CONTRACEPTION: THE CHOICES

Birth control methods are safer and more reliable than ever. But they are not reliable when a user fails to follow the directions. A wide variety of birth control methods exist today. Women can now choose one that matches their lifestyle.

Abstinence is the cheapest and most effective birth control there is. Abstinence means having no sexual intercourse with the opposite sex. On-going or continuous abstinence protects against pregnancy and sexually transmitted diseases.

Tubal ligation for women and vasectomy for men are considered the most reliable and permanent forms of birth control. Each requires minor surgery. Once the procedure is done, the person, for the most part, does not need to worry about unplanned pregnancy. On a very rare occasion, pregnancy does occur; even after a vasectomy or tubal ligation.

Birth control pills are very effective when taken as prescribed. An examination and a prescription are needed to get them. A pill is taken once a day at the same time. Most women have no side effects from this, and they usually have lighter and less painful periods. A healthcare provider will help find the right pill for you.

Progesterone medications include hormonal implants (Norplant) or shots (Depo-Provera). These methods require no daily effort and are very effective. Both methods require an examination. A Depo-Provera shot only needs to be given every 3 months. Since Depo-Provera contains only progestin, it provides an alternative for women who cannot take estrogen.

Norplant consists of 6 matchstick-sized rubber rods that are surgically implanted under the skin of the upper arm. They release the contraceptive over a period of 5 years. In July 2002, Norplant's manufacturer announced it would no longer distribute the 6-rod Norplant system. Women who have the implants, can leave them in. But they should contact their healthcare provider to consider other options when it is time for them to be removed. Norplant has a toll free hotline to call for further information. The number is 1-800-364-9809.

A new vaginal contraceptive ring (NuvaRing) was introduced in 2001. It is a flexible ring about 2 inches in diameter that is inserted into the vagina for 3 weeks, removed for 1 week, and then replaced with a new ring. Estrogen and progesterone are released into the body from the ring, preventing ovulation.

A transdermal patch, called Ortho Evra, was also introduced in 2001. This is a skin patch that contains the hormones, estrogen and progestin. The medicated side is placed on the skin of the lower abdomen, buttocks, or upper body; but not the breasts. It is worn for 1 week; then thrown away. This is repeated on weeks 2 and 3 and no patch is worn on the 4th week.

Intrauterine devices, or IUDs, work by changing the environment in the uterus. This prevents the egg from being fertilized, or from implanting and growing in the uterus. IUDs are inserted by a provider and last for several years. Today's IUDs are safe and more effective than most contraceptives. This is especially true for women who are a low infection risk, such as those with only one partner.

Barrier methods include diaphragms, cervical caps, and condoms for both men and women. These have the least side effects, but are also the least reliable. The diaphragm and cap need to be fitted by a healthcare provider. Barrier methods, especially the condom, offer the added advantage of enhanced protection against sexually transmitted diseases.

Chemical barriers include vaginal creams, gels, foams, and suppositories. They have an ingredient that slows down and kills the sperm. They should be put in the vagina within 30 minutes before sex. When used alone, the pregnancy rate is high. But when used with a diaphragm or condom, the pregnancy rate drops. Chemical barrier methods are available in drugstores without a prescription.

Natural birth control methods are 75 to 80 percent effective when used regularly and as instructed. To prevent pregnancy, you cannot have sex for about 7 to 10 days during each menstrual cycle. No exam is needed. There are books that teach how to effectively use this method.

The withdrawal method involves removing the penis from the vagina just before semen starts coming out (ejaculation). Often sperm are deposited in the vagina before or during withdrawal, making this method unreliable.

For more information about birth control, contact your provider, your local health department, Planned Parenthood, or visit the website of EngenderHealth, a non-profit organization dedicated to making reproductive health care accessible to women and men around the world, at www.engenderhealth.org.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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