What are good options for birth control?

Q:  I’m currently on the pill.  Are there other good options for birth control? 

A: There are lots of birth control options out there, each with their own pros and cons.  Here is a quick primer on all of them.  Remember, this is a general discussion – you can always make an appointment with Student Health Women’s Services to determine which option is best for you. 

Oral Contraceptive Pills (OCP’s, “the Pill”) – These work by preventing ovulation as well as thickening cervical mucus to prevent sperm penetration. There are so many different birth control pills on the market that it would be impossible to list them all here, but they all fall into 2 main categories: combination estrogen/progesterone pills and progesterone only pills. 

The pill is easy to use and allows for spontaneity of sex – you don’t have to fish around your purse for one when the mood strikes.  The failure rate is very low; with perfect use, only 1-2% of users become pregnant per year (although the failure rate is slightly higher in “real life”).  The major down side with the pill is that they do not provide protection from STIs, and they can cause side effects such as nausea, bloating, weight gain and increased risk of blood clots, especially in smokers and women over 35.  Also, for some people it’s hard to remember to take a pill at the same time every day.

Vaginal ring – Sold under the brand name NuvaRing, the vaginal ring releases the same hormones as one of the combination pills. The ring is typically left in for 3-4 weeks and then taken out for one week. The pros: it’s good for people who tend to forget to take their pills. The cons: it can cause the same side effects as the pill; you and/or your partner might feel it during sex; it could be expelled unintentionally; and there is the potential “ick” factor of having to insert and remove the ring yourself.

Injectable Contraceptives (“Depo,” “the shot”) – Depo-Provera is an injection that prevents pregnancy for 3 months.  It works like other hormonal contraceptives by preventing ovulation and thickening cervical mucus.  With Depo-Provera, you only have to remember to get a shot once every 3 months instead of taking a pill every day and it has one of the lowest failure rates: only 0.3% of people become pregnant in the first year if using it correctly.  It can cause side effects such as irregular menstrual bleeding, weight gain and breast tenderness and some women may not return to regular ovulation for 6-18 months after discontinuing Depo-Provera, so if you’re thinking about getting pregnant in the near future, this might not be the method for you.

IUD – The IUD is one of the most widely used forms of birth control in the world, but for various reasons it’s gotten a bad rap here in the United States.  The IUD is a small T-shaped device which contains either copper (Paragard) or a hormone (Mirena).  It is inserted into the uterus by your health care provider, and prevents pregnancy by making the uterus a hostile environment for sperm (the exact mechanism isn’t entirely understood).  The IUD is an effective, long term form of birth control; Paragard works for 10 yrs and Mirena for 5 yrs and the failure rate is less than 1%.

The downside to the IUD is that the initial cost is high (although it works out to be a good deal if you compare it to the cost of 10 years worth of pills or shots) and there is a slightly higher risk of pelvic inflammatory disease (PID) if a woman has an STI at the time of insertion.  However, modern IUD’s are safe and effective and therefore can be used by most sexually active women who receive proper STI screening tests.  The IUD can cause menstrual irregularities and an increased risk of spontaneous abortion in women who become pregnant with the IUD in place. 

Male condom – The old standby!  Condoms are cheap, plentiful, effective and easy to use.  With perfect use they are 98% effective in preventing pregnancy (but again, in real life this is more like 85%).  The biggest benefit of condoms is that for STI prevention, the male condom is still #1!  The downside is that they can interfere with the spontaneity of sex, they can tear, people with latex sensitivity can’t use them, and some partners are reluctant to use them.  Ladies, if your partner is unwilling to wear a condom for your protection, maybe it’s time to rethink whether you really want to be having sex with him!

Female condom – The female condom is a polyurethane sheath placed inside the vagina. It has the potential to protect against STIs, but not as well as the male condom. They do allow you to take protection into your own hands when your partner refuses to use a condom but the downside is that they are more expensive than male condoms, have a higher failure rate than male condoms (21% of users typically become pregnant within one year of use) and the polyurethane version can make some weird noises during sex.

The withdrawal method (“Coitus Interruptus”).  While it doesn’t cost you a dime, the withdrawal method provides no protection against STI’s and has a failure rate of 15-25%!  And it’s not just because guys tend to stay in when it’s time to get out – during sex, a sperm-containing fluid will often leak out of the penis before the man actually ejaculates and this can lead to pregnancy.   

Rhythm method – This is where the couple plans sex around the woman’s cycle and abstains when she is most likely to be fertile.  I like to quote my 7^th grade Sex Ed teacher about this one: What do you call people who use the rhythm method?  Parents!

Abstinence – The most effective birth control method ever invented – it’s totally free, has no side effects and has a guaranteed 100% success rate in preventing pregnancy and STI’s!  When in doubt, this is always your best bet.  But when the time is right, make sure you know about the other options!

Angela Walker, Med IV (OSU COM)

Ryo Choi-Pearson, MD (OSU SHS)