Contraception makes it possible to prevent pregnancy and to plan the time of pregnancy. Some methods can also protect against infections. Modern contraceptive methods include oral contraceptives (such as birth control pills), vaginal contraceptive rings, condoms, intrauterine devices (also called IUDs), injectable and implantable products, and sterilization.

Long-acting reversible contraception

Intrauterine methods

An intrauterine device (IUD), also known as an intrauterine system (IUS), is a small, T-shaped device that is inserted into the uterus to prevent pregnancy. A healthcare provider places the device. An IUD can stay in place and function effectively for years. After the recommended length of time, or when the woman no longer needs or wants contraception, a healthcare professional will remove or replace the device.

• A hormonal IUD or IUS releases a progestin hormone (levonorgestrel) into the uterus. ³ The released hormone causes thickening of the cervical mucus, prevents sperm from reaching or fertilizing the egg, thins the uterine lining and may prevent the ovaries from releasing eggs. The failure rate of a hormonal IUS is less than 1%; however, in a small percentage of women, the device can be turned off and must be reinserted. ³ Some research also suggests that these IUDs maintain their effectiveness for up to a year after their recommended period of use. ⁴ This method can also be used to treat heavy menstrual bleeding, as the hormone often reduces or eliminates uterine bleeding.
• A copper IUD prevents sperm from reaching and fertilizing the egg, and it can prevent the egg from attaching itself in the uterus. ³ If fertilization of the egg does occur, the physical presence of the device prevents the fertilized egg from nesting in the endometrium. The rate of failure and expulsion / reinsertion of a copper IUD is comparable to that of a hormonal IUD. ³ Copper IUDs can remain in the body for 10 years. ³ A copper IUD is not recommended for women who may be pregnant, have pelvic infections, or have had uterine perforations during previous IUD insertions. It is also not recommended for women with cervical or uterine cancer, unexplained vaginal bleeding, or pelvic tuberculosis. Currently, ParaGard® is the only FDA-approved copper IUD.

Implants

Implants are implantable rods. Each rod is matchstick size, flexible and plastic. The method has a failure rate of less than 1%. ³ A doctor surgically inserts the swab under the skin of the woman's upper arm.

The rod releases a progestogen and can remain implanted for up to 5 years. Currently Implanon and Nexplanon ^{® ®,} which release etonogestrel, the only implantable rods which are available in the United States. A method using two rods, Jadelle ^®, which releases levonorgestrel, is approved by the FDA but is currently not distributed in America. A new method of delivering levonorgestrel with two rods, Sino-implant (II) ^® , is in clinical development.

Hormonal methods

Short-acting hormonal methods

Hormonal methods of birth control use hormones to regulate or stop ovulation and prevent pregnancy. Ovulation is the biological process by which the ovary releases an egg, making it available for fertilization. Hormones can be introduced into the body through a variety of methods, including pills, injections, skin patches, transdermal gels, vaginal rings, intrauterine systems and implantable rods. Depending on the types of hormones used, these methods can prevent ovulation; thicker cervical mucus, which helps prevent sperm from reaching the egg; or thin the lining of the uterus. Healthcare providers prescribe and monitor hormonal contraceptives.

Short acting hormonal methods (eg Injectables, pills, patches, rings) are very effective when used perfectly, but with normal use they have a range of failure rates.

• Injectable birth control. In this method, a progestogen, Depo-Provera® (depot medroxyprogesterone acetate [DMPA]), injected into the arm or buttocks every 3 months. ⁵ This method of contraception can cause temporary loss of bone density, especially in adolescents. However, this bone loss is generally restored upon discontinuation of DMPA. Most patients using injectable birth control should be on a diet rich in calcium and vitamin D or take vitamin supplements while taking this drug. A new self-injectable formulation of DMPA, Sayana® Press, has been approved in the UK and is expected to be more widely approved in the near future. This subcutaneous injectable product has a lower amount of hormone and may be more acceptable to some users.
• Progestogen-only pills (POPs). A woman takes one pill every day, preferably at the same time every day. POPs can interfere with ovulation or sperm function. POPs thicken the cervical mucus, making it difficult for sperm to swim into the uterus or enter the fallopian tube. POPs alter the normal cyclic changes in the endometrium and can result in unplanned or breakthrough bleeding. These hormones do not appear to be associated with an increased risk of blood clots.

Combined hormonal methods

Combined hormonal methods contain a synthetic estrogen (ethinyl estradiol) and one of many progestins approved in the United States. All products work by inhibiting ovulation and thickening of cervical mucus. The combined estrogen / progestin drugs can be delivered by pills, a patch, or a vaginal ring. The combined hormonal methods have some medical risks, such as blood clots, related to the synthetic estrogen in the product. These risks have not been observed with progestogen-only hormonal methods such as injectable contraception, POPs or hormonal LARCs. Your healthcare provider can discuss your risk factors and help you choose the most appropriate birth control method for you.

• Combined oral contraceptives (COCs, "the pill"). COCs contain a synthetic estrogen and a progestogen, which inhibit ovulation. A woman takes one pill every day, preferably at the same time every day. Many types of oral contraceptives are available, and a health care provider will help determine which type is best for a woman's needs.
• Contraceptive patch. This is a thin, plastic patch that sticks to the skin and releases hormones into the bloodstream through the skin. The patch is placed on the lower abdomen, buttocks, outer arm or upper body. A new patch is applied once a week for 3 weeks and no patch is used for the fourth week to allow menstruation. ³ Currently, Ortho Evra® is the only patch approved by the FDA.
• Vaginal ring. The ring is thin, flexible and about 5 cm in diameter. It provides a combination of ethinyl estradiol and a progestin. The ring is inserted into the vagina, where it releases hormones continuously for 3 weeks. The woman removes it for the fourth week and inserts a new ring 7 days later. The risks of this method of contraception are similar to those of combined oral contraceptive pills. A vaginal ring may not be recommended for women with certain health conditions, including high blood pressure, heart disease, or certain types of cancer. ⁶ Currently, the NuvaRing® is the only FDA-approved vaginal ring. A new contraceptive vaginal ring that can be used for 13 cycles is in clinical development.

Barrier methods

Designed to prevent sperm from entering the uterus, barrier methods are removable and may be an option for women who cannot use hormonal methods of contraception. Failure rates for barrier methods differ depending on the method. ⁷

Types of barrier methods that do not require a health care professional visit include:

• Condoms for men. This condom is a thin shell that covers the penis to collect semen and prevent it from entering the woman's body. Male condoms are usually made of latex or polyurethane, but a natural alternative is lambskin (made
  
  
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