Methods of Birth Control and Family Planning: An Overview
There is a lot of confusing and contradictory information out there about different methods of family planning and their mechanisms of action and effectiveness. As a life issues organization, we wanted to do some research for you so that you can get this vital information from a trusted source. It is really important to know if the method of family planning you use aligns with your values.
All of our information has been taken from either the Mayo Clinic website, John' Hopkins, or the websites owned by the companies that produce and advertise the different types of contraceptives reviewed.
As we dive into forms of what people might call “birth control” or “contraceptives” lets define some terms.
Birth Control: The practice of preventing unwanted pregnancies, especially by use of contraception.
Contraception is used commonly to refer the prevention of pregnancy either through the prevention of fertilization or the prevention of implantation of an already fertilized egg/zygote into the endometrium.
This means that some hormonal methods of contraception (if they can prevent implantation), may act as an abortifacient in some cases. Through the blog we will draw attention to these methods through bolded text. The Equal Rights Institute has a great video about whether certain contraception methods can cause early abortions!
Effectiveness is mentioned at the end of each method. You can learn more about how perfect versus typical effectiveness is measured in this article from Vitae Fertility.
Natural Methods
Abstinence
Abstinence is a free, 100-percent effective, method of preventing pregnancy with no physical side effects.
Mainstream discussions of abstinence have led many to believe that it is a naïve and unrealistic notion, but abstinence isn’t ignorance. It is the thoughtful choice to abstain from the only natural physical act that can create a new human being. If it is vitally important to your situation that no pregnancy occurs, we suggest considering abstinence. Take it as an opportunity to grow your intimacy as a couple in a different way.
Pros
Free
No hormones
100% Effective (barring divine intervention)
No physical side effects
Protects you from sexually transmitted infections (STI)
Cons
Can be difficult
Social stigma
Less easily achievable in a long term relationship
Natural Family Planning or Fertility Awareness
There are many forms of Natural Family Planning (NFP) or Fertility Awareness Methods (FAM). Most often people associate NFP with the temperature taking and calendar methods that were popular before the 1960’s. Natural Family Planning has come a long way since then! The most popular and effective forms of NFP are The Marquette Method, The Creighton Method, and the Billings Method.
How it Works
Pregnancy is only a possibility during a woman's fertile window. Natural family planning methods seek to identify when this is occurring using either hormonal testing or physical symptoms, or a combination of both. During the fertile widow of a woman's cycle, couples either abstain, or use a barrier method of contraception.
Pros
Protective of children at all stages of development
No synthetic hormones
Allows women to familiarize themselves with their body
Does not put the onus on the woman in the relationship to suppress her natural fertility
Is a joint venture between the couple
No physical side effects
Cons
May have a higher front end cost than most birth control methods
Does not protect against STIs
Abstaining during indicated times may be difficult
Depending on what method you choose to use it can be difficult to track the symptoms and is best done with training or guidance of a professional
Can be more difficult if you experience an inconsistent cycle
Each method will have its own typical and perfect use results. One example is the Marquette method that has a 98.4 % effective in perfect use and 98% effective in typical use rating.
For more information on FAM, we are hosting an event on Natural Family Planning on February 12th! Join us online!
Hormonal Methods
The combination pills contains both estrogen and progesterone. There are many iterations of the combination pill. The preferred frequency of withdrawal bleeding and the hormonal dosage may determine what type of combination pill is used (conventional vs. continuous dosing and monophasic vs. multiphasic). A prescription is required. Some of the major contraindications include (but are not limited to): being recently postpartum, being older than age 35 and smoking, having a blood clotting disorder, history of deep vein thrombosis or pulmonary embolism, and having migraines with aura or diabetes. We suggest asking your doctor and pharmacist about contraindications that may apply to you.
Mechanism of Action
Combination pills suppress ovulation (or the release of an egg). They also increase the volume of cervical mucus and thin the lining of the uterus (endometrium) which may prevent implantation if ovulation suppression fails and a zygote/embryo is created.
Pros
May reduce menstrual cramps (dysmenorrhea) and PMS
May improve appearance of acne
Shorter, lighter and more predictable flow, or may stop cycle entirely
Reduction in menorrhagia and related anemia
Reduced symptoms of endometriosis
Lowered risk of ovarian, endometrial and colorectal cancers
May help increase bone mineral density
May attenuate unwanted hair growth as a side effect of polycystic ovarian syndrome (PCOS)
Cons
Skipping pills or taking them late may reduce effectiveness
Side effects may include: irregular bleeding, bloating, breast tenderness, nausea, depression, weight gain and headache
No protection against STIs
Increased risk of high cholesterol, heart attack and stroke
Increased risk of blood clots, especially for smokers and women older than 35 years of age, with a slightly greater risk of blood clots linked to pills that contain higher doses of estrogen
Increased risk of cervical cancer and breast cancer for women who are currently taking combined birth control pills, but this risk appears to gradually decline to normal levels once you stop taking the pills
A mini-pill only contains progestin and must be taken at the same time everyday. A prescription is required. Contraindications include but are not limited to: history of or current diagnosis of breast cancer, some liver diseases, undiagnosed uterine bleeding. We suggest you speak to your doctor and pharmacist before taking any medication.
Mechanism of Action:
The mini-pill slows an egg's progress through the fallopian tubes, thickens cervical mucus and alters the endometrium to prevent implantation of a zygote. The minipill sometimes also suppresses ovulation.
Pros
Can quickly become pregnant when use is stopped
Can be taken even if you have a higher risk of blood clots, migraines, high blood pressure or a high risk of heart disease
Are less likely than combined pills to interfere with breast-feeding
Lowered risk of endometrial cancer
Cons
Must be taken at the same time every day, follow up with a health care professional for details
No protection against STIs
Side effects may include: irregular menstrual bleeding, ovarian cysts, decreased libido, headache, breast tenderness, acne, weight gain, depression and hirsutism
Increased risk of ectopic pregnancy
In Alberta, the hormonal intrauterine devices (IUD) Kyleena and Mirena are most commonly available. They are T-shaped plastic frames that are inserted into the uterus, where they release a type of the hormone progestin. Mirena has a higher circulating levonorgestrel (testosterone derived pseudo-progestin) than Kyleena. A doctor would determine which IUD would be more effective based on several factors and would perform the insertion. A prescription is required. Contraindications include but are not limited to: a history of uterine or cervical cancer, uterine abnormalities e.g., fibroids, pelvic infection or inflammatory disease, and unexplained vaginal bleeding. We suggest you speak to your doctor and pharmacist before taking any medication.
Mechanism of Action:
The exact mechanism of action is unknown but it works through a probably combination of thickening the mucosal lining of the cervix, altering the lining of the uterus to prevent implantation of a zygote, and partially suppressed ovulation.
Pros:
Long-term
Doesn't require daily action
Doesn't carry the risk of side effects related to birth control methods containing estrogen
Works for up to 5 years
Fertility returns quickly
May decrease menstrual pain and pain related to endometriosis
Can decrease risk of certain cancers
Cons:
No protect against STIs
When conception occurs, implantation is more likely to happen outside of the uterus and in the fallopian tubes (ectopic pregnancy)
In a small number of cases the uterus can be perforated
Side effects may include: headache, acne, breast tenderness, irregular bleeding, mood changes, cramping and pelvic pain
>99% Effective (it is it placed in the uterus by a health care professional and requires no action for upkeep by the wearer; there is no statistic for typical use)
Depo-Provera Injection
Medroxyprogesterone acetate, which is sold under the brand name Depo-Provera is an intramuscular injection that contains progestin. It is given every three months. Contraindications include but are not limited to: having unexplained vaginal bleeding, indications of potential osteoporosis, or a history of depression, heart attack, or stroke. We suggest you speak to your doctor and pharmacist about all the contraindications before taking any medication.
Mechanism of Action
Like most hormonal methods it suppresses ovulation, increases cervical mucus, and alters the lining of the uterus to prevent implantation.
Pros
Doesn't require daily action
Can decrease menstrual cramps and pain
Can lessens menstrual blood flow, and in some cases stops menstruation
Decreases the risk of endometrial cancer
Many experts believe progestin-only contraceptive methods, such as Depo-Provera, carry significantly lower risks of these types of complications than do contraceptive methods that contain both estrogen and progestin.
Cons
You might have a delay in your return to fertility. A normal cycle may not return for 10 months.
Does not protect against sexually transmitted infections
It might affect bone mineral density (the FDA suggests it is not used for longer than 2 years)
Side effects may include: Abdominal pain, bloating, depressed libido, depression, dizziness, headaches, irregular periods or breakthrough bleeding, nervousness, weakness or fatigue, and weight gain
94% Effective for typical use
Patch
In this method, a small patch that deposits estrogen and progesterone is placed on the skin every week for three consecutive weeks. No patch is placed on the fourth week allowing for withdrawal bleeding. A prescription is required. Contraindications include but are not limited to: Being 35 or older and smoking, having chest pain, weighing more than 198 pounds (90 kilograms), or having a history of heart attack, cancers, or migraines with aura. We suggest you speak to your doctor and pharmacist before taking any medication.
Mechanism of Action
As a hormonal method like the combination pill, the mechanism of action is to suppress ovulation, increase cervical mucus, and alter the lining of the uterus to prevent implantation of a zygote.
Pros:
Doesn't require daily attention or having to remember to take a pill every day
Provides a steady dose of hormones.
It's easier to use if you have trouble swallowing pills.
It can be removed at any time, allowing for a quick return to fertility.
Cons:
An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and high blood pressure
Breakthrough bleeding or spotting
The birth control patch doesn't protect against sexually transmitted infections (STIs).
Side effects may include: Skin irritation, breast tenderness or pain, menstrual pain, headaches, nausea or vomiting, abdominal pain, mood swings, weight gain, dizziness, acne, diarrhea, muscle spasms, vaginal infections and discharge, fatigue, and fluid retention
The patch may increase the risk of estrogen-adverse effects (such as blood clots) more than the birth control pill as it seems to elevate the circulating estrogen to a greater degree.
91-93% Effective with typical use
>99% Effective with perfect use
Vaginal Ring
A plastic ring containing estrogen and progesterone is inserted into the vagina for three weeks. After a week to allow withdrawal bleeding, a new ring is inserted. A prescription is required. Contraindications include but are not limited to: being older than 35 and smoking, taking certain medications used to treat hepatitis C. We suggest you speak to your doctor and pharmacist before taking any medication. Please mention especially if you are experiencing: diabetes with complications related to your blood vessels, medical history of blood clots, toxic shock syndrome, breast, uterine or liver cancer, or other liver disease, heart attack or stroke, migraines with aura (or, if you're over age 35, any migraines), uncontrolled hypertension, vaginal bleeding for unknown reasons, depression, gallbladder or heart disease, high cholesterol or high triglycerides.
Mechanism of Action:
Again, as a hormonal method like the combination pill, the mechanism of action is to suppress ovulation, increase cervical mucus, and thin the lining of the uterus to prevent implantation of a zygote.
Pros
Speedy return to fertility after it is removed
Likely will not cause weight gain
Less likely to have cycle irregularity than with combination pill
Smaller amount of circulating hormone, decreasing likelihood of side effects
Do not have to remember to take a pill every day
Cons
Does not protect against STIs
Side effects may include: Breakthrough bleeding or spotting, vaginal infection or irritation, increased vaginal discharge, headache, nausea, depression, decreased libido, breast tenderness, abdominal pain, and diarrhea.
An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and toxic shock syndrome
99% Effective with typical use
Implant
Another long-term method is the rod implant. This rod, which is placed under the skin above the elbow, releases continuous progestin. It can be used for up to three years. Contraindications include but are not limited to: having had a serious blood clot, heart attack, or stroke, having undiagnosed vaginal bleeding, or having depression, diabetes, gallbladder disease, hypertension, high cholesterol/triglycerides, or a history of seizures or epilepsy. We suggest you speak to your doctor and pharmacist before taking any medication.
Mechanism of Action
It works by thickening cervical mucus and thinning the lining of the uterus (endometrium) to prevent implantation. It likely also suppresses ovulation.
Pros
Contains no estrogen
Fast return of fertility
Do not have to remember to take a pill every day
Cons
No protection from STIs
If fertilization occurs, higher risk of ectopic pregnancy
Side effects may include: Abdominal or back pain, increased risk of noncancerous ovarian cysts, changes in vaginal bleeding patterns (including amenorrhea), depressed libido, dizziness, headaches, mild insulin resistance, mood swings and depression, nausea or upset stomach, sore breasts, vaginal inflammation or dryness, and weight gain.
There are also possible interactions with other medications; tell your doctor about any other medication you are using before getting the implant
>99% Effective (it is it placed in the arm by a health care professional and requires no action for upkeep by the wearer, there is no statistic for typical use)
Non-Hormonal Methods
IUD (Copper)
An intrauterine device (IUD) that can provide long-term contraception. It's sometimes referred to as a nonhormonal IUD option. It is a T-shaped plastic frame inserted into the uterus. The device gets its name from the copper wire wrapped around the frame. It requires a prescription. Contraindications include but are not limited to: Uterine abnormalities, fibroids, unexplained vaginal bleeding, and Wilson's disease. We suggest you speak to your doctor and pharmacist before using an type of birth control
Mechanism of Action:
Copper produces an inflammatory reaction that is toxic to sperm and eggs (ova), the primary mechanism of action is to prevent implantation of a zygote.
Pros
Can remain in place for up to 10 years
Can be removed at any time
Can be used while breast-feeding
Doesn't carry the risk of side effects, such as blood clots, related to hormonal birth control methods
Cons
No protection from STIs
When conception occurs, implantation is more likely to happen outside of the uterus and in the fallopian tubes.
Side effects may include: dysmenorrhea, menorrhagia, bleeding through menstrual cycle, cramping
>99% Effective (it is it placed in the uterus by a health care professional and requires no action for upkeep by the wearer, there is no statistic for typical use)
Physical Barrier Methods
Male Condoms
A male condom is a thin cover placed over the penis usually made from latex or polyurethane.
Mechanism of Action
It provides a physical barrier between sexual partners. Semen is caught within the condom during sex and therefore cannot meet with and fertilize the female ovum.
Pros
Provide protection from most STIs as well as prevent fertilization
Non-hormonal
Does not put the onus only on the woman in the relationship to suppress her natural fertility
No physical side effects
Cons
One-time use
Susceptible to tampering or physical damage
98% effective with Perfect use at preventing pregnancy
85% Effective with typical use
*Female condoms also exist but they are used so infrequently that for the length of the blog post we decided to leave them out
Diaphragm/Cervical Cap & Spermicide
The diaphragm is a small cup made of either rubber or silicon placed over the cervix. It must be used with spermicide to be effective. It does not protect against sexually transmitted diseases. There are not used very commonly in Canada.
Mechanism of Action
Spermicide kills incoming sperm and the small cap covers the cervix preventing most sperm from entering into the uterus/fallopian tubes.
Pros
Non-hormonal
Does not require a woman to suppress her natural fertility
No physical side effects
Cons
Does not protect against STIs
Susceptible to tampering or physical damage
May be difficult to find
94% Effective with perfect use
88% Effective with typical use
Sterilization Procedures
A vasectomy is a surgical procedure that slices and seals the vas deferens, preventing sperm from entering the ejaculate.
Pros
Non-hormonal
Does not require a woman to suppress her natural fertility
Minor physical side effects
Cons
Does not protect against STIs
May take a few months to take effect
No guarantee is it reversible
Will have to recover from surgery
Men will likely experience swelling and pain after the operation and in a small minority of cases there are long term side effects.
Almost 100% Effective at preventing pregnancy (after about 3 months).
Tubal ligation is a female specific sterilization method. It is performed by snipping or blocking the fallopian tubes. No egg is available to be fertilized during the sexual act and fertilization cannot occur. This is a permanent form of contraception. However, in very rare occasions women’s bodies have healed themselves and pregnancy occurs.
Pros
Non-hormonal
Minor physical side effects
Cons
Does not protect against STIs
No guarantee it is reversible
Will have to recover from surgery
Some risks of the procedure are improper healing after surgery, continued abdominal or pelvic pain, and possible damage to the major blood vessels, bowls, or bladder.
Almost 100% Effective at preventing pregnancy
As we can see from this article, there is no 100% effective way to prevent pregnancy aside from abstaining from sexual activity. If you are interested in talking about this information further, we encourage you to reach out!