By Andrea Rodrigo BSc, MSc (embryologist) and Sara Salgado BSc, MSc (embryologist).
Last Update: 12/07/2016

By contraception, birth control methods or contraceptive methods we mean any way through which fertilization and subsequent odds of getting pregnant are prevented or considerably reduced despite having sexual intercourse with vaginal penetration.

There exist different types of birth control options, hormonal and non-hormonal, as well as permanent and non-permanent. The following is a guide to contraception: definition, pros and cons, types, and frequently asked questions.

The different sections of this article have been assembled into the following table of contents.

Definition of contraception

Contraception is medically defined as an option used in family planning to prevent pregnancy by interfering with the normal process of ovulation in the woman. This, at the same time, impedes fertilization and therefore embryo implantation to the uterus. Some synonyms are: contraceptive methods or birth control options.

There exist different methods of contraception that can be classified according to the stage at which they act: from ovulation, through fertilization, to implantation. In other words, we can find hormonal, barrier, and permanent sterilization options, each one with its own side effects, risks and efficacy.

The effectiveness rates of contraceptives vary depending on which one you choose. In general, hormonal birth control methods are 92% to 99.7% accurate at preventing a pregnancy, while others such as the diaphragm, spermicides, and female condoms range from 70 to 85% as regards their actual use. The most unreliable ones are withdrawal and the sponge (68-73%).

History

Historically, different fertility awareness options have been used, with different effectiveness and failure rates. Planning and provision of birth control is referred to as family planning, and knowledge should be spread by means of sex education, which depends on the culture surrounding it.

The modern birth control movement started during the 1800s, when it became a political issue in Britain. It was the economist Thomas Malthus who argued that two types of checks keep population within resource limits: positive checks and preventive ones. The latter includes abortion, birth control, postponement of marriage… According to Malthus, by limiting the birth rates, the society can ensure a higher standard of living.

While those in favor of Malthus agreed to promote birth control as a way to limit population growth, feminists coined the term “voluntary motherhood” in the 1870s as a critique and a way of expressing a desire for women’s emancipation.

The birth control movement became increasingly popular by the end of the 1870s, as it turned out to be a way of permitting sexual intercourse as desired without the risk of becoming pregnant, as well as a way for women to have control over their reproduction.

Throughout the 1920s, taboos about sex, pleasure and reproductive health were broke down and contraceptive methods spread across industrialized countries. The first permanent birth control clinic, founded by Marie Stopes, was established in Britain in 1921.

In the 20th century, birth control lead to the separation of the concept of sexual activity from procreation, which is considered by many as another way of abortion. This has turned the issue of birth control into a highly controversial one in some countries, depending on factors such as religion, rights of women, regulations, etc.

Advantages and disadvantages

Nowadays, one can find a number of contraceptive devices, from natural family planning to condoms, pills, rings, intrauterine devices, etc. All of them are methods for family planning, a practice which is available for teens, female-male married or unmarried couples, women over 35-40 after having had a child (postpartum use), etc.

Broadly speaking, these are the main advantages of family planning by means of contraception:

  • Planning can help assure that any person or couple with a desire to have children has the resources required to raise a child
  • It reduces the rate of maternal death, especially in less developed countries, mostly located in sub-Saharan Africa and South Asia
  • Contraceptives prevent unwanted pregnancies and reduce the number of abortions
  • Access to it is not only a human right, but also central to gender equality

As for the disadvantages, it should be noted that each method has a series of side effects which severity can vary. Normally, hormonal birth control options are the ones carrying a higher number of adverse reactions, such as mood swings, loss of libido, formation of blood clots or even anxiety.

The following article may be of interest: Family planning methods.

Common myths and facts

A poor management of sex education leads to misconceptions and to the creation of myths in a society or community. Many young people or even married couples think they know all the facts about contraceptives, when the truth is, there is a lot to be learned about them.

Myths and misinformation about contraception could increase the risk for the transmission of STDs or the rate of unintended pregnancies. The most common misconceptions are:

  • “Hormonal contraceptives cause you to gain weight”: It depends on each patient’s prescription. While some studies conducted with placebos lead to the same results as those done with actual hormonal methods, there is also evidence that Depo-Provera shots can lead to weight gain. If you are concerned, talk to your doctor.
  • “Being on the pill for a long time has a negative impact on your fertility”: It is possible to get pregnant successfully right after stopping with the birth control, with the exception of the Depo-Provera shot.
  • “IUD should not be used unless you’ve already had children”: Although some forms of the IUD (like Mirena) are prescribed to women with children, the reason behind it is that their cervix and uterus is slightly larger after giving birth, which makes the IUD more comfortable. Otherwise, there is no reason for rejecting the coil even if you are childless.
  • “Condoms diminish male pleasure”: Both men and women can enjoy sex with and without condoms. There exist numerous pleasure-enhancing options to make your hormone-free sex life as pleasant as any other.
  • “A woman’s body needs a break from contraception”: With the exception of Depo-Provera, since it has been linked to a greater potential for bone mineral loss, you can stay on any other type of birth control for as long as you want and stop if you are planning to have a baby.
  • “Birth control is not needed while breastfeeding”: Even though it is true that breastfeeding can suppress the hormones from the pituitary gland that make a woman ovulate, the chances of getting pregnant are still quite high.

There is a lot of misinformation about how to use contraception, so you are recommended not to trust everything you hear.

Natural family planning

These types of birth control methods are based upon controlling the menstrual cycle, so that the couple avoids having sexual intercourse when the woman is on her fertile days, which is to say, when she is ovulating. In general, this process takes place around halfway through the menstrual cycle, but it does not work with such precision among many women, thereby reducing the accuracy of this method.

The main advantages of this method are the absence of side effects, its zero costs, and the fact that it can be used either during pregnancy or while nursing. However, it is only 75% accurate and, what’s more, it does not protect against sexually transmitted diseases (STDs). Another significant drawback is that it requires a precise monitoring of the menstrual cycle as well as the woman’s menstrual periods to be perfectly regular.

There is another type of natural birth control called pull-out method or withdrawal. It consists in withdrawing the penis from inside the vagina when the man is about to ejaculate. It presents the same advantages and disadvantages as calendar-based contraceptive methods.

There exist various types of birth control methods that can be broadly classified into the groups listed hereunder.

Barrier methods

Here we can find both broadly used male condoms as well as female condoms and the diaphragm; the latter is a soft silicone dome that is placed in the vagina in order to block the entrance to the uterus, thereby preventing the passage of sperm.

These contraceptive methods work by impeding the sperm to reach the egg in physical form.

Male condom

It is enough to use them during intercourse, medical supervision is unnecessary, and they present no side effect. Their accuracy rate reaches 97% and can be used throughout pregnancy and breastfeeding as well. Besides, contrary to what happens with the diaphragm, condoms do protect against the vast majority of sexually transmitted diseases.

Female condom

The female condom is a pouch which is inserted into the vagina with the purpose of preventing pregnancy. Its use is very similar to the male condom, with the difference that they are placed deep inside the vagina. It can be used during anal intercourse as well, as it reduces the risk of sexually transmitted infections.

Given that they collect pre-ejaculate and semen when a man ejaculates, the sperm cannot enter the vagina. If women always use the female condom properly, 5 out of 100 will become pregnant annually. The main benefit is that they can be used by people who are allergic to latex.

Non-hormonal IUD

IUD or coil (intrauterine device) is also included within this group of contraceptives. It should be inserted by an specialist inside the woman’s womb. Among its main cons, we can highlight an increase in the risk of transmitting certain diseases, as well as the development of side effects, such as bleeding or infections.

Nonetheless, its accuracy success rate is around 95%. There exists a type of IUI that releases ions, which inhibit sperm motility, and a type of IUD that releases hormones. The latter shall be explained below.

Contraceptive diaphragm

The diaphragm is a cervical barrier type of birth control. This shallow silicone cup should be inserted into the vagina just before sex, and acts by covering the cervix, thereby blocking the passage of the sperm toward the womb. It is 92-96% effective as long as a spermicide is used along with it.

It should be left in place for at least 6 hours after having engaged into sexual intercourse. After that period of time, you can take it out and wash it, as it is reusable and can last up to 2 years. An advantage is that they come in different sizes, although the correct size for each woman should be determined by a trained doctor or nurse.

Contraceptive sponge

Despite being less popular, the contraceptive sponge is also a barrier method. It contains spermicide and is placed on the vagina with the purpose of blocking the cervical opening and literally absorbing sperm. Even though its effectiveness varies from 70 to 90%, it must be moistened before being inserted, which may cause vaginal itching.

Spermicides

Spermicide is a contraceptive substance that basically destroys sperms. It should be inserted vaginally prior to intercourse and combined with any of the above listed barrier contraceptive methods. Although it can be used alone, the pregnancy rate experienced by couples not using any other contraceptive method is higher than those used combined options.

Spermicides come in many different forms: foam, gel, jelly, cream, film… The main benefit is that they can be easily carried out in your pocket or purse. Also, it has no effect on a woman’s natural hormones. It is very easy to get in drugstores or even supermarkets.

Hormonal birth control

Although there are various routes of hormone administration, all of them are synthetic versions of estrogens or progesterone (female sex hormones), which work by altering the woman’s natural hormone levels in order to avoid ovulation. Thus, even though a sperm met the egg, fertilization wouldn’t happen. They also prevent the uterus from preparing for embryo implantation.

If used properly and general prescribing guidance is followed, hormonal contraception is highly accurate (98-99%) and helps monitoring menstrual bleedings between periods. Hormonal birth control methods can consist of estrogens (to suppress ovulation) and progesterone (to avoid endometrial preparation and changes in cervical mucus), or just be composed of the latter.

Since they work by regulating each woman’s endocrine system, many tend to develop some undesired adverse effects. Besides, it should be taken into account that not every woman may be able to use them and they do not prevent the transmission of STDs.

Available types are classified as follows:

Combined oral contraceptive pills

They consist of pills that must be taken on a daily basis by oral route. These are some of their advantages:

  • They reduce monthly menstrual flow and help ease period pain.
  • They are often prescribed to prevent anemia.
  • They help regulate menstrual periods.
  • They protect against ovarian and endometrial cancer.
  • They diminish the risk of developing pelvic inflammatory disease (PID).
  • They can be prescribed for acne treatment.

Its main disadvantage is that they are meant for daily dosage, which is to say, they must be taken daily at the same time each day. Moreover, they may increase the risk of developing cardiovascular diseases and may give rise to undesired side effects such as weight changes, breast enlargement and tenderness, cellulite, bloating, etc. In addition, they must be administered under medical supervision.

The most common brands of contraceptive pills today are: Yaz, Zoely, and Yasmin. The mini-pill or progestogen-only pill (POP), commercialized with the name of Zelleta, has also became very popular, especially in women who are already on motherhood. Given that it does not contain estrogen, it is considered to be a low hormone birth control.

Contraceptive injection

It can be administered once a month or every three months, depending on the hormone dosage prescribed. It is a highly accurate contraception, with the added advantage that they mustn’t be administered daily. However, they do not protect yourself from STD transmission and may cause some side effects. In case you stop using it to get pregnant, your body may eventually start to ovulate again.

Birth control patch

It is a small patch applied to the skin that releases hormones on an ongoing basis. It is changed once a week and, even though it is usually highly accurate, it may be less effective in women who are overweight. The birth control patch can be attached to your skin on different areas of your body: buttocks, abdomen, upper torso, or upper/outer arm.

It presents the same pros and cons as birth control pills. Even so, we would add the following downsides:

  • No protection against STIs.
  • Bleeding or spotting when you first start using it.
  • Sore or irritated skin.
  • Possibility that it becomes detached.
  • They are not indicated for women aged above 35 years.
  • Its effectiveness diminishes in women whose weight is 90 kg or more.
  • It is expensive, if compared to other birth control methods.

Contraceptive implant

It is a small flexible tube that is inserted under the skin of a woman’s upper arm and works by releasing hormones into her body in order to prevent ovulation. The main advantage of the implant is that it may last one, three, or even five years.

Its failure rate is very low and it helps regulating the menstrual cycle, reducing menstrual flow, and easing period pain. As for its disadvantages, they are equal to those of birth control pills, except for the fact that it is not meant for daily dosage. Besides, it must be inserted by an specialist in a minor surgical procedure, which may leave you a small scar on your arm.

Hormonal IUD

It is a small, “T-shaped” device that is placed in the uterus and releases hormones on a regular basis, thereby preventing embryo implantation. It may last for up to 5 years and should be inserted by an specialist. Nonetheless, its insertion may be painful, cause some cramping, back pain, irregular and painful menstrual periods, pelvic inflammation, inflammation of the cervix, and/or ectopic pregnancies.

It is only advisable for women who have previously given birth. In addition, it could be spontaneously expelled by the body and is an expensive birth control method.

Vaginal ring

It consists of a flexible ring that is placed in the cervix and keeps on releasing hormones. The woman herself has to replace it once a month after three weeks. It is removed from the vagina during the fourth week and then her period is expected in that moment. A new ring has to be inserted the next week.

It works more or less the same way as birth control pills, with the additional advantage that it does not have to be taken daily, but just be removed every three weeks. Then, a new ring will be replaced after the period week.

Permanent & semi-permanent methods

Male and female sterilization methods are permanent surgical procedures to prevent pregnancy. Despite they were considered irreversible when they first began to be used, today both males and females have the chance to revert them, even though the fertilization potential is not absolutely guaranteed.

  • Vasectomy: it prevents the exit of spermatozoa from the testis, thereby eliminating their presence in the ejaculate.
  • Tubal ligation: it blocks the passage of the egg through the Fallopian tubes; this way, sperm won’t ever be capable of reaching it.

Patients who decide to undergo male or female sterilization are asked to be completely sure that they won’t wish to have a baby in the future.

Emergency contraception (EC)

We refer here to the morning-after pill, a hormonal contraception that inhibits ovulation and fertilization. It usually entails a higher dose than that of birth control pills.

It is a plan-B birth control method that prevents pregnancy in a large percentage as long as it is taken within 72 hours following unsafe sexual intercourse. If taken within 12 hours after intercourse, it is highly effective.

It may cause side effects such as nausea, vomiting, headache, or menstrual irregularities in following cycles.

It should be clear that it is an emergency contraceptive method and should be used as a usual contraception under no circumstances. Besides, it does not protect against STDs.

Contraception for men

While the above mentioned methods are aimed at women, men have also a wide range of family planning options, each one of them with its effectiveness rates and potential side effects. However, the truth is, nowadays males have fewer options than women when it comes to choosing a birth control method.

Basically, the following are the five options available for men currently:

  • Abstinence: It is a behavior to prevent pregnancy that involves not having vaginal intercourse.
  • Male condoms: This barrier device is used during sexual intercourse to prevent pregnancy and STDs.
  • Outercourse: For some, it involves any sexual activity in which any form of penetration (vaginal, anal and oral) is avoided. For others, all forms of sexual activity other than vaginal penetration are accepted.
  • Withdrawal or pull-out method: Also called coitus interruptus, it consists in pulling the penis out of the vagina before ejaculation.
  • Vasectomy: As explained earlier, it is a method for male sterilization that is meant to be permanent. It involves closing or blocking the tubes that carry sperm.

Today, there are many ongoing research projects into new methods of male contraception. The two main areas of research are: hormonal birth control options and non-hormonal methods.

The goal of hormonal contraception in men is to find a way of temporarily blocking the effects of testosterone and stopping sperm production by means of a “male pill” made of synthetic testosterone and other steroid combinations. On the other hand, projects involving non-hormonal contraception involve the vas deferens.

FAQs from users

Which contraceptive is best for women with high blood pressure?

By Andrea Rodrigo BSc, MSc (embryologist).

The mini-pill or progestogen-only pill, as well as the contraceptive injection, are the safest birth control methods in these cases. Even though the mini-pill is not as reliable as the combined pill, if used carefully the failure rate is low. The combined pill is unadvisable because it can increase the risk for arterial disease.

Can female sterilization be reversed?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, through a procedure called tubal ligation reversal. However, untying the tubes is not always possible and depends on the type of tubectomy the woman underwent for having her tubes tied. More information on the following post: Tubal ligation or tubectomy: How does female sterilization work?

Can birth control cause female infertility?

By Sara Salgado BSc, MSc (embryologist).

Women who have been using hormonal contraception for a long period of time can take several month to recover normal menstrual cycles, and therefore their fertility. So the answer is yes, hormonal contraceptives can cause temporary infertility in females.

Which methods of contraception are available on the NHS?

By Andrea Rodrigo BSc, MSc (embryologist).

The NHS has created a contraception guide on their website where you can find the contraceptive that best suits you. There are 15 methods available on the NHS. You can find information about all of them here: Contraception guide – NHS Choices.

How appropriate are contraceptive methods for women over 40?

By Andrea Rodrigo BSc, MSc (embryologist).

In principle, women in their 40s or 50s have access to all available methods, so long as there is no health risk involved. Barrier methods are, however, the most advisable in these cases, as they help prevent sexually transmitted infections.

The combined pill is not indicated for women who smoke, and/or suffer from obesity or high blood pressure, as they may lead to heart, stroke or blood clotting problems. On the other hand, the pill has many advantages for women in this age group, as it regulates periods and helps maintain bone mineral density.

Are there contraceptive methods that don’t make you gain weight?

By Andrea Rodrigo BSc, MSc (embryologist).

This side effect can only be experienced if you take a hormonal birth control method. Barrier methods and natural family planning do not interact with your hormones, and therefore there is no way this symptom can appear.

Anyway, there is no conclusive proof that hormonal birth control methods can make women gain weight. Some women have even reported experiencing a weight loss after starting using the pill or the vaginal ring, for example.

Are there birth control methods that don’t lower libido?

By Andrea Rodrigo BSc, MSc (embryologist).

First of all, it should be clear that not all women taking the pill or using NuvaRing will experience this side effect. Some studies have linked this side effect to a diminished level of testosterone (the hormone linked to desire, sex drive, and lubrication), as a consequence of the ovaries being shut down by birth control pills.

How could oral contraceptives increase breast cancer risk?

By Andrea Rodrigo BSc, MSc (embryologist).

A woman’s risk of developing breast cancer depends on several factors. While some are related to her natural hormones, others are linked to reproductive history factors. Beginning menstruation at an early age, not having children, or experiencing menopause at a late age are factors that may increase the risk of breast cancer.

Several studies have shown that women who use or have ever used the pill have a slightly higher risk of developing breast cancer than those who have never used it. The risk is a bit higher if the woman started using it as a teenager.

Can hormonal imbalances be treated with birth control pills?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, in some cases adolescent girls and women with polycystic ovary syndrome (PCOS), endometriosis, primary ovarian insufficiency (POI), irregular menstrual periods, amenhorrhea, acne, menstrual cramps or premenstrual syndrome (PMS) are prescribed birth control pills to lower their hormone levels, and therefore regulare their menstrual periods.

Can birth control methods be used for the treatment of migraine with aura?

By Andrea Rodrigo BSc, MSc (embryologist).

Combined oral contraceptives and progestogen-only pills can help improve a woman’s headaches and migraines but also worsen them. It depends on each woman and the type of hormone in the pill. Studies, however, suggest that the lowest dose pills (those containing 20 micrograms of estrogen) are the most suitable for women who suffer from migraine regularly.

What’s the best birth control for diabetics?

By Andrea Rodrigo BSc, MSc (embryologist).

Diabetics should remember that birth control pills alter a woman’s hormonal levels. In this sense, high doses of hormones can have a negative impact on blood sugar levels, which can make it harder for them to control their diabetes.

Moreover, there is an increased risk for heart attack or stroke among women who use the pill, a risk that is higher in the case of diabetics. This applies to other types of hormonal contraception such as Depo-Provera, the contraceptive implant, the patch and the vaginal ring.

Intrauterine devices are neither indicated for diabetics because they increase the risk of developing infections in the uterus, a risk which is already higher among women with type 2 diabetes.

Female sterilization by means of tubal ligation is, outside of abstinence, perhaps the most secure method for diabetics, as it does not affect a woman’s blood sugar levels. However, surgery is not without risk, and women should keep in mind that it is a permanent method of birth control, which in many cases cannot be reversed.

Can birth control cause permanent hair loss?

By Andrea Rodrigo BSc, MSc (embryologist).

There is no scientific proof that contraception can cause permanent hair loss. However, hair loss is included as a side effect caused by the pill, although the loss is commonly minimal. It may not occur until after the woman has stopped taking it. Those whose family histories include hair loss are not recommended to use a method other than the pill.

Can hormonal contraceptives lead to breast tissue growth?

By Andrea Rodrigo BSc, MSc (embryologist).

Yes, it may happen, although the extent to which breast size increases depends on the woman and the birth control method used. Estrogen and progestin can cause you to experience an increase in breast size, but it generally reverses after a few cycles or when the woman stops using them. This side effect is often accompanied by breast tenderness (i.e. mastalgia).

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Authors and contributors

 Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information
 Sara Salgado
BSc, MSc
Embryologist
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information
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3 comments

    1. steve

      I had a girlfriend in the ’80s that used a diaphragm. I got her pregnant three times in one year while she had it in. The problem is that my penis is 9″ long and her vagina is shallower than most women. I was actually bumping into her cervix with my penis during sex and dislodging the diaphragm.

    2. Thanks for this

      Thanks for this guide to contraception! I didn’t know about the ring, to be honest. I find it very attractive, any opinions out there?

    3. margaret99

      Hello, I have implanon and I have unprotected sex ever since… Before implanon, IUD was my contraceptive method of choice, so I had unsafe sex also. The week I had the IUD removed, I had unsafe sex (I had no birth control method on me). By the end of that week, my doctor told me to use the contraceptive patch up until I had Implanon inserted. When I told doc I had had sex without condom or contraception, he said I should take the morning-after pill. I did it as he said, but now I’m worried that pregnancy has happened. Now I have the implant, but I’m worried I’m pregnant… I haven’t tested for pregnancy but I’m feeling something inside my stomach. I’ve gained weight and I can’t stop craving food…. Besides I’m totally exhausted from morning to midnight… What is happening to my body?