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Categories > Pregnancy and Childbirth > Contraception

Contraceptive choices in the 21st century

Today’s women have more choices than ever to conceive a baby at just the right time. So many, in fact, that it may become a little confusing to find the method that suits you best. Here’s some help.

Barrier methods Condom

What is it? A thin latex or polyurethane sheath that’s placed on the penis before intercourse. The female version is a soft, thin, prelubricated polyurethane sheath that lines the vagina with a small ring against the cervix and a larger, thinner ring outside the vagina.

How does it work? A condom creates a physical barrier between the sperm and the uterus.

Pros: A condom is a prescription-free way to protect against HIV (AIDS virus) and some sexually transmitted diseases (STDs).

Cons: A condom must be used consistently and correctly and may decrease spontaneity.

Diaphragm

What is it? A thin rubber dome that you fill with spermicidal jelly and insert into your vagina.

How does it work? It blocks sperm from entering the uterus.

Pros: You can insert it two to three hours before intercourse.

Cons:

  • It provides little protection from STDs.
  • It requires a prescription and an annual fitting in the office.
  • It must remain in place up to eight hours after intercourse.

Sponge

What is it? Spermicide-containing solid polyurethane foam “sponge” that’s inserted into the vagina.

How does it work? It covers the cervix, blocking sperm. It also continually releases spermicide, immobilizing sperm.

Pros: No prescription is required, and it can be inserted hours before intercourse.

Cons: It provides no protection from sexually transmitted diseases.

Hormonal options Hormone implants

What are they? Five, soft, matchstick-size capsules surgically placed beneath the skin of the upper arm.

How do they work? The capsules release a steady dose of progesterone, which suppresses ovulation.

Pros: Hormone implants can remain in place up to five years—and allow for spontaneity.

Cons:

  • They won’t protect you from STDs.
  • They can be costly, and removal may be uncomfortable.
  • You may experience irregular periods (or no periods at all), weight gain, acne, hair loss or mood changes.
  • They’re a bad choice if you have liver disease, breast cancer, unexplained vaginal bleeding or a history of blood clots.

Hormone injections

What are they? Progesterone shots injected into the buttocks.

How do they work? They suppress ovulation.

Pros: Highly reliable, the method allows for spontaneity.

Cons:

  • The injections don’t protect you from STDs. And you must see your doctor for a shot every three months.
  • You may experience irregular periods (or no periods at all), weight gain, acne, hair loss or mood changes. You may be infertile for several months after stopping the injections.

The patch

What is it? A thin beige plastic patch worn on the skin of the upper arm, abdomen or buttocks for three weeks in a row and changed once a week.

How does it work? Hormones in the patch prevent ovulation and thicken the cervical mucus.

Pros: It does not interfere with having sex, and it’s reversible.

Cons:

*It may initially cause bleeding between periods, tender breasts, weight gain, and headache.

*It may be affected by certain medications and herbs.

The ring

What is it? A small flexible plastic ring inserted into the vagina once a month and left in for three weeks.

How does it work? The ring releases synthetic hormones that suppress ovulation.

Pros: It does not interfere with having sex, and it’s reversible.

Cons:

*It may initially cause bleeding between periods, tender breasts, weight gain, and headache.

*It may be affected by certain medications.

The combined pill

What is it? An estrogen and progesterone pill taken daily for 21 days, followed by placebos or no pills for seven days.

How does it work? It prevents ovulation and blocks sperm from entering the uterus.

Pros:

  • It’s highly reliable, allows for spontaneity and doesn’t affect future fertility.
  • It reduces fibrocystic changes in your breasts, regulates your periods, decreases menstrual flow and eases cramps.
  • It may reduce your risk of ovarian and endometrial cancers, osteoporosis, iron-deficiency anemia, ectopic pregnancies and pelvic inflammatory disease.

Cons:

  • Neither the combined pill nor the minipill (see below) protects against STDs. Both require prescriptions and must be taken daily. They may cause breast swelling, fluid retention, nausea or headaches.
  • The combined pill is not appropriate if you’re breastfeeding and/or a smoker who is at least 35 years old. Don’t take it if you have advanced diabetes, heart disease, liver disease or hepatitis B infections or a history of breast cancer or blood clots.
  • Some drugs, such as antibiotics and antiseizure medications, reduce the pill’s effectiveness.

The minipill

What is it? A progesterone pill taken daily.

How does it work? It blocks ovulation and prevents sperm from entering the uterus.

Pros: You can take the minipill if you’re breastfeeding, if you smoke, are over 35 or have a history of blood clots.

Cons:

  • Compared to the combined pill, you’re more likely to conceive if you forget to take the minipill.
  • Irregular bleeding may occur.

Intrauterine device

What is it? A ½”-by-1”, T-shaped copper or progesterone-containing device that is inserted into your uterus.

How does it work? It prevents the implantation of a fertilized egg by causing changes in the uterine lining.

Pros: An IUD is highly reliable and allows for spontaneity. You can keep a copper IUD in place for up to 10 years and the progesterone-containing IUD for one year.

Cons:

  • It provides no protection from STDs.
  • It may increase your risk of pelvic infections and poses a small risk of abnormal bleeding.

Tubal ligation

If you’re sure you never want to become pregnant, you may want to consider sterilization, either in the form of a vasectomy for your partner or a tubal ligation for yourself.

What is tubal ligation? A surgical procedure in which the fallopian tubes are either (1) looped and banded closed with rubber rings, (2) pinched closed with metal or plastic clips, (3) cut and tied or (4) cauterized (burned) and cut.

How does it work? It prevents eggs from traveling down the fallopian tubes.

Pros: It’s highly reliable and allows for spontaneity.

Cons:

  • Sterilization won’t protect you from STDs.
  • It requires considerable cost and is usually irreversible.
  • A tubal ligation poses the usual risks of surgery.