As promised, this is my birth control 101 post. The types of birth control I will be covering in this post are: condoms, cervical caps, diaphragms, the pill, the patch, the shot, Nuvarings, IUDs, the implant and emergency contraception. With each type of birth control, I want to answer the following questions: What is it? How does it work? How effective is it? What are the pros and cons of using the birth control? Does it protect against STIs? Where can one find it? How much does it cost? And finally, since it is election season, I will also discuss how our potential 2012 presidential candidates feel about birth control.
Note: Similar to my other 101 posts (HIV 101 and Safer sex 101), I will cite my sources at the end of the post.
The Main Types of Birth Control
Condom
What is it?
There are two types of condoms: the male (external) condom and the female (internal) condom. Both condoms can be made from latex or polyurethane (if someone has a latex allergy). External condoms cover the outside of the penis and internal condoms are placed inside the vagina or anus.
How does it work?
Both types of condoms block pre-cum and semen from entering the uterus and potentially fertilizing an egg.
Effectiveness?
The external condom is 85-98% effective and the internal condom is 79-95% effective. The effectiveness (i.e. the ability of the birth control to prevent pregnancy) depends on how frequently they are being used and whether or not they are being used correctly.
Pros?
Both condoms are relatively cheap and easy to find (the external condoms more so than the internal condoms).
There’s no need for a prescription from a doctor.
Condoms can be used with other forms of birth control for extra insurance against pregnancy and for protection against STIs.
Cons?
Most condoms are made out of latex, which can be a problem for people who are allergic. However, polyurethane condoms are available in those cases.
Does it protect against STIs?
Yes. Using a condom consistently and correctly reduces the chances of contracting an STI.
Where can one find it?
Condoms can be found in pharmacies, doctor’s offices, health centers, schools, clinics and online.
Cost?
Packs of condoms can cost from $2 to $25, depending on the amount of condoms in the pack. Many health centers, clinics and schools give out condoms for free.
Cervical Cap
What is it?
The cervical cap is a silicone cup placed over the cervix.
How does it work?
The cervical cap is used to stop sperm from fertilizing the egg by blocking the sperm from entering the uterus. Spermicide is used along with the cervical cap to stop the sperm’s movements.
Effectiveness?
The cervical cap is about 71-86% effective. Ensuring the cervical cap is positioned correctly on the cervix and using spermicide increases the effectiveness of the cervical cap.
Pros?
The cap can be used by individuals who cannot take hormones, like estrogen.
It can be put into place hours before one has sex.
It can be used while breastfeeding.
Cons?
It cannot be used during one’s period.
It may be difficult for some individuals to position the cap over the cervix.
It can be moved around during sexual intercourse.
It may be uncomfortable for some people.
One can have an allergic reaction to the spermicide.
Does it protect against STIs?
No, the cervical cap does not protect against STIs. One could use an external condom in conjunction with a cervical cap to protect against STIs.
Where can one find it?
Only health care providers can distribute cervical caps.
Cost?
Cervical caps range from $60 to $75 and spermicide costs about $8 to $17.
Diaphragm
What is it?
A diaphragm is silicone cup with a flexible rim that is placed over the cervix. It is similar to the cervical cap in function, but the diaphragm is larger and covers a wider area.
How does it work?
The diaphragm blocks sperm from entering the uterus and spermicide is used to stop the sperm’s movements.
Effectiveness?
The diaphragm is 84–94% effective. The effectiveness of the diaphragm is influenced by proper placement of the diaphragm over the cervix and the use of spermicide.
Pros?
Similar to the cap, the diaphragm does not use hormones.
The diaphragm can be put into position hours before sexual intercourse.
It can be used while breastfeeding.
Cons?
It may be difficult for some women to place the diaphragm over the cervix.
It may be moved around during sex.
It may be uncomfortable for some individuals.
One may have an allergic reaction to the spermicide.
Some individuals may develop urinary tract infections due to using the diaphragm.
Does it protect against STIs?
No, the diaphragm does not protect against STIs. Using an external condom in conjunction with a diaphragm can provide protection against STIs.
Where can one find it?
Only health care providers can distribute diaphragms.
Cost?
Diaphragms range from $15 to $75 and the price of spermicide ranges from $8 to $17.
The Pill
What is it?
The birth control pill is an oral contraceptive that is taken every day to prevent pregnancy. There are two types of pills: combination pills, which contain the hormones estrogen and progestin, and progestin-only pills. The combination pills are the most common type.
How does it work?
The hormones in the pill do three things in order to prevent pregnancy:
- They prevent ovulation (the process in which the ovaries release an egg to be fertilized).
- They thicken the cervical mucus to block the sperm from fertilizing the egg.
- They also thin the lining of the uterus to keep the egg from attaching to the uterine wall.
In a usual package of birth control pills, there are 3 weeks of pills with varying levels of hormones in them. The 4th week of pills do not have hormones in them at all. It is during this 4th week that menstruation begins.
Effectiveness?
The birth control pill is 92–99% effective at preventing pregnancy.
Certain medicines/supplements and behaviors may make the pill less effective:
- The antibiotic rifampin
- Certain oral medicines for yeast infections
- Certain HIV medicines
- Certain anti-seizure medicines
- St. John's wort
- Vomiting and diarrhea
Pros?
Combination and progestin-only pills reduce menstrual cramps and lighten period flows.
Some benefits to combination pills include protection against acne, bone thinning and ovarian and endometrial cancers.
Also combination pills can be used to control when and how often an individual has their period.
Cons?
Some common side effects include: breast tenderness, bleeding between periods, nausea and vomiting. These side effects tend to go away after the first few months.
Does it protect against STIs?
No. Birth control pills do not provide protection against STIs. It recommended that one use condoms along with the pill to protect against STIs.
Where can one find it?
Birth control pills can be purchased with a prescription at pharmacies and clinics.
Cost?
The price ranges from $15-$50 a month.
The Patch
What is it?
The birth control patch is a thin, beige, plastic patch that sticks to the skin. A new patch is placed on the skin once a week for three weeks in a row, followed by a patch-free week. On the fourth week, one has their period. The patch can be placed on the stomach, butt, upper torso or upper arm.
The birth control patch is commonly referred to by its brand name: Ortho Evra.
How does it work?
The patch has the same hormones in it as the pill (estrogen and progestin) and works in the same way:
- Prevents ovulation (the process in which the ovaries release an egg to be fertilized).
- Thickens the cervical mucus to block the sperm from fertilizing the egg.
- Thins the lining of the uterus to keep the egg from attaching to the uterine wall.
Effectiveness?
The patch is 92–99% effective. However, it seems to be less effective in individuals who weigh more than 198 pounds. The patch works best when it is constantly in contact with the skin so the correct level of hormones are consistently in the body.
Like the pill, certain medicines and supplements may make the birth control patch less effective, including:
- The antibiotic rifampin
- Certain oral yeast infection medicines
- Certain HIV medicines
- Certain anti-seizure medicines
- St. John's wort
Pros?
It has similar benefits to the pill. It can lighten period blood flows and lessen menstrual cramps. The patch can also protect against acne, bone thinning, ovarian cancers, etc. Also one does not have to remember to take a pill every day.
Cons?
Most common side effects (breast tenderness, bleeding between periods, vomiting and nausea) disappear in a few months.
The skin around the patch may become irritated.
Does it protect against STIs?
No, the patch does not protect against STIs. Condoms can be used along with the patch to protect against STIs.
Where can one find it?
The patch can be purchased at a drugstore or clinic with a prescription.
Cost?
The patch costs about $15-$80 a month.
The Shot
What is it?
The birth control shot is an injection of the hormone progestin (also found in birth control pills and patches). Each shot prevents pregnancy for three months.The shot is also known by the brand name Depo-Provera, or by the name of the medicine in the shot, DMPA.
How does it work?
The progestin in the shot works by preventing ovulation (when the ovaries release egg to be fertilized). Progestin also thickens the cervical mucus to block sperm from joining with an egg.
Progestin thins the lining of the uterus keep a fertilized egg from attaching to the uterus.
Effectiveness?
It is 97–99% effective.
Pros?
Prevents pregnancy for 3 months without having to take a pill, put something against the cervix, put on a condom or check on a patch.
The shot does not contain estrogen so individuals who cannot take estrogen can still use the shot.
It can also prevent cancer of the lining of the uterus.
Cons?
Some side effects include: bleeding between periods, irregular periods, no periods at all after year of use, lighter periods or heavier periods. It depends on the individual.
Also long-term use of the shot tends to cause bone thinning. Talk to a health care provider to see if this is a major risk. One could increase their calcium and vitamin D intake as well as exercise to counteract these effects.
One should not use the shot if they:
- Are taking aminoglutethamide to treat Cushing's syndrome
- Are pregnant
- Have breast cancer
- Have had fragility bone fractures
Does it protect against STIs?
No, the shot does not protect against STIs. One should use condoms along with the shot to protect oneself against STIs.
Where can one find it?
A health care provider will administer the shot every 3 months.
Cost?
Each shot costs between $35 and $75, and each visit after the initial exam may cost between $20 and $40.
NuvaRing (The Vaginal Ring)
What is it?
The vaginal ring is a small, flexible ring inserted into the vagina once a month to prevent pregnancy. It is used for three weeks and taken out for the fourth week so menstruation can begin. The vaginal ring is commonly called NuvaRing, its brand name.
The hormones in NuvaRing are the same hormones used in the combination birth control pills and in the patches: estrogen and progestin.
How does it work?
Similar to other hormone-based contraceptives, the hormones prevent ovulation, thicken cervical mucus and thin the lining of the uterus.
Effectiveness?
It is 92–99% effective.
Certain medicines and supplements may make NuvaRing less effective including:
- The antibiotic rifampin
- Certain oral yeast infection medicines
- Certain HIV medicines
- Certain anti-seizure medicines
- St. John's wort
Pros?
The ring has the same benefits as the pill including protection against acne, bone thinning and ovarian and endometrial cancers. The ring, like the pill, can also be used to control when and how often one has their period.
Cons?
Some common side effects of the ring include: bleeding between periods, breast tenderness, nausea and vomiting. Possible long-term side effects are vaginal irritation, increased vaginal discharge and vaginal infection.
Does it protect against STIs?
No, the vaginal ring does not protect against STIs. One can use external condoms along with the vaginal ring to protect against STIs.
Where can one find it?
The vaginal ring can be purchased with a prescription at a pharmacy or clinic.
Cost?
The ring costs about $15–$80 a month.
IUD
What is it?
IUD stands for "intrauterine device." IUDs are small "T-shaped" devices made of flexible plastic that is inserted into the uterus. There are two brands of IUD available in the US: ParaGard and Mirena.
The Mirena IUD contains progestin and is effective for 5 years.
How does it work?
Both the ParaGard and the Mirena IUDs prevent sperm from fertilizing an egg and alter the lining of the uterus.
The progestin in the Mirena IUD prevents ovulation and thickens the cervical mucus.
Effectiveness?
The IUD is more than 99% effective.
Pros?
The ParaGard IUD does not use hormones.
The Mirena IUD may reduce period cramps and lighten period flows.
IUDs can be used during breastfeeding.
The IUD is the most inexpensive long-term and reversible form of birth control available.
Cons?
Some side effects include:
- Mild to moderate pain when the IUD is inserted into the uterus
- Cramping or backache for a few days
- Spotting between periods in the first 3–6 months
- With the Mirena IUD: Irregular periods in the first 3–6 months
- With the ParaGuard IUD: Heavier periods and worse menstrual cramps
Does it protect against STIs?
No, IUDs do not protect against STIs. One should use a condom for protection against STIs.
Where can one find it?
A health care provider will insert the IUD into the uterus.
Cost?
The cost for the medical exam, the IUD, the insertion of the IUD, and follow-up visits to your health care provider can range from $500 to $1,000. The Mirena IUD tends to be more expensive than the ParaGard IUD.
The Implant
What is it?
Implanon is a thin, flexible plastic implant that is inserted under the skin of the upper arm. It uses the hormone progestin to prevent pregnancy and is effective for up to three years.
How does it work?
Similar to the other hormone-based contraceptives, the Implanon prevents ovulation, thickens the cervical mucus and thins the lining of the uterus.
Effectiveness?
The Implanon is 99% effective.
Certain medicines and supplements may make Implanon less effective including:
- The antibiotic rifampin
- Certain oral yeast infection medicines
- Certain HIV medicines
- Certain anti-seizure medicines
- St. John's wort
Pros?
It can be used while breastfeeding.
It can be used by individuals who cannot take estrogen.
It is a long-lasting form of birth control that is also reversible.
There is no medicine to take every day or patch to keep an eye on.
Cons?
Some common side effects include irregular periods, lighter periods, bleeding between periods and heavier periods.
Does it protect against STIs?
No, Implanon does not protect against STIs. One should use a condom along with Implanon to prevent the contraction of a STI.
Where can one find it?
A health care provider can insert the Implanon.
Cost?
The cost of the exam, Implanon, and insertion ranges from $400–$800. Removing the implant costs between $100 and $300.
Emergency Contraception
What is it?
Emergency contraception is a type of birth control used after an individual has unprotected sex.
There are two kinds of EC:
- The pill, also known as the morning-after pill, Plan B, Next Choice and Ella.
- The ParaGuard (copper) IUD inserted into the uterus.
Both types of EC can be used up to 5 days after the incident of unprotected sex, but is more effective the sooner it is used.
How does it work?
EC is NOT an abortion. One more time: emergency contraception is NOT an abortion. EC will not work if the individual is already pregnant. EC is a last chance emergency option to PREVENT pregnancy. Anyone who calls EC an abortion or says it has abortion-like qualities is either ignorant or lying. Period.
EC uses the hormone progestin (found in birth control pills, patches, IUDs, rings, implants and shots) to prevent ovulation, thicken the cervical mucus and thin the lining of the uterus.
EC should not be used as a regular form of birth control because there are cheaper and more effective methods of birth control. It is so much easier and less stressful to use the other methods before having sex than to take EC after having unprotected sex and risking the chance of missing the 5 day window period.
Effectiveness?
The pill is 89% effective if taken soon after unprotected sex, but the effectiveness decreases over the 5 day period.
The IUD is 99% effective.
Pros?
An individual can keep some EC pills in the medicine cabinet just in case.
Cons?
The IUD EC would require scheduling a doctor’s visit which might be hard to do in 5 days.
Side effects include: nausea, vomiting, breast tenderness, irregular bleeding, dizziness and headaches.
Does it protect against STIs?
No, emergency contraception does not protect against STIs. It is highly recommended that an individual is tested for STIs because they may have been put at risk by the unprotected sex.
Where can one find it?
The pill can be purchased at pharmacies and health centers/clinics without a prescription by individuals who are 17 and older. Individuals younger than 17 need a prescription.
The IUD needs to be inserted by a health care provider.
Cost?
The price of the EC pill ranges from $10 to $70. For individuals who are younger than 17 and need a prescription, the health center visit may cost up to $250.
2012 Potential Presidential Candidates and Birth Control
President Barack Obama
January 2012 – The Obama administration decided to not allow “religiously affiliated employers such as universities and hospitals to deny full birth control coverage to the women they employ”.
December 2011 – Obama administration overruled EC being sold over the counter to women of all ages.
April 2008 – He said that teens should learn about abstinence and contraception in order to reduce unwanted pregnancies and abortions at the Democratic Candidates Compassion Forum at Messiah College in Grantham, Pennsylvania.
May 2006 – He sponsored a bill providing contraceptives for low-income women.
March 2005 – He voted yes to an amendment in the Senate's 2006 Fiscal Year Budget to reduce teen pregnancy and abortions and improve healthcare for women through sex education & contraceptives.
Mitt Romney
January 2012 – He states: “I can't imagine a state banning contraception. I can't imagine the circumstances where a state would want to do so, and if I were a governor of a state or a state legislature, I would totally and completely oppose any effort to ban contraception.”
2005 – As Massachusetts state governor, he vetoes a bill to allow EC to be made available without a prescription. He states: “This bill does not require parental consent for even young teenagers. It disregards not only the seriousness of abortion but the importance of parental involvement.”
2005 – He vetoes a bill requiring hospital ER doctors to offer EC to rape survivors and would make EC available to the survivors without prescription from pharmacies.
Newt Gingrich
December 2011 – Gingrich, like Rick Santorum, Rick Perry, and Ron Paul signed the Personhood USA Pledge in favor of an anti-abortion and contraceptive amendment to the Constitution recognizing embryos as people.
December 2011 – He states: “Any kind of pre-conception birth control would be legal. But I think post-conception birth control would be a form of abortion” at an Iowa campaign event.
Rick Santorum
January 2012 – He stated that states have the right to ban contraception, but shouldn’t.
October 2011 – About contraception: “It’s not okay. It’s a license to do things in a sexual realm that is counter to how things are supposed to be.”
September 2006 – He believes that the Plan B pill is dangerous and is like an abortion, stating: “I agree that it is an abortifacient, and that it’s dangerous to give a dose of hormones equivalent to one third of a whole series of birth control pills to someone without any kind of doctor supervision.”
March 2005 – He voted no to an amendment in the Senate's 2006 Fiscal Year Budget to reduce teen pregnancy and abortions and improve healthcare for women through sex education & contraceptives.
He believes that the right to privacy that set the precedent for Roe v Wade is not constitutional and the states do not have to respect that right: “The idea of the "right to privacy" is that the state doesn't have rights to limit individuals' passions. I disagree with that. There are consequences to letting people live out whatever passions they desire. And we're seeing it in our society.”
Ron Paul
January 2011: He co-sponsored the Title X Abortion Provider Prohibition Act, which called for a prohibition in funding centers, like Planned Parenthood.
http://www.nytimes.com/2011/12/08/health/policy/sebelius-overrules-fda-on-freer-sale-of-emergency-contraceptives.html?_r=1
