Birth control: the 9 most effective methods

Contraceptive pill, mini-pill, vaginal hormonal ring (Nuvaring), contraceptive patch (Evra), contraceptive injection, contraceptive implant (Implanon), UIS (Mirena), UID or not having sex…

It can be difficult to choose a birth control method because there are quite a few products for birth control on the market and each one of them has different pros and cons. Here’s a list of the most effective methods and their pros and cons:

contraceptive pill

Also called the combined contraceptive (COC) pill because it contains two kinds of hormones, in most cases estrogen and progestin (synthetic progesterone)*. It comes in 21 or 28-day packs. The pill, if taken correctly, stops ovulation, in other words it prevents the ovary from growing and releasing an egg. The uterus builds up its endometrium (the thickened uterine lining), just like it would have done in a natural cycle, because the synthetic hormones trick the ovary into thinking that it has already released an egg. During the pill-free week (in case of a 21-day pack) or when taking the placebo pills of a 28-day pack, the endometrium is released. The bleeding that follows is not a real period, but the body's reaction to the withdrawal of the normal hormonal cycle, technically referred to as a withdrawal period.

Pros: a very effective birth control method (99%); easy to use; possibility to control periods; can reduce painful and heavy periods; can reduce premenstrual syndrome (PMS); can reduce endometriosis symptoms.

Cons: it’s possible to forget taking the pill, which can lead to an unwanted pregnancy; possible side effects are headaches, abdominal pain, acne, weight gain, breast swelling and tenderness, increased risk of thrombosis.

* Qlaira is a new oral contraceptive, the first pill to deliver estrogen in “natural form”. Qlaira contains estradiol valerate and dienogest instead of estrogen and progestin. Estradiol valerate is rapidly converted by the body into estradiol, a naturally occurring estrogen. Besides the attractiveness of a pill delivering a “body-identical” hormone, clinical trials show that taking Qlaira monthly bleeds are generally lighter and shorter compared with regular combined oral contraception.

mini-pill

Not a low-dose version of the combined pill, but a progestin-only pill (POP). It contains just one hormone instead of two. That hormone is progestin, which is an artificially manufactured progesterone, one of the female hormones the body produces. The mini-pill contains no estrogen at all, which is the hormone responsible for many of it the side effects of estrogen-containing contraceptives. It's particularly useful for some groups of women who shouldn’t take the pill or for whom it is a little risky, like women who are breastfeeding,diabetics, women who smoke or whose blood pressure has gone up on the pill and older women. You must take the mini-pill at roughly the same time of day, every day, even when you are menstruating. If you're more than 3 hours late in taking the tablet, you could fall pregnant. Also, if you’re significantly overweight the POP may not be effective enough for you.

Pros: an effective birth control method (almost 98%); only one hormone and therefore less side effects than the combined pill.

Cons: lower effectiveness than the combined pill*; must be very careful to take it every day on time*; possible side effects are irregular bleeding or spotting, headache, acne, weight change, breast swelling and tenderness, nausea.

* Cerazette, a new version of the mini-pill, seems to have an effectiveness that isn't all that much below that of the combined pill. You can be 12 hours late taking it, just like the combined pill.

vaginal hormonal ring (Nuvaring)

A monthly birth control option that must be insterted into the vagina, removed after 3 weeks, and a new ring must be inserted no more than 7 days later. The ring releases a continuous low dose of estrogen and progestin, the same hormones found in the oral contraceptive pill. When Nuvaring is inserted, the hormones are absorbed and distributed into the bloodstream.

Pros: a very effective birth control method (99%); possibility to control periods; can reduce painful and heavy periods; can reduce premenstrual syndrome (PMS); can reduce endometriosis symptoms.

Cons: possible side effects are headaches, abdominal pain, acne, weight gain, breast swelling and tenderness, increased risk of thrombosis.

contraceptive patch (Evra)

A once-a-week birth control patch that has to be put on the skin and releases two horones: estrogen and progestin (the same as the combined pill). It can be applied on the buttock, upper torso (front and back, excluding breasts), abdomen and upper outer arm. It is important when using the patch to change where you stick it on your body each week to avoid skin irritation. The patch adheres well to the skin, allowing you to perform your daily activities such as bathing, showering, swimming and exercising without interruption. If the sticky surface of the patch becomes wet, discard it and apply a new patch. It has to be worn for 3 weeks, then 1 week patchless.

Pros: a very effective birth control method (99%); possibility to control periods; can reduce painful and heavy periods; can reduce premenstrual syndrome (PMS); can reduce endometriosis symptoms.

Cons: possible side effects are headaches, abdominal pain, acne, weight gain, breast swelling and tenderness, increased risk of thrombosis.

contraceptive injection (Depo-Provera)

A progestin only contraceptive in the form of a 3-month shot (every 13 weeks). Although a very effective birth control method, I wouldn’t recommend Depo-Provera because it may cause you to lose stored calcium in the bones. The longer you use Depo-Provera Contraceptive Injection the more calcium you are likely to lose and it may not return completely even once you stop using it. Loss of calcium may cause weak, porous bones (osteoporosis) that could increase the risk that your bones might break, especially after menopause.

Pros: avery effective birth control method (99.7%); 3 months protection against pregnancy.

Cons: may cause you to lose stored calcium in the bones and therefore shouldn’t be used long term (for example, more than 2 years) and only if other methods of birth control are not right for you; delayed return of fertility; possible side effects are weight gain, irregular menstrual bleeding, amenorrhea, headache, abdominal cramps, dizziness, weakness or fatigue and nervousness.

contraceptive implant (Implanon)

A small, thin, implantable hormonal contraceptive inserted by a clinician under the skin of the upper arm after using a local anaesthetic. It provides contraception for 3 years. It contains the active ingredient etonogestrel, which is a synthetic form of the naturally occurring female sex hormone, progesterone. It prevents pregnancy by stopping the release of eggs from the ovaries and increasing the cervical mucus, making it more difficult for sperm to cross from the vagina into the womb.

Pros: avery effective birth control method (more than 99%); 3 years protection against pregnancy; ability to get pregnant usually returns quickly.

Cons: serious consequences may be associated with the insertion and removal of Implanon, 1.0% of patients had complications at implant insertion and 1.7% had complications at implant removal; possible side effects are irregular bleedings, headaches, abdominal pain, acne, weight gain, breast swelling and tenderness, ectopic pregnancy, ovarian cysts, increased risk of thrombosis.

Progestin-only intrauterine system (Mirena)

An intrauterine system (IUS) that delivers small amounts of hormone directly to the uterus. It is a tiny T-shaped piece of soft, flexible plastic, that is put in place by a clinician during an office visit. The IUD works continuously, without a pill, without a daily hassle and it can be left in as long as you want, for up to 5 years. Once the system is properly placed, the clinician will show how to check the threads, which you have to do once a month.

Pros: a very effective birth control method (99.3-99.9%); lighter periods or complete cessation; don’t have to think about it for 5 years; hormone levels are steadier and lower than with the combined pill.

Cons: placement can be very painful; can be uncomfortabe, especially during the first weeks; possible expulsion of the coil; possible ovary cysts (approximately 12% of women using Mirena), which usually disappear on their own in a month or two but they can cause pain and sometimes cysts will need surgery.

Copper intrauterine device (Paragard)

A copper intrauterine device (IUD) is inserted by a clinician and offers long-term reversible contraception with no hormone release. Depending on the type, a single IUD is approved for 5 to 10 years. It prevents pregnancy because the presence of the device in the uterus prompts the release of leukocytes and prostaglandins by the endometrium, substances that are hostile to both sperm and eggs. The copper increases the spermicidal effect.

Pros: an effective birth control method (almost 98%); don’t have to think about it for up to 10 years; no hormone release and therefore no side effects associated with hormone-based contraceptives; ability to get pregnant usually returns immediately after removal.

Cons: placement can be very painful; can be uncomfortabe, especially during the first weeks; possible expulsion of the coil; possible infection (most likely within 3 weeks after insertion); can make periods heavier, longer and more painful.

Note: Please beware that the birth control methods descibed above DO NOT protect against AIDS (HIV) and other sexually transmitted diseases (STD’s). To practice safe sex it is absolutely necessary to use a condom.

Not having sex

Pros and cons are obvious...