The SEAM Guide to Contraception: A Comprehensive List of Your Options and Everything You Need to Know
In the United States, 99 percent of women who have been sexually active report having used some form of contraception at some point in their lives. As a result, birth control is championed as a groundbreaking innovation that provides women with reproductive freedom to prevent pregnancy or manage period symptoms. But with the Supreme Court's recent decision to overturn Roe vs. Wade, the landscape for reproductive liberties has shifted.
If you are hoping to delay pregnancy for a few more years or avoid it altogether, it's vital to understand your choices to find the best contraceptive method for your needs. So, here is a complete guide to safe and effective contraceptive methods with and without hormones.
What is Contraception?
When used consistently and correctly, contraception prevents unwanted pregnancy and gives you control over your fertility. There are many different types; some work better than others at preventing pregnancy. The best contraception method for you is the one that complements your lifestyle. Generally, birth control poses few severe health risks, but each method has pros and cons.
Hormonal birth control prevents your ovaries from releasing eggs or thickens your cervical mucus so sperm can't get through. Non-hormonal methods don't affect your hormones but prevent pregnancy by creating physical barriers or hostile environments so the fertilized egg can't implant into the lining of your uterus.
Hormonal contraceptive options
Hormonal contraceptives mimic the naturally-occurring hormones produced in your body. Prescribed by a healthcare provider, there are several methods available:
Hormonal Intrauterine Device (IUD): This T-shaped device is placed inside your uterus and releases a small amount of progestin daily to prevent pregnancy. The hormonal IUD can remain in place for 3 to 6 years, depending on the device chosen. Once you decide you're ready to start your family, you can have your IUD removed, and you should be able to return to your regular cycle.
You may experience spotting and irregular bleeding during the first 3 to 6 months while using a hormonal IUD. For some, the IUD stops their period altogether. You may also experience headaches, nausea, depression, and breast tenderness.
Implant: The birth control implant is a thin, flexible progestin-based rod inserted under the skin of your upper arm by your healthcare provider. The implant can remain in place for over three years. You may experience lighter, heavier, extended periods or bleeding between periods with the implant.
Depo Provera: "The shot" contains the hormone progestin. Depo is given as an injection every twelve weeks. You must continue seeing your healthcare provider to receive your medicine. Most women on Depo will have changes to their period, like more bleeding, spotting between periods, or not having a period at all. Other possible side effects include nausea, weight gain, headaches, and sore breasts.
Combined oral contraceptives: The "pill" contains both estrogen and progestin hormones. You take one pill at the same time each day. Combined hormonal pills come in a 21–day pill pack or as a 23, 24, or 28–day pill pack.
Progestin-only birth control pills: Unlike combined pills, the "mini-pill" only contains the progestin hormone. You take one pill at the same time each day for maximum effectiveness. If you miss taking your medicine by more than 3 hours, use a backup method like a condom for the next 48 hours to help prevent pregnancy.
Transdermal Patch: This adhesive patch contains progestin and estrogen and is worn on your lower abdomen, buttock, arm, or upper body. You wear one patch for one week at a time for a total of 3 weeks. Skip wearing a patch during the fourth week, and you will have your period. At the end of week 4, put on a new patch and repeat the cycle. Place your patch on the same day of the week, even if you still are bleeding.
Hormonal vaginal contraceptive ring: The ring is inserted inside your vagina and releases progestin and estrogen hormones. The ring is worn for three weeks and taken out on the fourth week to start your period. You will then insert a new ring once your period is over.
Side Effects of Combined Hormonal Contraceptive
After starting combined hormonal contraceptive methods like the "pill," patch, and ring, you may experience side effects like headaches, nausea, sore breasts, spotting, or changes to your period- like it coming earlier, later, or stopping altogether. However, these symptoms are usually minor and go away after a few months.
Combined hormonal contraceptives are generally safe but are associated with a small increased risk of blood clots, heart attack, and stroke if you have risk factors like high cholesterol, high blood pressure, diabetes, or migraine headaches with aura. Or if you are over 35 and smoke more than 15 cigarettes daily.
Plan B Emergency Contraception: Emergency contraception helps prevent pregnancy after unprotected sex or if your birth control method fails. Emergency contraception isn't meant to be used as a routine birth control option.
Emergency contraceptive pills (Plan B, Ella, or the generic versions) are more effective the sooner you take them but can be used up to five days after unprotected sex. Some emergency contraceptive pills (Plan B) are available over the counter without a prescription. The copper IUD (ParaGard) can also be used as an emergency contraceptive if inserted within five days after unprotected sex or birth control failure.
Non-hormonal Contraceptive Options
Many hormone-free birth control choices are available if you can't take hormonals or simply prefer non-hormonal methods. Here are the hormone-free options you should consider.
Tubal sterilization: Having your "tubes tied" is a permanent form of birth control. Your healthcare provider will block or cut your fallopian tubes during the procedure. This prevents your eggs from traveling down the fallopian tube and keeps sperm from reaching your egg. This method of birth control is highly effective as fewer than 1 in 100 women get pregnant within one year of surgery.
This contraceptive method is permanent, so be sure you no longer want to get pregnant again since there is no guarantee that attempts to reverse the procedure will work.
Copper IUD: The copper IUD (Paragard) is the most effective hormone-free contraception. The IUD is inserted into your uterus. This "T" shaped device can remain in place for up to 10 years or until you are ready to start your family. Once you decide you're ready to become pregnant, you can have the IUD removed, and your regular cycle should return. During the first few months with your IUD, you may experience side effects like cramps, bleeding, or bleeding between periods. However, these symptoms usually go away within the first year of use.
Condoms: Condoms are available with or without spermicide and are worn internally (in the vagina) or externally (over the penis). The external condom is a thin sheath made from polyurethane (plastic), latex (rubber), or natural (animal) membrane. The internal condom (a thin plastic pouch) lines the vagina. It is held in place by a closed inner ring near the cervix and an outer ring at the opening of the vagina.
Condoms are the only contraceptive method to protect you against sexually transmitted infections, including HIV. Using a condom and an effective form of birth control, like the IUD, implant, or Depo shot, provides dual protection against infections and pregnancy.
Diaphragm, Cervical Cap, Sponge
Diaphragm: This reusable rounded cup fits inside your vagina and covers your cervix. The diaphragm is made of latex or silicone. Diaphragms are available in different sizes that your healthcare provider must fit. A newer diaphragm on the market (Caya) is one-size-fits-all. All diaphragms must be used with spermicide and left in place for 6 hours after sex but no more than 24 hours total.
The cervical cap: This small, bendable rubber cap fits tightly over the cervix to prevent the sperm from entering your uterus. The cervical cap is prescribed and fitted by a healthcare professional. Like the diaphragm, the cervical cap must be used with a spermicide and left in place for 6 hours after sex, but no more than 48 hours total.
After pregnancy, weight loss, weight gain, or vaginal birth, your cervical cap may fit differently, so follow up with a provider to refit your cervical cap. Of note: the cervical cap is less effective in preventing pregnancy for women who have already given birth.
The sponge: This soft round foam contains spermicide and covers your cervix to block sperm. The sponge can be placed up to 24 hours before sex and should be left in place for at least 6 hours after sex. You should not wear the sponge for more than 30 hours total. The sponge is less effective in preventing pregnancy in women who have given birth.
Fertility awareness tracking: This method works by knowing and recognizing when you are most fertile each month so you can avoid having sex or use a barrier method, like a condom, during your fertile window to prevent pregnancy.
There are a few different ways to track your fertility signs. You can use one or more of these methods to help you predict when you will ovulate:
· Temperature method: Take your temperature first thing in the morning before leaving the bed. Your body's normal temperature increases slightly during ovulation and remains high until the end of your menstrual cycle.
· Cervical mucus method: By checking your vaginal discharge daily, you will recognize changes in how your cervical mucus looks and feels.
· Calendar method: By charting your menstrual cycle on a calendar, you will begin to recognize the days during your menstrual cycle when you are the most fertile and should avoid having sex or use a barrier method of birth control on these days.
On average, 12 to 24 percent of women will become pregnant using the fertility awareness method each year.
Things to consider when selecting a contraceptive method
Choosing a birth control method can be daunting. Still, it's essential to recognize the many factors that may influence your decision over your lifetime. These include:
· Your age
· Side effects
· Cost and how you will pay for it
· Your reproductive goals (the number of children you want and how soon you want to get pregnant)
You should always feel in control of your reproductive health. Setting clear goals and communicating openly and honestly with your provider will help you to become more confident in your choice.
Low-Cost Birth Control
It's no secret that birth control can be costly, but there are strategies you can use to help you save money. If you have health insurance, often, your plan will offer many options. But be sure to check with your insurance provider to find out which methods they cover and if there are any out-of-pocket expenses.
Medicaid insurance often covers the cost of birth control prescriptions and office visits. But because programs vary between states, it's best to check with your state's Medicaid program to check your benefits.
If you are underinsured or uninsured, don't panic. Family planning clinics, local health departments, or online retailers are available in some states. They can provide some birth control methods for free or at a low cost. You can call your local clinic or use a clinic finder tool to learn more.
Contraceptive Choices
There is a lot to consider when choosing a contraceptive method. But by knowing your options, chances are you will find one that works best for you.
Janelle King is a Registered Nurse with a Master of Public Health. She has written articles for Sisters from AARP, The Body: The HIV/AIDS Resource, Modern Fertility, among many others, and featured in Women's Day Magazine. You can find her writing about reproductive health and wellness in her blog The Nurse Note in her spare time. Follow her on Facebook and Instagram @thenursenote.