Contraception: Pros and Cons of Different Contraceptive Methods

Here’s a list of the many available types of contraception, and the pros and cons of using each.

Hormonal Implants
Success Rate with Typical Use: 99%
Pros	Cons
Long-term method of birth control (protects against pregnancy for 3 years after insertion–it can be removed by a health care provider when you want to, or you can wait for 3 years when it’s time for a change of implant) Very effective against pregnancy May cause light or no menstrual periods	Doesn’t protect against STIs Requires minor surgery and insertion of the tiny rod(s) underneath the skin Requires minor surgery to remove device Can cause side effects such as irregular menstrual periods, depression, nervousness, hair loss, and weight gain Could get infection at area where rod is implanted

Intra-Uterine Device: Two types- LNG-IUS (Levonorgestrel hormone-releasing intrauterine system) and Copper IUD (no hormones)
Success Rate with Typical Use: 99%
Pros	Cons
Very effective against pregnancy Provide protection against pregnancy when in place in your uterus- protects as soon as inserted (so don’t need to remember to use contraception if you have sexual intercourse) Doesn’t need daily attention Comfortable- you and your partner cannot feel the IUD, although you partner may feel the string The levonorgestrel IUD (Mirena®, Skyla®, Lilleta®, Kyleena™) lessens menstrual flow and can be used to treat heavy periods	Both types do not protect against STIs. Other methods should be considered if high risk for STIs. Needs to be inserted by a health care provider. Slightly higher risk of infection in the first 20 days after insertion Cannot be placed in patients with known uterine anomalies Can fall out or can rarely puncture the uterus Slightly higher risk for infection in the first 20 days after insertion The Copper IUD can have side effects such as menstrual cramping, longer and/or heavier menstrual periods, and spotting between menstrual periods.

Depo-Provera Hormonal Injection
Success Rate with Typical Use: 96%
Pros	Cons
Each injection provides 3 months of protection against pregnancy Very effective against pregnancy if used correctly Many women stop getting their menstrual period while getting injections. (This is not a medical problem and menstrual periods usually return 6-18 months after you stop taking injections) Helps protect against uterine cancer Doesn’t interrupt sexual activity	Doesn’t protect against STIs Need to see your health care provider every 3 months for an injection Depending on your insurance, your birth control may be free or there may be a co-pay May have side effects such as weight gain, tiredness, and possibly a decrease in bone density Many women have very irregular menstrual bleeding or spotting for the first 3 to 6 months and sometimes longer

Birth Control Pills
Success Rate with Typical Use: 93%
Pros	Cons
Very effective against pregnancy if used correctly Makes menstrual periods more regular and lighter Decreases menstrual cramps and acne Makes you less likely to get ovarian and uterine cancer, pelvic inflammatory disease, ovarian cysts, and anemia	Doesn’t protect against STIs Depending on your insurance, your birth control may be free or there may be a co-pay. Need to remember to take every day at the same time Can’t be used by women with certain medical problems or by women taking certain medications Can occasionally cause side effects such as nausea, increased appetite, headaches, and, very rarely, blood clots Need a prescription

Hormone Patch (Ortho-Evra) (Xulane)
Success Rate with Typical Use: 91%
Pros	Cons
Very effective against pregnancy if used correctly Makes menstrual periods more regular and lighter Decreases menstrual cramps and acne Makes you less likely to get ovarian and uterine cancer, pelvic inflammatory disease, ovarian cysts, and anemia Doesn’t interrupt sexual activity	Doesn’t protect against STIs Still need condoms to lower the risk of STIs Can’t be used by women with certain medical problems or by women taking certain medications Can occasionally cause side effects such as nausea, increased appetite, headaches, and irregular bleeding in the first few cycles Increased risk of blood clots Need a prescription

Vaginal Hormonal Ring (NuvaRing®, Annovera™)
93% (NuvaRing),-97% (Annovera™)
Pros	Cons
Very effective against pregnancy if used correctly Makes menstrual periods more regular and lighter Decreases menstrual cramps and acne Makes you less likely to get ovarian and uterine cancer, pelvic inflammatory disease, ovarian cysts, and anemia Doesn’t interrupt sexual activity	Doesn’t protect against STIs Still need condoms to lower the risk of STIs Can’t be used by women with certain medical problems or by women taking certain medications Can occasionally cause side effects such as nausea, increased appetite, headaches Increased risk of blood clots

Diaphragm
Success Rate with Typical Use: 83%
Pros	Cons
Can be put in place right before intercourse or 2-3 hours before intercourse Don’t need to take out between acts of sexual intercourse (protects against pregnancy for about 6 hours, but need to reapply spermicide)	Doesn’t protect against STIs Need to get fitted by a health care provider and need a prescription May be difficult to find Can’t take out until 6 hours after intercourse Cost $25-$45, plus the cost of spermicidal gel May get moved out of place during sexual intercourse Some women may be allergic to the diaphragm or to the spermicide Need to be re-fitted after a 10 pound weight gain or loss and after pregnancy Can be messy Need to reapply spermicide with each act of sexual intercourse Can cause an increase in urinary tract infections

Cervical Cap
Success Rate with Typical Use: 83%
Pros	Cons
Can insert several hours before sexual intercourse Can leave in place 24-48 hours, will give protected sex for up to 48 hours Use less spermicide with the cap than with the diaphragm, no need to apply more spermicide with each act of intercourse	Doesn’t protect against STIs Cost $30-$50, plus the cost of spermicidal gel Need to be fitted by a health care provider and need a prescription Limited sizes available Can’t take out until 6-8 hours after intercourse May get moved out of place Some women may be allergic to material of cap or to spermicide Can’t be used by women with a history of abnormal Pap tests Can cause increased urinary tract infections

External (Male) Condom
Success Rate with Typical Use: 87%
Pros	Cons
Lowers risk of STIs Contraception that provides the most protection against sexually transmitted infections (latex condoms are best) Don’t cost much (50 cents each), can buy at almost any drug store (don’t need a prescription) Men feel they can “last longer” when using a condom Allow men to have an active part in preventing pregnancy	Have to use a new one every time you have sexual intercourse (can only be used once) May disrupt/interrupt sexual activity as it needs to be put on just before penetration Can break Women may be allergic to latex

Internal (Female )Condom
Success Rate with Typical Use: 79%
Pros	Cons
Provide protection against STIs (new product, so not clear how much protection given) and pregnancy Can be inserted well before intercourse so less interruption of sexual activity Male does not need to withdraw right after ejaculation, as he does with a male condom	May move or be uncomfortable Can only use for one act of sexual intercourse Cost about $2.50 each

Withdrawal
Success Rate with Typical Use: 80%
Pros	Cons
Natural, so no side effects Doesn’t cost anything Allows men to be an active part of preventing pregnancy	Doesn’t protect against STIs Not very effective method of contraception Difficult for male to always predict ejaculation May decrease sexual pleasure of woman since need to always be thinking about what is happening during sexual intercourse No control by women- need to rely completely on men to prevent pregnancy

Contraceptive Sponge
Success Rate with Typical Use: 76-83%
Pros	Cons
Can insert right before or several hours before sexual intercourse and will provide protection against pregnancy for a total of 24 hours Don’t need a prescription	Doesn’t protect against STIs and may increase the risk of HIV infection in women who have sex multiple times daily because of irritation from the spermicide Can’t take out until 6 hours after sexual intercourse Can’t be used by women who are allergic to nonoxynol-9 (in the spermicides) Increases urinary tract infections

Lactational Amenorrhea Method (LAM)
Success Rate with Typical Use (only applies if you meet all conditions): 98%
Pros	Cons
Natural Costs nothing No side effects	Only effective in women who have given birth in last 6 months, who have not had a menstrual period after childbirth and are feeding their babies only breast milk Doesn’t protect against STIs Only effective until menstrual period returns May need to use a lubricant with sexual intercourse because of vaginal dryness

Fertility Awareness Based Methods
Success Rate with Typical Use: 75-86% depending on method
Pros	Cons
Natural Approved by many religions Woman gets to know her body and menstrual cycles Can be helpful for partners who are very careful and don’t have sex during ovulation period and several days before and after	Doesn’t protect against STIs Need to figure out when ovulating for each month, which may be difficult in those with irregular periods Requires a lot of work- need careful instruction and the woman needs to figure out when ovulating

Spermicide
Success Rate with Typical Use: 79%
Pros	Cons
Doesn’t cost much, available at many drug stores, don’t need a prescription	Doesn’t protect against STIs and may increase the risk of HIV infection in women who have sex multiple times daily because of irritation from the spermicide Effectiveness usually lasts only one hour (need to reapply each time have sexual intercourse) Some women and men may be allergic to spermicides May interrupt sexual activity (some forms need to be inserted at 10-20 minutes before intercourse) Has a lower effectiveness against pregnancy than many other types of contraception- should use with another form of contraception to increase effectiveness

Tubal Ligation (Female Sterilization)
Success Rate with Typical Use: 99%
Pros	Cons
Very effective against pregnancy One time decision that will provide protection against pregnancy forever	Need to have minor surgery Permanent (although it is possible to undo sterilization with major surgery, it’s not always successful) Only should be used by women who are absolutely sure that they do not want any or any more children Expensive- ranges from $1000-$2500- but cost for contraception spread over rest of life No protection against STIs

https://www.cdc.gov/reproductivehealth/contraception/index.htm#Contraceptive-Effectiveness

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