Which birth control option is best for you?


September 2020

By: Brenda Johnson, CNM, IBCLC
Midwifery Care
Amery Hospital & Clinic

As a certified nurse midwife with 30+ years of experience, I’ve helped educate many women about how their bodies work. In my role – and one of the most enjoyable parts of my work – I discuss with women and with couples their plans for childbearing. These discussions often involve birth control and which option is best for them at the time.

Birth Control Usage and Options

Almost all women in the United States use birth control at some point during their childbearing years. After all, it’s one of the easiest ways to take control of when and if to have children, and there are so many options available that meet women’s varying lifestyles. With so many possibilities, where do you start? What should you keep in mind? What questions should you ask your clinician?

Types of birth control

Generally, there are six categories of birth control methods. Each method works in a different way, like preventing sperm from getting to an egg or discouraging your body from releasing eggs. But every contraceptive technique has the same primary goal: helping avoid an unwanted pregnancy.

One thing to note before we dive in is that birth control and sexually transmitted infection (STI) prevention aren’t the same. Only condoms can protect against STIs when used correctly, so if contracting an STI is a concern, you’ll want to use condoms in combination with another birth control method.

1. Short-acting hormonal contraception

Hormonal birth control involves adjusting your body’s natural estrogen and/or progestin levels to make pregnancy much less likely. Common methods include pills you take every day, a patch you replace every week, a vaginal ring you change every month or a shot your doctor gives you every three months. All of these methods require a prescription. For most women, with typical use they’re about 91 percent to 95 percent effective at preventing pregnancy. With perfect use, these methods are more than 99 percent effective in preventing pregnancy.

Hormonal birth control side effects can vary, especially when you’re just starting out. But one beneficial side effect that many women notice is a decrease in period flow, frequency or pain. If your menstrual cycle gives you trouble, a hormonal birth control option is definitely worth exploring.

2. Long-term contraception

Long-term contraception can be a good choice if you want effective, lasting birth control without much maintenance. Choices include an implant inserted into your arm or an intrauterine device (IUD) inserted into your uterus. These methods are more than 99 percent effective at preventing pregnancy. They’ll work for 3 to 10 years, depending on the particular method you choose. The implant (Nexplanon) and hormonal IUx (Skyla, Mirena, Kyleena) work by adjusting your body’s progestin levels over time. The copper IUD (ParaGard) does not use hormones. Instead, the copper stops sperm from fertilizing your eggs mainly as a foreign body and is toxic to sperm.

Implants or IUDs can be great options because they don’t require any extra work on your part: Once your clinician puts in the device, you’re covered. But if your plans change and you’d like to have kids, it’s easy to get your implant or IUD removed. You may experience a little discomfort when your device is put in place, and some people can experience a few temporary or (less commonly) ongoing side effects such as weight gain, headaches and soreness. But many women find the benefits of low-maintenance, long-term birth control to be well worth it.

3. One-time barrier contraception

Condoms (male and female varieties), sponges, diaphragms, cervical caps and spermicide are all barrier birth control methods. They each work differently, but they all create a sperm “barrier” during sex to prevent sperm from reaching an egg. Barrier contraception methods don’t require a prescription and are available at many stores or online. Additionally, condoms help protect against STIs, the only birth control method to do so.

You only use barrier contraception when you’re actually having sex. You need to use it every time you have sex and also need to use barrier contraception correctly for it to be most effective. Because of this, barrier contraceptive techniques don’t usually work as well. They prevent pregnancy between 71 percent and 88 percent of the time, depending on the method. But you can also combine methods for greater effectiveness. For example, it’s recommended that you also use spermicide if you’re using a diaphragm or cervical cap. Talk to your clinician for specifics.

4. Permanent contraception

Tubal ligation (for women) or vasectomy (for men) are relatively simple surgical procedures intended to make pregnancy impossible. They’re almost 100 percent effective at preventing pregnancy. If you’re very sure you don’t want to have children in the future, they’re a great option to consider.

Recovery time from these procedures usually takes only a few days. Your (and your partner’s) sexual function won’t be impacted, and if you choose tubal ligation, you’ll still get your period. Essentially, nothing will change in your day-to-day life, except that you won’t be able to get pregnant. This makes permanent contraception one of the most convenient birth control options, but only if you’re confident you don’t want kids going forward. Reversing a tubal ligation or vasectomy is possible, but there isn’t any guarantee your fertility will return.

5. Emergency contraception

If you have sex without using birth control – or your birth control fails – emergency contraception can help prevent pregnancy. If you need emergency birth control, there are two types of pills available as well as a copper IUD. No matter which method you prefer, you’ll want to use emergency contraception as soon as possible for it to be most effective.

One type of pill, often called “Plan B,” is available from most pharmacies without a prescription; it can prevent pregnancy up to three days after sex. The more effective pill, often called “Ella,” does need a prescription but can prevent pregnancy up to five days after sex. Copper IUDs also require you to see a clinician, but they’re almost 100 percent effective when inserted within five days of intercourse.

Emergency contraception isn’t meant to be your primary birth control method – only a backup in case something doesn’t go as planned. You’ll have more control if you regularly use other methods first.

6. Fertility Awareness Methods

These methods involve learning the ways in which women’s bodies let us know when we may or may not be fertile. In each woman’s cycle, there are 5 to7 days leading up to ovulation (releasing an egg) when conditions are right in the vagina and uterus for sperm to be able to live longer. The conditions provide sort of a road map for the sperm to find their way into the uterus, then into the tubes where the egg is after ovulation.

For these methods to work well, it’s extremely important to be educated about timing of ovulation and signs of fertility. There may be a combination of signs that include checking a basal body temperature (BBT) daily, tracking all periods (calendar method) and monitoring for changes in vaginal discharge/cervical mucus. With perfect use, these methods are 95-99 percent effective; however, the importance of receiving accurate information on the use of each method is critical. The typical use effectiveness of these methods is 76-88 percent.

So what’s the best form of birth control?

It all depends on you. For starters, you’ll want to consider what your goals are, what your lifestyle is like, how often you have sex, whether you have insurance, what you and your partner are comfortable with and what you’re planning for the future.

Because every woman is different, the contraception that works best for your friends or family members may or may not be convenient or most effective for you. But regardless of the birth control method you end up choosing, use it as directed for the lowest chance of pregnancy.

Of course, you’ll want to talk to a clinician – an OB GYN, nurse-midwife, nurse-practitioner, family practice doctor or physician’s assistant – to get personalized birth control advice. They can give you more details about each option, and they’ll help you make a choice (or choices) you’ll feel great about. If you don’t have a clinician, call Amery Hospital & Clinic at 715-268-8000 and we’ll help.

Taking time to make sure you’ve selected the best birth control option for you can give you more power over your choices. And that’s well worth it for your health, your well-being, your peace of mind and your future.

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