Birth Control Methods


Condoms may be the first thing that comes to mind for birth control, but what other options are available? Which ones are more effective at preventing pregnancy?


A Canadian study from 2006 found that 15% of Canadians ages 15 to 44 do not use any method of contraception (aka ‘birth control’). Without any method of contraception, the risk of pregnancy is approximately 85% in one year for women in their 20s. The same study also found that many women are not familiar with the different contraceptive methods that are available.


There are a wide variety of contraceptive options on the market with varying efficacy. Here, we outline what these options include, along with their failure rates. For reference, correct use refers to how well the method itself works when used exactly as instructed whereas typical use is the effectiveness of what generally happens in real life with human error.



The Most Effective Options


Intrauterine Device/System (Copper IUD, Mirena IUS, Jaydess IUS, Kyleena IUS)

  • Small T-shaped device inserted into the uterus by a health care practitioner

  • Can be non-hormonal (copper) or hormonal (levonorgestrel)

  • Provides protection for 2.5--10 years depending on the device

  • Recommended by the Canadian Paediatric Society as a first-line option for all young women

  • Failure rate: 0.2--0.6% with correct use, 0.8--1.2% with typical use

  • Possible side effects: Frequent bleeding/spotting in the first 3--6 months, amenorrhea (stopping of periods)


Injection (Depo-Provera)

  • Intramuscular injection of medroxyprogesterone acetate every 12--13 weeks

  • Failure rate: 0.2% with correct use, 6% with typical use

  • Side effects: amenorrhea (common), breast tenderness, insomnia or somnolence, fatigue, mood changes (e.g., depression or irritability), weight gain, menstrual irregularities, decreased libido, skin sensitivity reactions, high fever, acne


Birth Control Pills


Combined Oral Contraceptive Pills (Alesse, Aviane, Tricira, Yaz)

  • Contains estrogen and progestin

  • Typically 1 pill taken daily for 21 days, followed by a 7-day hormone-free interval (with placebo pills or no pills)

  • Side effects: breakthrough bleeding/spotting, amenorrhea, nausea/vomiting, bloating, chloasma (dark patches of skin), breast tenderness, mood changes, headache

  • Failure rate: 0.3% with correct use, 9% with typical use


Progestin--Only Pill / Mini--Pill (Micronor)

  • Only contains progestin

  • 1 pill taken daily continuously (no hormone-free interval)

  • Must be taken same time each day (within a 3 hour time-frame)

  • Side effects: irregular bleeding

  • Failure rate: 0.3% with correct use, 9% with typical use


Other Hormonal Methods


Transdermal Contraceptive Patch (Evra)

  • Contains estrogen and progestin

  • Patch is applied to the buttock, upper arm, or abdomen once weekly for 3 weeks, followed by 1 week without the patch

  • Failure rates & side effects: Similar to combined oral contraceptive pills


Vaginal Contraceptive Ring (Nuvaring)

  • Contains estrogen and progestin

  • Ring is inserted into the vagina and left in place for 3 weeks, followed by 1 week without the ring

  • Failure rates & side effects: Similar to combined oral contraceptive pills


*A prescription is required for all of the above contraceptive options.



Condoms


Condoms are the only contraceptive that protects against sexually transmitted diseases and infections. They can be used in addition to any other form of contraception to protect from STI transmission as well as to decrease chances of pregnancy.


Male Condom

  • Made from latex, polyurethane, or polyisoprene

  • Lambskin condoms are also available but have higher risk of slippage and less protection against STIs

  • Failure rate: 2% with correct use, 18% with typical use (similar for all materials)


Female Condom (FC2)

  • Inserted into vagina up to 8 hours before intercourse

  • Made from nitrile (latex free)

  • Failure rate: 5% with correct use, 21% with typical use


*Do not use male and female condoms at the same time.



Other Methods

Diaphragm (Milex Wide-Seal Arcing Style, Milex Wide-Seal Omniflex Style, Caya Silcs)

  • Small, reusable, soft dome inserted into the vagina

  • Gel that kills or decreases mobility of sperm is applied to the diaphragm before insertion

  • Inserted before intercourse and kept in place for at least 6 hours after intercourse, up to a maximum of 24 hours

  • More gel should be added with an applicator for each repeated act of intercourse or if intercourse hasn’t occurred in 2 hours

  • Failure rate: 6% with correct use, 16% with typical use


Contraceptive Sponge (Today Sponge)

  • Single-use sponges filled with spermicide

  • Inserted into the vagina anytime before intercourse and kept in place at least 6 hours after intercourse

  • Failure rate with correct use: 9% in women who haven’t given birth, 20% in women who have given birth

  • Failure rate with typical use: 20% in women who haven’t given birth, 40% in women who have given birth


Cervical Cap (Femcap)

  • Reusable, dome-shaped device inserted to the vagina

  • Gel is applied on both sides of the dome before insertion to decrease mobility of sperm

  • More gel should be added for each repeated act of intercourse or if intercourse hasn’t occurred within 2 hours of insertion

  • Left in place for at least 8 hours after intercourse but no longer than 48 hours at once

  • Failure rate with correct use: 9% in women who haven’t given birth, 26% in women who have given birth

  • Failure rate with typical use: 20% in women who haven’t given birth, 40% in women who have given birth


Withdrawal

  • Withdraw penis from vagina before ejaculation

  • Failure rate: 4% with correct use, 22% failure with typical use


Spermicides

  • Contains substances that kill or immobilize sperm, inserted vaginally

  • Inserted 30--60 minutes before intercourse

  • More foam is inserted if more time has passed and for every new act of intercourse

  • Any residual spermicide should not be removed for at least 6 hours

  • Products containing nonoxynol-9 are not recommend for women who have multiple acts of intercourse daily

  • Failure rate: 18% with correct use, 29% with typical use


Conclusion


With so many different contraceptive methods available it, it can be difficult to decide which one to go with. Speak with your health care practitioner to learn more about these options, how to properly use them, and how to determine which method is right for you, as one may be more appropriate than others for certain health conditions.



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References

  1. Chacko, M. Contraception: Issues specific to adolescents. UpToDate. Updated. September 14, 2020. Accessed November 30, 2020. https://www-uptodate-com.proxy.lib.uwaterloo.ca/contents/contraception-issues-specific-to-adolescents/print?search=contraception&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

  2. Graves, G. Contraception. In: Compendium of Therapeutic Choices. Canadian Pharmacists Association. Updated September 3, 2019. Accessed November 30, 2020. https://myrxtx-ca.proxy.lib.uwaterloo.ca/search

  3. Other Hormonal Birth Control Options. RxFiles. Updated October 2020. Accessed November 30, 2020. https://www-rxfiles-ca.proxy.lib.uwaterloo.ca/rxfiles/uploads/documents/members/CHT-OC-NonOC-Alternatives-cht.pdf

  4. Whelan, A.M. Contraception. In: Compendium of Therapeutics for Minor Ailments. Canadian Pharmacists Association. Updated August 15, 2018. Accessed November 30, 2020. https://myrxtx-ca.proxy.lib.uwaterloo.ca/search

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