Female Birth Control Methods

You have many options when it comes to birth control. Your choice depends on your health, personal preferences, frequency of sexual encounters, number of sexual partners and your desire to have children in the future.

Listed in this article are the various forms of birth control, their pros and cons, medical risks and side effects, the effectiveness, and how you can get that particular contraceptive. Effectiveness rates reported here depend mostly on clinical trial information that the Food and Drug Administration receives.

Keep in mind that there are no guarantees that you won't get pregnant, with the exception of abstinence. Some are more comfortable to use than others. You may have side effects or other problems not noted here.

The opposite of intercourse, outercourse involves sexual stimulation without penetration of the vagina to theoretically prevent sperm from joining the egg.

Available in foam, cream, jelly, film, suppository or tablet forms, spermicides are inserted deep into the vagina and contain a chemical that destroys sperm. Package instructions must be carefully followed because some products require a 10-minute wait before having sex. One dose is usually effective for one hour. For repeated intercourse, additional spermicide must be applied. Following intercourse, the spermicide must remain in place for at least six to eight hours.

In addition to the male condom, there is a female version (brand name FC Female Condom® in the US, Femidom, Dominique, Femy, Myfemy, Protectiv' or Care in other countries) that fits inside a woman. Before sex, the female condom is placed inside the vagina with one end outside the vagina and the other covering the cervix. These condoms are made of polyurethane and are coated inside and out with a silicone-based lubricant, which is not spermicide.

A rubber disk that must be filled with spermicide and then placed deep in the vagina to cover the cervix. The diaphragm holds the spermicide in place over the cervix to block entry of sperm into the vagina.

The diaphragm can be inserted as long as 6 hours before intercourse, and must be left in place at least six hours after the last act of intercourse. For repeated intercourse the diaphragm must be left in place and fresh spermicide should be inserted into the vagina for additional protection.

The diaphragm should be left in place for at least six hours after the last act of intercourse, but for no longer than a total of 24 hours.

Like a diaphragm but smaller, the cap (brand name in the USA FemCap®) fits snugly around the cervix. The cervical cap is used with spermicide to protect for 48 hours and for multiple acts of intercourse within this time. The cap must stay in place for six hours after intercourse. Cervical caps are made out of silicone, are washable and reusable.

The vaginal contraceptive sponge (brand name Today®) was re-approved by the FDA for use in the United States in 2005. It is a disposable, donut-shaped polyurethane device that contains spermicide that is inserted into the vagina to cover the cervix. It works in two ways - it kills sperm in the vagina and it blocks the cervix to keep sperm from entering. The sponge protects for up to 24 hours and for multiple acts of intercourse. Like the diaphragm, it should be left in place for at least six hours after intercourse.

This device (brand name Lea's Shield®) is a dome-shaped rubber disk with a valve and a loop that is held in place by the vaginal wall. It covers the upper vagina and cervix so that sperm cannot reach the uterus. Spermicide is used before insertion. It can be used for 48 hours, and if necessary a few hours more. The device should be inserted before sex and left in at least eight hours after. Each time it is used during sex, spermicide should be used.

It is not the same as the cervical cap, which is held in place by the cervix. Sizing is essential in purchasing and using a cervical cap because cervixes vary in size. Lea's Shield is held in place by the muscles in the vagina. Lea's Shield is also not a diaphragm, which requires sizing by a doctor to keep it in place during sex.

Highly effective, the pill is the most popular form of reversible birth control in the United States. It uses the hormones estrogen and progestin to suppress ovulation. Recent studies indicate that many women are reluctant to take the pill because of fear of medical risks. However, current low-dose pills have fewer risks associated with them than earlier versions. In fact, the FDA suggests that for most women, birth control pills are safer even than delivering a baby.

The 90-day pill (brand name: Seasonale®), containing estrogen and progestin, is taken in three-month cycles of 12 weeks of active pills followed by one week of inactive pills, to allow for menstruation. Periods occur in the 13th week of the cycle.

Also known as the "morning-after pill," this type of contraceptive are pills that have progestin alone or progestin plus estrogen to prevent pregnancy. Plan B® is a brand of emergency contraceptive pill (ECP) that contains progestin only. Other ECPs are combination pills of estrogen and progestin. The emergency contraception can also be insertion of an IUD. The pills prevent pregnancy by stopping ovulation or fertilization. IUDs prevent fertilization.

Plan B and other pills are taken in either one dose or two, which are spaced 12 hours apart. Combination pills are taken in two doses, 12 hours apart. ECPs can reduce the risk of pregnancy if taken within the 120 hours after unprotected vaginal intercourse.

These are meant for emergencies only and do not continue to prevent pregnancy throughout the rest of the cycle. Other contraception must be used.

Worn on the skin, the patch (brand name Ortho Evra®) delivers a steady flow of hormones - progestin and estrogen - to prevent pregnancy and is a reversible form of birth control. One patch is used for seven days at a time. The woman puts on a new patch once a week, for three consecutive weeks each month. Then she goes patch-free" the fourth week in order to get her period. The patch can be worn in four parts of the body - upper outer arm, upper torso (front and back, excluding the breasts), abdomen or buttocks. An updated label for the Ortho Evra contraceptive patch warns that the patch exposes women to higher levels of estrogen than most birth control pills approved by the FDA.

Implants are match-sized sticks placed under the skin of a woman's upper arm. These capsules constantly release small amounts of hormone that suppress ovulation.

Norplant® is no longer commercially available in the United States. The newer version has just one rod, which is easier for the health care provider to remove than the six Norplant rods. For some women, the six Norplant rods caused pain and bruising when being removed by the health care provider. Implanon® is an implantable hormonal contraceptive that is effective for up to three years. It was approved in July, 2006 by the U.S. Food and Drug Administration. It contains progestin. Progestin is a synthetic hormone similar to the progesterone made by a woman's ovaries. It works in two ways. It keeps the ovaries from releasing eggs (stops ovulation). It also thickens the cervical mucus, preventing sperm from joining with an egg.

Depo-Provera® is a progestin that is injected into the buttocks or arm muscle every three months by a health care provider to suppress ovulation. Another injectable birth control is Lunelle®, which has both progestin and estrogen.

NOTE: The Food and Drug Administration announced in 2004 that a "black box" warning, highlighting that prolonged use may result in loss of bone density, has been added to the labeling of Depo-Provera. If you are concerned, talk with your doctor.

The ring (brand name NuvaRing®) is a flexible ring about 2 inches in diameter that is inserted into the vagina and releases progestin and estrogen to protest against pregnancy for one month. It keeps ovaries from releasing an egg. The woman inserts a new ring into the vagina that will remain in place for three weeks and she removes it for the fourth week so she can get her period. After that, she must insert a new one. It is not the same as a diaphragm because the ring contains hormones like the pill.

An IUD is a T-shaped device inserted into the uterus by a health care provider. It provides protection from pregnancy for 10 years

It's not entirely clear how IUDs prevent pregnancy. Research suggests that they prevent sperm and eggs from meeting by either immobilizing the sperm on their way to the fallopian tubes or changing the uterine lining so that the fertilized egg cannot implant in it. Although earlier models of the IUD were taken off the market because of associations with pelvic infections and infertility, today serious complications from IUDs are rare.

Before insertion, discuss with your clinician how to watch for possible side effects or other problems. Also, be sure to read the material your provider gives you about the IUD and its risks/benefits.

This means not having intercourse on the fertile days of a woman's cycle. These fertile days have the highest chance for a woman to become pregnant. That would be about mid-cycle. However, a woman may ovulate any time of the month; so this method of birth control is highly risky. A health care provider can teach you how to chart your menstrual cycle and to detect certain physical signs to help you predict "unsafe" days.

Here are brief descriptions to chart these changes:

• Temperature method - Take your temperature every morning before getting out of bed. Your temperature rises between 0.4 degrees F and 0.8 degrees F on the day of ovulation. It stays at that level until your next period.
• Cervical mucus method - Observe the changes in your cervical mucus. You must do so all through the first part of your menstrual cycle until you are sure you have ovulated. Normally cloudy, tacky mucus will become clear and slippery in the few days before ovulation. It also will stretch between the fingers. When this happens, you are in your most fertile phase. You must not have intercourse, or you should use a barrier contraceptive during this time.
• Calendar method - Chart your menstrual cycles on a calendar. You may be able to predict ovulation if your periods are the same every month. You must not have sex or should use a barrier method during your "unsafe days." It will be more difficult to predict the day of ovulation if the length of your cycle is different every month. In that case, you will have more "unsafe days." Do not to rely on this method alone.

It is best to combine the temperature method, the cervical mucus method and the calendar method.

Women breastfeed on demand for up to six months after giving birth and the baby cannot have any other food. Doing so keeps the ovaries from releasing an egg.

The man pulls out his penis from the vagina before he ejaculates.

If you feel absolutely certain that under no circumstances do you want to have additional children, sterilization may be a birth control option. Sterilization is very difficult to reverse, and should be thought of as permanent, although there is a 3 percent failure rate over a 10-year period.

Female sterilization is also referred to as tubal ligation. This surgery closes the fallopian tubes to prevent the passage of a woman's egg to her uterus. The surgery, usually performed on an outpatient basis, takes about 20 to 30 minutes. The physician administers general anesthesia, makes two small incisions and then inserts an instrument that will cut, sew or burn the fallopian tubes. Production of female hormones remains the same and menstrual cycles continue as before.

The Essure device is a permanent birth control method inserted by a doctor. Unlike tubal ligation, Essure does not need cutting into the abdomen and requires local anesthesia, meaning you are awake during the procedure but will not feel pain. Data from the pivotal trial of Essure showed 92 percent of Essure patients who were employed outside the home returned to work in one day or less after the procedure. By contrast, tubal ligation may require up to five days or more of rest. The Essure procedure typically takes 30 minutes, and women can go home 45 minutes after the doctor's work is finished.

The spring-like device works by creating scar tissue. Doctors use a thin tube to thread the device up into the vagina, into the uterus and into each fallopian tube. Flexible coils temporarily anchor it inside the tube. The mesh embedded in those coils irritates the tube's lining to cause scar tissue to grow that eventually permanently plugs the tube. But the scarring takes three months to develop. So women need to be careful and use another form of birth control during this time.

Related Articles Emergency Birth Control Methods Birth Control Male Birth Control Methods

External Sources The Food and Drug Administration. What Kind of Birth Control Is Best for You? Accessed May 24, 2007. Centers for Disease Control and Prevention. Clinical Prevention Guidance. Accessed May 24, 2007. The National Women's Health Information Center. Birth Control Methods. Accessed May 24, 2007. Association of Reproductive Health Professionals. Contraception Resource Center. Accessed May 24, 2007. Planned Parenthood. Birth Control. Accessed May 24, 2007.

This article was reviewed and updated June 2007.

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