress of being pregnant while caring for a newborn. For these reasons, it’s important to consider your birth control options.
For those who choose birth control, there are many different choices:
Hormonal methods. Examples include birth control pills, as well as a contraceptive patch (Ortho Evra), vaginal ring (NuvaRing), contraceptive implant (Implanon) and contraceptive injection (Depo-Provera).
Barrier methods. Examples include male and female condoms, as well as the diaphragm, cervical cap, and contraceptive sponge and spermicide.
Intrauterine devices. Examples include a copper IUD (ParaGard) and a hormonal IUD (Mirena).
Permanent methods. Examples include tubal ligation and hysteroscopic sterilization (Essure, Adiana) for women and vasectomy for men.
Natural family planning. Examples include the rhythm method and the basal body temperature and cervical mucus methods.
ISSUES TO CONSIDER
Some forms of contraception may be a better fit for you than others. Here are some questions to ask yourself as you consider your options:
How effective is it? To be effective, any method of contraception must be used consistently and correctly. But some methods tend to be more effective than others. For example, a hormonal IUD is more effective than is a diaphragm combined with spermicide. It’s up to you to determine the level of effectiveness you need.
Is it reversible? The method of contraception you choose depends on your reproductive goals. If you’re planning another pregnancy in the near future, you may want a method that’s easily stopped and quickly reversible, such as a hormonal method or a barrier method. If you’d like to become pregnant again — but not in the near future — you may want to consider an IUD, which provides continuous contraception for as long as it’s in place. If you’re certain that you don’t ever want to have more children, you may prefer a permanent method, such as sterilization.
Is it convenient? For some people, convenience suggests ease of use, no bothersome side effects or no disruption of the sexual experience. For others, convenience means no prescription is required. When choosing a method of contraception, consider how willing you are to plan ahead or, if necessary, adhere to a rigid schedule. It’s important to choose a type of birth control that suits your lifestyle.
Is it a good choice if you’re breast-feeding? If you’re breast-feeding, you’re more limited in your contraception options. Some hormonal methods aren’t recommended while breast-feeding because they can diminish your milk supply. There have been some questions regarding possible effects of contraceptive hormones on the baby, but there’s no evidence that oral contraceptives affect a baby’s development.
What are the side effects? Consider your tolerance for the possible side effects associated with a particular birth control method. Some methods, particularly those that contain hormones, pose more side effects than do others, such as barrier methods and natural family planning methods. Talk to your care provider about your medical history and how it might affect your choice of birth control.
Does the method offer any additional benefits? Besides preventing pregnancy, some contraceptives provide additional benefits — such as more predictable, lighter menstrual cycles, a decreased risk of sexually transmitted infections or a reduction in the risk of some cancers. If these benefits are important to you, they may influence your choice of birth control.
Will it protect you from sexually transmitted infections? Male and female condoms are the only methods of birth control that offer reliable protection from sexually transmitted infections (STIs). Other birth control options don’t protect against STIs.
Is the method acceptable to your sexual partner? Your partner may have birth control preferences that are similar to or different from your own. Discuss birth control options with your partner to help determine which method is acceptable to both of you.
Is the method compatible with your beliefs or practices? Some forms of birth control are considered a violation of certain religious laws or cultural traditions. When deciding on birth control, weigh the risks and benefits of a particular method against your personal convictions.
BREAST-FEEDING AND CONTRACEPTION
Contraception after childbirth isn’t quite as easy if you’re breast-feeding. That’s because breast-feeding affects fertility and birth control options in a couple of different ways.
Fertility The myth is that you can’t get pregnant if you’re breast-feeding. And it is just that, a myth. You can get pregnant while breast-feeding. However, breast-feeding does reduce fertility, so your chances of becoming pregnant aren’t as high as if you weren’t breast-feeding.
Knowing that fertility is reduced, some women choose natural family planning as their form of contraception while breast-feeding. This is certainly acceptable, but there are a couple of things you need to be aware of.
You may experience your first ovulation before your first period. That means you can’t use your first period as an indicator that you need to take precautions against pregnancy. You could become pregnant again without ever experiencing a period.
While breast-feeding, your period may not follow a consistent pattern. This makes natural family planning more difficult than normal.
Hormones and breast milk Certain types of birth control pills containing estrogen and progestin (combination oral contraceptives) traditionally haven’t been recommended for women who are breast-feeding. Depending on the type of hormonal contraceptive you use, the hormones involved can reduce your milk production. In the past, there’s also been concern that the estrogen in combined oral contraceptives could decrease the minerals or calories in breast milk. However, in well-nourished mothers, this generally isn’t a problem. There’s also no evidence that oral contraceptives affect baby’s development.
Here are some things you need to remember if you’re considering birth control pills or other hormonal contraceptives while breast-feeding.
It’s best to wait at least six weeks before using a hormonal contraceptive. This is to allow your breast-feeding pattern to become well established.
Not all oral contraceptives are the same. Some contain both estrogen and progestin, and others contain just progestin (sometimes called the mini pill). Contraceptives containing only progestin don’t affect milk production. The American Congress of Obstetricians and Gynecologists (ACOG) indicates that progestin-only methods, including the mini pill and the contraceptive Depo-Provera, are safe to use during breast-feeding. ACOG also indicates that in women with a well-established milk supply, contraceptives containing estrogen may be considered.
The mini pill is not as effective as combination oral contraceptives. It has to be taken exactly as prescribed to offer maximum protection. You can’t occasionally miss a pill and still expect to be protected.
Vaginal dryness Another way that breast-feeding affects fertility is that it can cause vaginal dryness. If you’re planning to use condoms as a form of contraception while you’re breast-feeding, be aware that vaginal dryness may make condom use a bit uncomfortable. However, lubricants can help prevent this problem.
OPTIONS
Following is a description of the contraceptives currently available to prevent pregnancy. Keep in mind that correct use increases a method’s effectiveness. Talk with your care provider for more information regarding which choice may be best for you.
Hormonal methods These methods prevent pregnancy by suppressing the release of certain hormones, in turn preventing the release of eggs from your ovaries.
Combination birth control pills Combination birth control pills, commonly referred to as “the pill,” are oral contraceptives that contain the hormones estrogen and a progestin. Combination birth control pills suppress ovulation — keeping your ovaries from releasing an egg. They also thicken cervical mucus and thin the lining of the uterus (endometrium) to keep sperm from reaching the egg.
Different types of combination birth control pills contain different doses of estrogen and progestin. Other types of combination birth control pills allow you to reduce the number of periods you have each year. For maximum effectiveness, you must take combination birth control pills at the same time every day.
Types. Combined oral contraceptives come in different quantities of active and inactive pills, including:
Conventional pack. The most common type of combination birth control pills contains 21 active pills and seven inactive pills. Formulations containing 24 active pills and four inactive pills, known as a shortened pill-free interval, also are available. Bleeding occurs the week you take the inactive pills.
Continuous dosing or extended cycle. These combinations typically contain 84 active pills and seven inactive pills. Bleeding generally occurs only four times a year during the days when you take the inactive pills.
Combination birth control pills also come in different formulations:
Monophasic. With this type of combination birth control pill, each active pill contains the same amount of estrogen and progestin.
Multiphasic. With this type of combination birth control pill, the combinations and amounts of hormones in active pills vary. In some types, the progestin content steadily increases, while in others the progestin dose remains steady and the estrogen content increases.
Combination birth control pills that contain less than 35 micrograms of ethinyl estradiol, a type of estrogen, are known as low-dose pills. Women who are sensitive to hormones may benefit from taking a lower dose pill. However, low-dose pills may result in more breakthrough bleeding than higher dose pills.
Effectiveness. An estimated 8 out of 100 women who use combination birth control pills for one year will get pregnant.
Benefits and risks. Combination birth control pills are an easily reversible method of contraception. Your fertility may return to normal two weeks after you stop taking combination birth control pills. Benefits may include:
A decreased risk of ovarian and endometrial cancers, ectopic pregnancy, ovarian cysts, uterine fibroids, benign breast disease and iron deficiency anemia
Reduced pain for women who experience severe menstrual cramps, a condition called dysmenorrhea
Relief from premenstrual syndrome (PMS)
Shorter, lighter and more predictable periods or, for some types of combination pills, fewer periods each year
An improvement in acne
Possible side effects of combination birth control pills include:
An increased risk of blood clots in the legs or lungs, heart attack, stroke and cervical cancer, although the overall risk is low
Elevated blood pressure
Nausea
Bloating
Breast tenderness
Mood changes
Headaches
Combination birth control pills may not be the best choice if you’re older than age 35 and smoke, have poorly controlled high blood pressure or have a history of blood clots, stroke, breast, liver or endometrial cancer. The risk of complications is higher in these situations.
Mini pill The mini pill, also known as the progestin-only birth control pill, is an oral contraceptive that contains only the hormone progestin. It does not contain estrogen.
The mini pill thickens cervical mucus and thins the lining of the uterus (endometrium), preventing sperm from reaching the egg. The mini pill also sometimes suppresses ovulation.
Effectiveness. An estimated 1 to 13 out of 100 women who use the mini pill for one year will get pregnant. Given the low dose of progestin, the failure rate of the mini pill in highly fertile women is higher than that of other hormonal contraceptive methods.
Benefits and risks. The mini pill is an easily reversible method of contraception. Your fertility may return to normal immediately after you stop taking the mini pill.
Your care provider may recommend the mini pill if:
You’re breast-feeding. Because there’s no estrogen in the pill, you don’t have to worry about it interfering with your milk supply.
You have certain health problems, such as a high risk of heart disease, high blood pressure or migraines.
You’re older than age 35 and a smoker.
Your care provider may discourage use of the mini pill if you have breast cancer or unexplained uterine bleeding or if you’re taking medications that contain anticonvulsants or anti-tuberculous agents.
Possible side effects of the mini pill include:
Irregular menstrual bleeding
Ovarian cysts
Depression
Weight gain or loss
Decreased libido
Headache
Contraceptive patch Ortho Evra is a contraceptive patch for women that contains the hormones estrogen and progestin. To use Ortho Evra, you apply the small patch to your skin once a week for three weeks. On the fourth week, you don’t use a patch, which allows menstruation to occur.
Similar to combination birth control pills, Ortho Evra prevents pregnancy by releasing the hormones estrogen and progestin into your bloodstream. The hormones suppress ovulation, keeping your ovaries from releasing an egg. Ortho Evra also thickens cervical mucus to keep sperm from reaching the egg.
Effectiveness. An estimated 5 out of 100 women who use Ortho Evra for one year will get pregnant.
Benefits and risks. The benefits and risks are similar to those of the combination birth control pills. However, studies indicate that Ortho Evra causes a higher level of estrogen to circulate in the body than do combination birth control pills. As a result, your care provider may worry about a slightly higher risk of side effects while taking Ortho Evra than if you took combination birth control pills.
Vaginal ring NuvaRing is a flexible, transparent plastic ring that contains the hormones estrogen and progestin. It’s inserted deep into the vagina and worn for three weeks. You remove NuvaRing for one week — allowing menstruation to occur — then insert a new ring.
Similar to combination birth control pills, NuvaRing prevents pregnancy by releasing hormones into your body, which suppress ovulation — keeping your ovaries from releasing an egg. NuvaRing also thickens cervical mucus to keep sperm from reaching the egg.
Effectiveness. An estimated 5 out of 100 women who use NuvaRing for one year will get pregnant.
Benefits and risks. NuvaRing doesn’t require a personalized fitting. It can be removed at any time, followed by a quick return to fertility. It isn’t appropriate for everyone, however. You must be comfortable with self-insertion and removal of the device. Your care provider may discourage use of NuvaRing if:
You’re older than age 35 and smoke
You’re breast-feeding or recently gave birth, had a miscarriage or had an abortion
You have a history of heart attack or stroke
You have a history of breast, uterine or liver cancer
You have a history of blood clots in your legs, lungs or eyes
You have severe high blood pressure
Possible side effects of NuvaRing are similar to combination birth control pills and include an increased risk of blood-clotting problems, heart attack, stroke, liver cancer and high blood pressure. Other possible side effects include breakthrough bleeding or spotting, vaginal infection or irritation, and headache.
Contraceptive implant Implanon is a contraceptive implant for women that’s placed under the skin of the upper arm. Implanon releases a low, steady dose of the hormone progestin to thicken cervical mucus and thin the lining of the uterus (endometrium) — preventing sperm from reaching the egg. The implant typically suppresses ovulation as well.
Presently, Implanon is the only contraceptive implant that has Food and Drug Administration (FDA) approval. The implant prevents pregnancy for up to three years after insertion.
Effectiveness. An estimated 1 out of 100 women who use Implanon for one year will get pregnant. If you do conceive while using Implanon, there’s a higher chance the pregnancy will be ectopic, when the fertilized egg implants outside the uterus, usually in a fallopian tube.
Benefits and risks. Implanon doesn’t require a personalized fitting or regular attention. It also can be removed at any time, followed by a quick return to fertility.
Your care provider may discourage use of Implanon if you:
Have had serious blood clots, a heart attack or stroke
Have hepatic tumors or liver disease
Have undiagnosed abnormal genital bleeding
Have known or suspected breast cancer or a history of breast cancer
Risks associated with the contraceptive implant include:
Changes in vaginal bleeding patterns, including the absence of menstruation (amenorrhea); irregular bleeding may resolve within three to nine months
Mood swings
Depression
Weight gain
Acne
Headaches
Slight risk of ovarian cysts and blood clots
Contraceptive injection Depo-Provera is a contraceptive that’s given in the form of a shot. You visit your care provider for an injection once every three months. Depo-Provera suppresses ovulation, keeping your ovaries from releasing an egg. It also thickens cervical mucus to keep sperm from reaching the egg. It may take 10 months or more for fertility to return after stopping Depo-Provera injections.
Types. Two injectables — Depo-Provera and Depo-subQ Provera 104 — are currently available. Both contain the hormone progestin, but Depo-subQ Provera 104 contains a lower dose.
Effectiveness. An estimated 3 out of 100 women who use Depo-Provera for one year will get pregnant.
Benefits and risks. Among various benefits, Depo-Provera:
Doesn’t require a personalized fitting or daily attention
Decreases the risk of endometrial cancer, pelvic inflammatory disease and uterine fibroids
Has no adverse effects on breast-feeding (The hormone estrogen, used in many other birth control methods, may interfere with milk supply.)
Your care provider may discourage its use if you have unexplained vaginal bleeding, breast cancer, liver disease or a history of blood-clotting problems. Side effects of the contraceptive may include:
A temporary loss of bone mineral density (The loss increases the longer Depo-Provera is used and may not be completely reversible.)
Irregular periods and breakthrough bleeding
Weight gain
Breast soreness
Headaches
Barrier methods These methods prevent pregnancy by creating a “barrier” to prevent male sperm from reaching female eggs.
Male and female condoms Condoms are a very effective way to prevent pregnancy and protect yourself and your partner from sexually transmitted infections (STIs). Condoms are simple to use, in-expensive and widely available. They’re sold with or without a lubricant in a variety of lengths, shapes, widths and thicknesses, and they come in different colors and textures.
Types. A male condom is a thin sheath that’s placed over the erect penis just before sexual intercourse. The female condom is a soft, loosefitting pouch with a ring on each end. Before sex, one ring is inserted into the vagina to hold the female condom in place. The ring at the open end of the condom remains outside the vagina. While the male condom is fairly easy to use, some women find the female condom difficult to insert.
Effectiveness. Condoms are an effective form of birth control — when they’re used. With perfect use, about 2 in 100 couples who use male condoms will get pregnant in a year. If you consider more typical use, the statistics are 15 in 100. Chances of pregnancy increase if condoms are used incorrectly or sporadically — a condom isn’t effective at all if it lies unopened in a drawer.
An estimated 21 out of 100 women who use the female condom for one year will get pregnant — usually because they don’t use condoms every time they have sex. When female condoms are used correctly and all of the time, pregnancy results about 5 percent of the time.
Benefits and risks. Condoms don’t have the side effects found in some forms of female contraception, such as birth control pills or shots, or potential complications of an intrauterine device (IUD). They’re also available without a prescription and are easy to obtain.
Some people are allergic to latex, and if either partner is allergic, he or she may react to contact with a latex condom. The female condom may also cause discomfort, including burning, itching or a rash.
Diaphragm The diaphragm prevents sperm from entering the uterus. It’s a small, reusable rubber or silicone cup with a flexible rim that covers the cervix. Before sex, the diaphragm is inserted deep into the vagina so part of the rim fits snugly behind the pubic bone. The device is held in place by the vaginal muscles.
Effectiveness. An estimated 16 out of 100 women who use the diaphragm for one year will get pregnant. The device is effective at preventing pregnancy only when used with spermicide, which blocks or kills sperm.
Benefits and risks. The diaphragm can be used as a backup method of birth control and it doesn’t pose a risk of side effects. However, your care provider may discourage use of the diaphragm if you just gave birth, or if you:
Have an allergy to silicone, latex or spermicide
Have vaginal abnormalities that interfere with the fit, placement or retention of the diaphragm
Have an infection in your vagina or pelvic area
Have frequent urinary tract infections
Cervical cap The cervical cap is a contraceptive device that prevents sperm from entering the uterus. The cervical cap is a reusable, deep cup that fits tightly over the cervix. Before sex, the device is inserted into the vagina and held in place by suction. A strap helps with removal.
Presently, only one cervical cap — FemCap — has Food and Drug Administration (FDA) approval. FemCap is made of silicone rubber. It must be fitted and prescribed by a doctor.
Effectiveness. An estimated 14 out of 100 women who’ve never been pregnant or given birth vaginally and use the cervical cap for one year will get pregnant. An estimated 29 out of 100 women who’ve given birth vaginally and use the cervical cap for one year will get pregnant. This decrease in effectiveness is due to changes in the shape of the cervix after childbirth, making it more difficult for the cap to fit properly. The failure rate of newer models may be lower.
Benefits and risks. The cervical cap can be used as a backup method of birth control and doesn’t pose a risk of side effects. It may not be the best choice if you just gave birth, or if you:
Have an allergy to spermicide or silicone
Are experiencing vaginal bleeding or you have an infection in your vagina, cervix or pelvic area
Have vaginal abnormalities that interfere with the fit, placement or retention of the cervical cap
Have a history of pelvic inflammatory disease, toxic shock syndrome, cervical cancer, third-degree uterine prolapse, uterine tract infections, or vaginal or cervical tissue tears
Some women find the cervical cap difficult to insert.
Contraceptive sponge and spermicide The contraceptive sponge is a soft, disk-shaped device made of polyurethane foam that covers the cervix. The device is sold over-the-counter. Before sex, the sponge is moistened with water and inserted deep into the vagina, where it’s held in place by vaginal muscles. It has a loop to assist with removal. The contraceptive sponge contains spermicide, which immobilizes or kills sperm before they enter the uterus.
Effectiveness. An estimated 16 out of 100 women who’ve never given birth and use the contraceptive sponge for one year will get pregnant. An estimated 32 out of 100 women who’ve given birth and use the contraceptive sponge for one year will get pregnant.
Benefits and risks. The contraceptive sponge doesn’t require a prescription or fitting, can be inserted hours before sex and provides protection from pregnancy for 24 hours. However, it may not be appropriate if you just gave birth, or if you:
Are sensitive or allergic to spermicide or polyurethane
Have vaginal abnormalities that interfere with the fit, placement or retention of the contraceptive sponge
Have frequent urinary tract infections
Spermicide may increase your risk of urinary tract infections and cause vaginal irritation — sometimes resulting in burning, itching or a rash. Frequent use of spermicide can increase vaginal irritation.
Intrauterine devices Intrauterine devices (IUDs) affect the way sperm move, preventing them from joining with an egg. An IUD is a small, flexible, plastic T-shaped device, which is placed in the uterus by a care provider.
Types. There are two types of IUDs, the copper IUD (ParaGard) and the hormonal IUD (Mirena).
ParaGard continuously releases copper, preventing sperm from entering the fallopian tubes. If fertilization occurs, ParaGard keeps the fertilized egg from implanting in the lining of the uterus. ParaGard prevents pregnancy for up to 10 years after insertion.
With the hormonal IUD, the hormone progestin is released from the device. Mirena thickens the cervical mucus and thins the lining of the uterus (endometrium) — preventing sperm from entering the fallopian tubes. Mirena prevents pregnancy for up to five years after insertion.
Effectiveness. An estimated 1 out of 100 women who use either type of IUD for one year will get pregnant.
Benefits and risks. An IUD provides continuous contraception as long as it’s in place. It stays in your uterus for as long as you want to avoid pregnancy — up to five years for Mirena and 10 years for ParaGard.
There may be some discomfort with placement of an IUD, and there’s a small risk of uterine infection the first few days after placement. ParaGard generally tends to cause longer, heavier and more painful menstrual periods. Mirena may cause irregular bleeding for the first three to six months after insertion, but after this time, periods tend to be lighter. In fact, some women using Mirena experience an absence of periods. Side effects associated with Mirena include headache, acne, breast tenderness and mood changes.
In addition, IUDs can dislodge from the uterus, and you may not know it’s happened. Expulsion occurs most often during your first period after the device is inserted. If you’re worried about expulsion, you may want to see your care provider to make sure the IUD is still in place.
The overall risk of ectopic pregnancy with an IUD is less than the risk for women who don’t use contraception. However, if pregnancy does occur with an IUD in place, the risk of ectopic pregnancy is higher. If you have an IUD in place and you’re concerned that you might be pregnant, contact your care provider right away so he or she can determine that it’s not an ectopic pregnancy.
Permanent methods Sterilization is generally irreversible. Before undergoing these procedures, you need to be certain that you don’t wish to have any more children.
Tubal ligation A tubal ligation — also known as having your tubes tied — is a form of permanent birth control. During a tubal ligation, the fallopian tubes are cut or blocked, disrupting the movement of the egg to the uterus for fertilization and preventing sperm from traveling up the fallopian tubes to the egg.
Tubal ligation is usually done under short-acting general or regional anesthesia. It can be done while you’re recovering from vaginal childbirth or during a cesarean (C-section) delivery. It can also be done as an outpatient procedure at a later time. It’s possible to reverse a tubal ligation — but reversal requires major surgery and isn’t always effective.
Effectiveness. In the first year after a tubal ligation, an estimated 1 out of 100 women will get pregnant. If you do conceive after having a tubal ligation, there’s a higher chance that the pregnancy will be ectopic — when the fertilized egg implants outside the uterus, usually in a fallopian tube.
Benefits and risks. A tubal ligation permanently prevents pregnancy, ending the need for any type of contraception. Because it does involve surgery, it carries some risks, which include damage to the bowel, bladder or major blood vessels, adverse reaction to anesthesia, and wound infection.
Hysteroscopic sterilization Hysteroscopic sterilization is the “plugging up” of the fallopian tubes to prevent fertilization. This is done by way of nonsurgical methods performed in a doctor’s office or an outpatient surgery setting.
Essure system. This method consists of placing a small, coil-shaped metallic device within each fallopian tube. The devices cause scar tissue to form, effectively blocking the fallopian tube and preventing fertilization of the egg. Your doctor inserts the device into each of your fallopian tubes by threading a thin, flexible tube through the vagina into the uterus and on into the fallopian tube. For the following three months, you must use an alternate form of birth control. After this time, you undergo an X-ray to ensure that the scar tissue has developed. If the X-ray shows that your tubes are fully blocked, you can discontinue other forms of birth control.
Adiana system. With this procedure, your care provider heats a small portion of each of your fallopian tubes and then inserts a tiny silicone device into each tube. The Adiana system blocks the fallopian tubes and causes scar tissue to form around the devices, preventing sperm from reaching the egg. Similar to Essure, after three months an ultrasound exam or X-ray is performed to confirm your fallopian tubes are blocked. If the procedure is successful, you can stop using other forms of birth control.
Effectiveness. In the first year after implantation of the Essure system, an estimated 1 out of 100 women will get pregnant. With the Adiana system, an estimated 1 to 2 out of 100 women will get pregnant. If you do conceive after having either of these systems implanted, there’s a higher chance that the pregnancy will be ectopic, a condition in which fertilization happens outside the uterus.
Benefits and risks. Benefits of hysteroscopic sterilization include permanent sterilization and no significant long-term side effects. Your doctor may not recommend these forms of sterilization if you recently gave birth, you’re not certain that you don’t want to have more children, you’re sensitive to nickel or allergic to the contrast agent used to confirm tubal blockage, or you have a condition that prevents access to one or both tubal openings.
Vasectomy Vasectomy is a simple surgery that provides birth control for men. A vasectomy may be done in a doctor’s office with a local anesthetic. In this procedure, a man’s vasa deferentia — the ducts through which the sperm travel — are cut and sealed.
Effectiveness. Vasectomy is nearly 100 percent effective in protecting against pregnancy. However, vasectomy doesn’t provide immediate protection. Most men become free of sperm after eight to 10 ejaculations. Until your doctor determines that the ejaculate doesn’t contain sperm, another form of birth control needs to be used.
Benefits and risks. Vasectomy is a minor outpatient surgery with a low risk of complications or side effects. The cost of a vasectomy is far less than the cost of female sterilization (tubal ligation). Serious side effects or complications are rare. Minor side effects may include swelling, bruising of the scrotum and blood in the semen.
Natural family planning methods Natural family planning methods, also called rhythm methods, involve determining the days during your monthly cycle that you’re fertile (ovulating) and avoiding intercourse on those days. No devices or medications are required.
Types. Methods that can be used to assess when you’re most fertile include:
Calendar method. Using certain calculations, you determine the first and last days during which you can become pregnant in your cycle.
Cervical position and dilation. Your cervix opens and changes position at the time of ovulation. With this method, you check your cervical position using your finger. During ovulation, your cervix is slightly higher, softer and more open than it is at other times of the month.
Mucus inspection method. This involves tracking changes in your cervical mucus to determine when you’re ovulating.
Temperature method. Most women have a slight change in basal body temperature related to ovulation. Their temperature drops during ovulation and then rises slightly after ovulation.
Mucothermal method. This is a combination of the temperature and mucus inspection methods.
Symptothermal method. This is a combination of four methods — calendar, cervical position and dilation, mucus inspection, and temperature. Using more than one method provides a more accurate picture of your fertile phase.
If you plan to use a rhythm method, it’s best to take a class or receive training from a qualified teacher.
Effectiveness. The effectiveness of natural family planning methods depends on your diligence. Used perfectly, effectiveness ratings reach 90 percent, which means that 10 out of 100 women who use natural family planning as birth control for a year will become pregnant. Few couples use natural family planning perfectly, so they experience lower effectiveness rates.
It’s easier to be successful with natural family planning if your periods are very regular. Plus, you must carefully chart your cycles and observe signs of ovulation. Natural family planning is particularly challenging if you’re breast-feeding because you may not have periods or they may be irregular. Mucus inspection and cervical position and dilation become particularly important because ovulation may precede vaginal bleeding.
Benefits and risks. Some women choose natural family planning for religious reasons. It doesn’t cause side effects and it doesn’t pose any risks. However, it’s less effective than other options.
Emergency methods Emergency contraception isn’t meant to be used in place of routine birth control, but it’s an option if you’ve had unprotected sex, your method of birth control failed or you missed a birth control pill.
You may be able to choose from several different types of emergency contraception. Many women opt for Next Choice or Plan B One-Step, also known as the morning-after pill. The newest emergency contraceptive on the market is called Ella. It’s also possible to use combination birth control pills or ParaGard — an intrauterine device — for emergency contraception. Depending on where you are in your menstrual cycle, emergency contraception can prevent or delay ovulation, block fertilization, or keep a fertilized egg from implanting in the uterus.
To be effective, emergency contraception must be used as soon as possible after unprotected sex. Emergency contraceptive pills are most effective when taken within 72 hours of intercourse. Ella is designed to prevent pregnancy if taken within five days after unprotected sex. Emergency IUDs may be placed within seven days of intercourse.
Emergency contraceptives are generally very safe and have few side effects, but they’re not intended for frequent use and aren’t recommended as a routine form of birth control. Common side effects are nausea and vomiting, although they may occur more frequently with combination regimens. If you’re breast-feeding, your care provider may recommend a progestin-only regimen. After use of emergency contraceptive pills, your first period may be irregular.
MAKING YOUR DECISION
When you choose a contraceptive method, many factors come into play, including your age, health, emotional maturity, marital status, religious convictions and whether you’re breast-feeding. Knowing your options is part of the decision process — but an honest assessment of yourself, your partner and your relationship is just as important. Most people have to make some trade-offs. You might, for instance, prefer to deal with the mild side effects of a hormonal contraceptive in exchange for effectiveness, or forgo the convenience of an IUD for the low cost of a barrier method. Ideally, you and your partner will discuss the options and reach a mutually satisfying decision.