Contraception is not limited to condoms, pills, or interrupted intercourse. Today the choice of contraceptives is much wider.
Today, one can simply get lost in the variety of birth control methods (or family planning methods). Modern medicine offers a huge selection of options: from those that can be bought at a nearby pharmacy to expensive surgical operations. Despite this, at least 16.7 million unwanted pregnancies occur annually in the world. We selected the top 13 birth control methods and ranked them in decreasing order of effectiveness, based on the Pearl index, which shows the effectiveness of a particular protection method.
1. Abstention
The only 100% way to avoid unwanted pregnancy and infections is abstention from sex. However, it can be accompanied by side effects such as fading libido or even depression.
2. Sterilization
Female sterilization is also called tubal occlusion or tubal ligation. As a result of the operation, an artificial obstruction of the fallopian tubes is created: the female egg is isolated from spermatozoa and fertilization becomes impossible. Such a method of contraception is legally permitted in most countries only to women after 35 years of age with at least one child.
Pros: Almost 100% protection against unwanted pregnancy; the operation does not entail changes in health, in the hormonal background, does not affect sexual desire, and sometimes even increases it; the risk of ovarian cancer is reduced.
Cons: Sterilization is almost irreversible, the operation to restore fertility is very expensive and there is no guarantee of a successful outcome; the operation is performed under general anesthesia, and these are associated risks; sterilization does not protect against sexually transmitted diseases and HIV infection.
Pearl Index: 0, 15 (in an extremely small percentage of women, pregnancy occurred in the first year after surgery).
3. Vasectomy
Vasectomy is a type of male sterilization. During the operation, a part of the vas deferens is ligated or removed in a man, and thus the sperm do not get into the ejaculate.
Pros: Relatively simple operation; local anesthesia; libido, erection, ejaculation, sexual desire, orgasm do not undergo changes.
Cons: You need to carefully consider your decision since reconstructive surgery is much more complex, expensive and success is not guaranteed. It does not protect against genital infections.
Pearl Index: 0.4 pregnancies per 100 women.
4. Intrauterine device (IUD)
An intrauterine device is a fairly common method of contraception in women aged 25-30 years old. This is a small device that is inserted into the uterine cavity to prevent conception. Today, there are about 50 types of intrauterine devices: round, spiral, T-shaped, made of copper or silver, hormonal, etc. The IUD prevents the implantation of an egg into the uterine wall, has a detrimental effect on spermatozoa (copper-containing spirals), and affects their ability to pass through the cervix (hormonal). The average period of use is 2-5 years.
Pros: High protection against unwanted pregnancy. Using an IUD, you can forget about other methods of protection for several years. The device does not affect lactation, is inexpensive, and easily removed by a doctor.
Cons: In some cases, it can provoke heavy menstruation. A long stay of a foreign body in the body reduces immunity, and can also cause inflammatory processes. An IUD is not recommended for nulliparous girls.
Pearl Index: 1 pregnancy per 100 women.
5. Hormonal implants and capsules
This type of contraception is a small plastic stick (the size of a match) or a thin capsule filled with hormonal drugs and usually injected subcutaneously into the inner side of the left pre-shoulder. After installation, the implant regularly releases a hormone that prevents ovulation and also changes the mucous membrane of the cervix, making it difficult for sperm to travel. In 2018, a new progressive product was released on the American market – a hormonal chip contraceptive, which is implanted into the patient under the skin and controlled using a smartphone and a special application.
Pros: No need for frequent implant replacement. The effect lasts about 5 years. The operation is quite simple and painless.
Cons: Side effects: nausea, headaches, and allergic reactions. Implants are not widely represented on the market, so they are quite expensive. In addition, gynecologists do not recommend installing implants for women who have not yet given birth.
Pearl Index: 0.3 pregnancies per year per 100 women.
6. Combination oral contraceptives (COCs)
Combination oral contraceptives are synthetic analogues of female sex hormones. The mechanism of their action is as follows: ovulation occurs approximately in the middle of the menstrual cycle, and COCs do not allow the egg to mature and exit the ovary. Pills must be taken strictly for three weeks with a break for a 4th week (if you are using a 21 pill pack) or continuously for four weeks without any breaks (if you are using a 28 pill pack): you should get your period on the week 4 in both cases. There are many myths about birth control pills: a sharp increase in weight, an increase in the hairline, and others. Here’s what gynecologists say about this: “The reason for the myths is oral contraceptives of the previous generation. They did have a wide range of side effects. Today, a correctly selected contraceptive helps avoid unpleasant consequences. Before use, it is necessary to consult a gynecologist: an experienced doctor will select the necessary drugs for you based on your age, a number of sexual partners, contraindications, medical history. “
Pros: Highly effective and tested option – COCs have been widely used by women around the world for about 50 years. Some birth control pills help treat acne.
Cons: A risk of thrombosis if there is a predisposition. Need discipline and regularity of use. In addition, COCs can reduce libido, cause allergies, nausea, an increased sensitivity of breast, pigmentation, and mood swings.
Pearl Index: About 0.5 pregnancies per year per 100 women for combined oral medications.
7. Hormonal injections
Hormonal injections are intramuscular injections of the female hormone progesterone in the buttocks or shoulder. 1 injection has a contraceptive effect for up to three months. It is a suitable option for those who have a regular partner and who do not want to mess with taking pills.
Pros: High degree of protection. There is no need for daily use.
Cons: Injections do not protect against infections and can provoke a decrease in libido, nausea, thrombosis, and other side effects.
Pearl Index: About 1 pregnancy per year per 100 women.
8. Vaginal ring
This contraceptive is a flexible plastic ring that is inserted into the vagina. The ring releases 2 main female hormones: estrogen and progesterone, and they have a contraceptive effect.
Pros: Local action – the ring does not affect the body as a whole, like tablets, and is easy to use. It is enough to apply it once every few weeks.
Cons: Side effects – nausea, dizziness, headaches, cycle disturbances – are difficult to avoid. In addition, the ring does not protect against infections.
Pearl Index: Up to 1.18 pregnancies per 100 women per year.
9. Emergency contraception
Emergency contraception is used in cases of force majeure, after unprotected intercourse or when the condom breaks. You should remember that emergency methods are not an alternative to other methods of protection!
Pros: The risk of an unwanted pregnancy after unprotected intercourse is minimized (although not completely excluded).
Cons: Side effects: nausea, headache and a strong blow to the female reproductive system. A woman cannot abuse this method.
Pearl Index: 2.4 pregnancies per 100 women per year.
10. Male and female condoms
Condoms are the most common form of birth control. In addition to la-tex, there is also a spermicidal condom: its lubricant contains a small percentage of chemicals that destroy sperm. Gynecologists often advise patients to combine the use of condoms and oral contraceptives (in the absence of contraindications). This is the best option for protection from infections and unwanted conception. Do not forget to check the expiration date. Currently, Australian scientists with the support of the Bill and Melinda Gates Charitable Foundation are working hard to create a new generation of condoms made of polymer hydrogels: according to the developers, these condoms will be self-lubricating, biodegradable, will bring more pleasure, and will also be able to deliver a locally defined dose of medication (e.g., Viagra).
Pros: Accessibility and ease of use, wide selection. Condoms best protect against sexually transmitted diseases.
Cons: Protection against pregnancy is only 82% in male and 79% in female condoms. Many women complain about the absurdity of female condoms and that they may make inappropriate sounds during sex. A contraindication is a latex allergy.
Pearl Index: From 5 to 12 pregnancies per 100 women.
11. Birth control caps, vaginal diaphragms and sponges
The contraceptive cap is a reusable contraceptive, which is a silicone cup with a loop that is worn on the cervix. Caps are recommended for use with spermicides. A contraceptive is administered immediately before sexual intercourse and can be worn for about 48 hours.
The vaginal diaphragm has the shape of a cup with a metal spring along the edge, it is inserted before a sexual intercourse so that the rim is in the walls of the vagina, and the dome covers the cervix. The spring presses slightly on the walls of the moisture-urethra and the urethra. The selection of the diaphragm in size is done by a gynecologist, you can wear a contraceptive for no more than 24 hours.
A sponge soaked with a spermicidal solution looks like a small donut with a recess that should fit snugly against the cervix. The sponge combines both mechanical and chemical protection. The size of the sponge is uni-versal. In the USA, you can buy it in a regular supermarket.
Pros: Caps are reusable, they do not change the hormonal background, are suitable for breastfeeding women and for those who cannot use hormonal preparations for some reason.
Cons: In case of improper administration, the effect is extremely weak. They do not protect against infections, and the quality of sex is sometimes reduced. In addition, there are contraindications.
Pearl Index: From 6 to 20 pregnancies per 100 women.
12. Spermicides
Spermicides are chemicals that destroy sperm in a short period of time (up to 1 minute). They come in forms of special creams, jellies, suppositories, vaginal tablets, foams and films – all these options can be purchased freely in the pharmacy. Spermicides have a low contraceptive effect, so gynecologists advise combining them with barrier methods of birth control.
Pros: Ease of use, protection against certain infections.
Cons: Low contraceptive effect. Spermicides can negatively affect the vaginal flora. And one more thing: make sure that you are not pregnant because in this case there is a great risk to the fetus.
Pearl Index: 25-30 pregnancies per 100 women per year.
13. Interrupted intercourse and others
Interrupted sexual intercourse, a calendar method, a method involving monitoring basal temperature, monitoring the consistency of secretions and other methods inherited from our grandmothers and mothers – all these are natural methods of contraception. Even modern methods of birth control do not give a 100% guarantee, and the reliability of “natural” methods is under a big question: 20 out of 100 women who use interrupted sexual intercourse become pregnant within a year. In addition, none of the natural methods protects against sexually transmitted infections.
In conclusion, we recommend that you should consult your gynecologist before choosing birth control.