Which contraceptive should you use?

You may be using birth control, but is it sometimes too much bother or too easy to forget? Contraceptives will only prevent unwanted pregnancies if they're used properly and consistently. If you're using a method that you forget to use, that has unwanted side effects, or that is difficult to use, you're likely to stop using it or not to use it all the time. That's why it's important to use a method of birth control that suits you and your lifestyle.

When you're thinking about what kind of contraceptive to use, make sure to consider all the details. Ask yourself questions such as:

  • Which will work best with my schedule and habits? (Which will I be least likely to forget?)
  • Are there extra health benefits?
  • Which have possible unwanted effects or features?
  • Am I protected against sexually transmitted diseases?
  • Which kind is the most appropriate for my current state of health or medical history?
  • How effective is it?


For people who have no intention of having children in the future, surgery can be a viable option.

For men, the usual operation is a vasectomy. This operation involves cutting or blocking the tube that carries sperm from the testes to the penis. It can now be done in a very short time using local anaesthetic and requiring only a small puncture in the skin, with no stitches needed.

For women, the usual surgery is a tubal ligation: the fallopian tubes are cut, sealed, tied, or blocked, making a permanent barrier between sperm and egg. This is usually done via laparoscopy, using a small incision; the woman can normally go home the same day, but it is a more complicated operation than a vasectomy.

Both of these methods are designed to be permanent, but an operation called reanastomosis that unblocks or reconnects the tube(s) can restore fertility in roughly half of all cases.

Long-term options

Some forms of birth control last a long time and only have to be changed or used very infrequently. If you're constantly on the go, if you don't want the hassle of having to remember to take a birth control pill every day, and if you're not planning on starting a family in the near future, these birth control options may suit you:

  • contraceptive patch (change weekly)
  • hormonal injection or implants (receive once every 3 months)
  • vaginal ring (change once a month)
  • progestin-releasing intrauterine devices (change once every 5 years)
  • copper intrauterine devices (change once every 5 years)


Perhaps the best-known kind of birth control is "the pill." It's no longer just "the" pill – in fact, there are now many different kinds of birth control pills available. Some use a single hormone and some use a combination; some have low doses and some have high doses; some have a 28-day cycle of pills and some have 21 or 84 pills; and some have a 7-day period without pills, and others can have less. Talk to your doctor about which would be best for you. You may need to try a few before you find one you feel perfectly comfortable with.

And what about a pill for men? Research into a male birth control pill continues. Scientists in Great Britain have found a way to block the daily production of sperm and keep testosterone levels normal. Other major studies sponsored by the World Health Organization showed that high doses of testosterone were able to produce effects similar to the female birth control pill; however, there are unwanted side effects, so further study is required. In general, men will have to keep waiting for an option that will provide proven protection without undesirable side effects.

Barrier options

There are several kinds of birth control that work by keeping the sperm from reaching the egg. These normally have to be applied or inserted just before intercourse and removed shortly after it. They include:

  • diaphragm
  • cervical cap
  • vaginal sponge
  • male condom
  • female condom

Most of these come in several varieties, and it may be necessary to try a few of any given kind before you find one that has the right fit and sensation. Each has advantages and disadvantages. Sponges may be inserted hours before sex and removed hours after, for example, while condoms are the only kind of birth control that also offer reliable protection against sexually transmitted infections (STIs). Whichever barrier option of birth control you chose to try, make sure that you are familiar and confident on its proper application and use. Your doctor and pharmacist are excellent educational resources for this sort of information.

Be aware that using oil-based products like luubricants, or other products like powders or perfumes may decrease the barrier method's effectiveness or cause irritation. Ask your doctor or pharmacist if you have any concerns.

Emergency contraception

If you forget to use birth control or your usual method has failed, emergency contraception can prevent pregnancy after you've already had sex.

Emergency contraception works because the fertilization of an egg by the sperm doesn't happen right at the time of the intercourse. In fact, it can happen up to 2 or 3 days later. Emergency contraceptives work by preventing fertilization and implantation, just like other contraceptives. But they don't stop a pregnancy that is already in progress. That is why it is important to use emergency contraception as soon as possible after intercourse.

Emergency contraception is designed as a "last-chance" measure, and it can't protect you from sexually transmitted diseases. But, while it isn't meant to be relied upon as your primary method of birth control, it is an effective backup in circumstances such as the following:

  • You had sex and used no other form of birth control.
  • Your usual form of birth control failed – the condom broke or slipped, your diaphragm slipped out of place or was removed too soon after sex, or you missed 2 or more birth control pills.
  • You were on medication that may interfere with your oral contraceptives.
  • You were sexually assaulted.

Depending on how long it has been since you had unprotected sex, there is more than one option for emergency contraception. The better-known method is hormonal, which is most effective within 72 hours of unprotected sex and involves taking pills. These pills contain the same ingredients as regular birth control pills, but in higher strength.

Emergency contraception medication is available in 3 forms:

  • One form, available by prescription from your doctor, consists of four tablets of a birth control pill. If you have a drug plan that pays for your prescriptions and you want the medication to be eligible for reimbursement, a prescription will be required. This option is a little less convenient, as it involves consuming more tablets and is associated with more side effects, such as nausea and vomiting.
  • There are also products available without prescription at the dispensary counter in your local pharmacy. This option involves taking 2 tablets, either together at the same time, or one tablet followed by the second exactly 12 hours later.
  • With both methods of oral emergency contraception, your menstrual cycle may be altered a bit (periods may come earlier or later and be heavier or lighter; she may also experience some spotting); however, a regular menstrual cycle should still be expected at the normal time. If a period does not come within 2 to 3 weeks after taking oral emergency contraception, you should do a pregnancy test or see your doctor immediately.
  • If you've left it beyond the 72-hour window, there is still the option of inserting an IUD (intrauterine device), which prevents a fertilized egg from implanting itself in the uterus, and is effective up to a week after intercourse.

Contraceptives: what about your health?

Your method of birth control can actually do more than just protect against pregnancy. It may also affect things such as your appearance and your risk of certain kinds of cancer.

Health benefits

Some methods of birth control have benefits for your health.

Clearer skin: Studies have shown a connection between the use of some birth control pills and decreased amounts of acne. This is because some pills can moderate levels of hormones called androgens, regulating the production of oil in the skin.

Protection from certain diseases: The birth control pill is associated with protection from some diseases affecting women. These include benign ovarian cysts, endometrial (uterine) cancer, ovarian cancer, iron deficiency (anemia), and pelvic inflammatory disease.

Reduced pain and menstrual flow: Birth control methods that contain hormones are linked to a reduction in the volume of menstrual flow and the painful cramps that often accompany your period.

Protection against STIs: Condoms provide protection against sexually transmitted infections (STIs). Depending on the nature of your sexual relationship, this protection can be vital, even if you use another form of birth control, because the other forms of birth control do not provide protection from diseases such as AIDS/HIV, chlamydia, gonorrhea, genital herpes, human papilloma virus (associated with genital warts and cancer of the cervix), and syphilis.

Things to watch out for

Your state of health is an important consideration when deciding on or during the use of any birth control method. Certain birth control methods may affect some medical conditions, and medication for some conditions may change the effectiveness of some birth control methods.

Antibiotics: The antibiotic rifampin reduces the effectiveness of birth control pills. As for other antibiotics, there is less conclusive evidence that they decrease the effect of oral contraceptives. This effect may only occur in a small number of women. But it's best to err on the side of caution, as more research is needed to determine the effect of antibiotics on the modern low-dose birth control pills used today. Adding a barrier method (e.g., male or female condom) is a good idea if you're taking antibiotics.

Latex allergy: Most male condoms are made of latex. People who are allergic to latex can consider such options as condoms made from polyurethane. Lambskin condoms are also available, but they offer less protection against STIs. If protection from STIs is not an important issue, there are many contraception options, ranging from sponges to IUDs to pills.

Medical conditions: Women with epilepsy need to determine the proper form of birth control with their doctor and neurologist. Many anti-seizure medications may reduce the effectiveness of hormone-based birth control methods by speeding up the breakdown of these hormones in the liver. Including a barrier method will reduce the chance of pregnancy.

Women who have any of the following should talk to their doctor before deciding on a birth control method:

  • breast cancer
  • diabetes and associated damage to small blood vessels
  • family history of stroke
  • high blood pressure
  • history of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism)
  • liver disease
  • migraine headaches
  • smoking and over the age of 35

While taking the pill, watch out for early danger signs described by the acronym ACHES:

  • Abdominal pain (severe)
  • Chest pain (severe)
  • Headaches (severe)
  • Eye problems
  • Severe leg pain

If you experience any of the above symptoms, inform your doctor immediately.

What's new in contraception?

With birth control as with other areas of health and medicine, research is ongoing to develop newer and better options. Here are some of the latest advances.

Birth control patch: The birth control patch is a convenient alternative to the birth control pill. It is applied directly to the skin and is changed once or twice per week; it delivers the 2 hormones that are in regular birth control pills through the skin.

Contraceptive rings: Contraceptive rings are made of flexible plastic materials. They are inserted into the top of the vagina and held in place by the muscles there. A ring releases a low dose of hormones over a 3-week period and gives a high degree of contraceptive protection.

Nonprescription emergency contraception: As discussed in "Emergency contraception," emergency contraception is now available from your pharmacist without a doctor's prescription. These products contains a female hormone called levonorgesterol (a progesterone) taken as a single dose of both tablets at once or as 2 doses, the second dose taken 12 hours after the first tablet. Emergency contraception must be taken within 72 hours of unprotected sex and is between 61% and 95% effective in preventing pregnancy, depending on when it is taken. The sooner it is taken after unprotected sex, the more effective it is, as it does not stop a pregnancy once fertilization has occurred. Emergency contraception does not protect you from sexually transmitted diseases and is not a reliable form of ongoing birth control.

Continuous birth control pills: For years, women have taken the birth control pill continuously at times in order to adjust the timing of their periods; for example, their wedding day, honeymoon, or a special trip. Research into the safety of extended use of birth control pills has resulted in the introduction of a product in the United States and Canada. This product is taken for 84 days in a row, and then stopped for 7 days, causing a period. This process is repeated 3 more times, resulting in 4 menstrual periods a year.The safety of longer continuous use over 3 months without a hormone-free period has not been tested, and should not be attempted. There are contraceptives on the market that contain the identical active ingredients, which could be used similarly, although they are not officially approved for that use.