Contraception: Pros and Cons of Different Contraceptive Methods

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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