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Birth control choices

When it comes to birth control, there are lots of options and issues to consider.

Not all methods of birth control are created equal. Effectiveness, cost, side effects, protection against sexually transmitted infections (STIs) and convenience can vary widely from one method to the next. Even for the same person, the best option at one time of life may not be the best option at another time.

When you're trying to decide on a birth control method, talk to a healthcare provider about how the benefits and drawbacks of each option apply to you. Your lifestyle, priorities, medical history and future plans for children can impact the side effects, effectiveness or suitability of any form of contraception. For some people, combining methods is the best approach. Here's a rundown of the basics:

Abstinence. Abstinence means not having sexual contact with anyone. It is the only method of birth control that provides absolute protection from pregnancy and STIs.

Hormonal methods. Only available for women, hormonal methods of birth control work primarily by preventing ovulation (egg production). They also make it more difficult for sperm to reach an egg and may prevent a fertilized egg from attaching to the wall of the uterus. Hormonal contraceptives come in pills, patches, implants, injections and vaginal rings.

These methods are generally very effective at preventing pregnancy, but they offer no protection from STIs. Side effects may include irregular vaginal bleeding, weight gain, headaches, breast tenderness, blood clots, mood changes or upset stomach. On the other hand, these contraceptives can also cause lighter and less painful periods, improve acne, and reduce the risk of cancers of the ovaries and endometrium (the lining of the uterus), according to the Office on Women's Health (OWH).

Some hormonal methods require a physical examination and a prescription. The pill needs to be taken every day, the patch and ring need to be replaced every few weeks, injections must be given every few months, and implants are replaced every few years.

Barriers. Barriers work by preventing sperm from reaching an egg. They include male condoms, female condoms, diaphragms, the cervical cap, the sponge and spermicide. Diaphragms and cervical caps must be fitted by a healthcare provider. The others can be bought at drugstores and supermarkets.

All of these methods require a commitment to correct and consistent use before sexual activity. Some people don't like the way barriers feel or find them disruptive, messy or difficult to use. Some barriers can also slip or move during sex, reducing their effectiveness.

Also, some barriers are made of latex. These types of barriers are therefore off-limits to anyone with a latex allergy.

The diaphragm and cervical cap must be used with spermicide, and the sponge has spermicide in it. Spermicides may cause irritation of the penis or vagina, and all of these birth control methods (including spermicide alone) may increase a woman's risk of urinary tract infections.

The effectiveness of barriers varies depending on the type of barrier and whether it's used properly. In the case of diaphragms and cervical caps, a woman's history of vaginal childbirth significantly affects reliability. Spermicides used alone are one of the least effective methods of birth control. Male and female condoms are the best ways to prevent STI transmission during sex, according to OWH.

IUDs. An IUD (intrauterine device) is a T-shaped device that's placed inside a woman's uterus. Two types of IUD are available in the United States. One releases copper inside the uterus and the other releases hormones. Both alter the environment in the uterus to reduce a woman's fertility. They may prevent sperm from reaching an egg or prevent a fertilized egg from attaching to the wall of the uterus.

The copper IUD can remain in your body for as long as 10 years, and hormonal IUDs can last 3 to 5 years. All IUDs must be inserted and removed by a healthcare provider.

Possible drawbacks of IUDs include heavier and more painful periods (with copper IUDs), increased risk of serious complications if you contract an STI, and a small chance of your uterus pushing the IUD out. IUDs with hormones often produce lighter, less painful periods.

Both IUDs are highly effective at preventing pregnancy but provide no protection from STIs.

Fertility awareness. This is also called natural family planning or periodic abstinence. It requires a woman to track her menstrual cycles and abstain from sex or use a backup birth control method on days of the month when she's most fertile. Fertility can be predicted by checking body temperature daily, checking cervical mucus daily, recording menstrual cycles on a calendar or tracking several fertility indicators at once.

This method can only work when it's used correctly at all times, according to the American College of Obstetricians and Gynecologists. Both partners must commit to abstaining or using alternate birth control on fertile days, and women must know their bodies well. It works best for women with very regular menstrual cycles.

Fertility awareness provides no STI protection. It has a high failure rate compared to other methods of birth control, according to OWH.

Sterilization. For women, tubal sterilization blocks or cuts the fallopian tubes so eggs can't get into the uterus. For men, vasectomy cuts the tubes sperm travel through to the penis so that no sperm are in the ejaculate.

Sterilization is permanent birth control. You shouldn't have this surgery unless you're sure you never want to have biological children in the future. Sterilization doesn't protect you from STIs.

Decisions, decisions

You'll need to consider the benefits, risks and costs of these birth control methods to find the best fit for you. If one form doesn't meet your needs, try a different method or a combination of methods.

Your doctor can help you find the method or methods that are best for you.

Reviewed 11/9/2022

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