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There are a number of methods available to help prevent pregnancy, with some of the most popular including condoms and birth control pills. Deciding which method is right can be tough because there are many issues to consider, including costs, future pregnancy plans, side effects, and others.
This article reviews all methods of birth control. More detailed discussions of hormonal, long-term, and barrier birth control methods are available separately.
Most birth control methods are quite effective if used properly. However, contraceptives can fail for a number of reasons, including incorrect use and failure of the medication, device, or method itself.
Certain birth control methods, such as intrauterine devices (IUDs) and the implant have the lowest risk of failure (pregnancy). This is because they are the easiest to use properly. You should consider these methods if you want the lowest chance of a mistake or failure, which could lead to pregnancy.
Overall, birth control methods that are designed for use at or near the time of sex (eg, the condom, diaphragm) are generally less effective than other birth control methods (eg, IUD, birth control pill).
If you forget to use birth control or if your method fails, there is an option to reduce your risk of becoming pregnant for up to five days after you have sex. This is called the morning after pill, or emergency contraception.
It can be difficult to decide which birth control method is best because of the wide variety of options available. The best method is one that you will use consistently, is acceptable to you and your partner, and does not cause bothersome side effects. Other factors to consider include:
No method of birth control is perfect. You must balance the advantages and disadvantages of each method and then choose the method that you will be able to use consistently and correctly.
IUDs are placed by a healthcare provider through the vagina and cervix, into the uterus. The currently available IUDs are safe and effective. These devices include:
A single-rod progestin implant, Implanon, is available in South Africa. It is inserted by a healthcare provider into your arm. It prevents pregnancy for at least 3 years as the hormone is slowly absorbed into the body. It is effective within 24 hours of insertion. Irregular bleeding is the most bothersome side effect. Most women can become pregnant quickly after the rod is removed. (See Hormonal methods of birth control .)
There are two injectable methods of birth control currently available in South Africa – medroxyprogesterone acetate or DMPA (Depo-Provera), also known as “the 3-month injection”; and Nur Isterate – “the 2-month injection”. These are progestin hormones, which are long-lasting. Both are injected deep into a muscle, such as the buttock or upper arm, once every two or three months. A version that is given under the skin is also available.
DMPA is very effective, when used consistently. A full discussion is available separately. (See Hormonal methods of birth control .)
The most common side effects of DMPA are irregular or prolonged vaginal bleeding and spotting, particularly during the first three to six months. Up to 50 percent of women completely stop having menstrual periods after using DMPA for one year. Menstrual periods generally return within six months of the last DMPA injection.
Most birth control pills, also referred to as “the pill,” contain a combination of two female hormones. A full discussion of birth control pills is available separately. (See Hormonal methods of birth control.)
When taken properly, birth control pills are very effective. In general, if you miss one pill, you should take it as soon as possible, If you miss two or more pills, continue to take one pill per day and use a back-up method of birth control (eg, a condom) for seven days. If you miss two or more pills, you should also consider taking the morning after (emergency contraception) pill. (See Emergency contraception (morning after pill) .)
Side effects of the pill include:
Unlike traditional birth control pills, the progestin-only pill, also called the mini pill, does not contain estrogen. It does contain progestin, a hormone that is similar to the female hormone, progesterone. This type of pill is useful for women who cannot or should not take estrogen.
Progestin-only pills are as effective as combination pills if they are taken at the same time every day. However, the progestin-only pill becomes less effective if you are more than three hours late in taking it, in which case, emergency contraceptives may be considered.
Birth control skin patches contain two hormones, estrogen and progestin, similar to birth control pills. The patch is as effective as birth control pills, and may be preferred by some women because you do not have to take it every day.
Evra is the only skin patch birth control available in South Africa. You wear the patch for one week on the upper arm, shoulder, upper back, or hip. After one week, you remove the old patch and apply a new patch; you repeat this for three weeks. During the fourth week, you do not wear a patch and your menstrual period occurs during this week.
The risks and side effects of the patch are similar to those of a birth control pill, although there may be a slightly higher risk of developing a blood clot.
A flexible plastic vaginal ring (Nuvaring) contains estrogen and a progestin. You wear the ring in the vagina, where there hormones are slowly absorbed into the body. This prevents pregnancy, similar to a birth control pill. You wear the ring inside the vagina for three weeks, followed by one week when you do not wear the ring; your menstrual period occurs during the fourth week.
The ring is not noticeable, and it is easy for most women to insert and remove. You may take the ring out of the vagina for up to three hours if desired, such as during intercourse. Risks and side effects of the vaginal ring are similar to those of birth control pills.
Barrier contraceptives, like condoms, prevent sperm from entering the uterus. A full discussion of barrier methods of birth control is available separately. (See Barrier methods of birth control .)
The male condom is a thin, flexible sheath placed over the penis. To be effective, men who use condoms must carefully follow instructions for their use. Condoms are most effective when used with a vaginal spermicide (see ‘Spermicide’ below). Using the male condom and a vaginal spermicide is as effective as a hormonal method of birth control, and is more effective than a condom alone.
Many people who choose another method of birth control (eg, pills) also use condoms to decrease their risk of getting sexually transmitted diseases.
The female condom is worn by a woman to prevent semen from entering the vagina. It is a sheath made of polyurethane, and is prelubricated. You wear it inside the vagina.
Spermicides are chemical substances that destroy sperm. They are available in most pharmacies without a prescription. Spermicides are available in a variety of forms including gel, foam, cream, film, suppository, and tablet.
Sterilization is a procedure that permanently prevents you from becoming pregnant or having children. Tubal ligation (for women) and vasectomy (for men) are the two most common sterilization procedures. Sterilization is permanent, and should only be considered after you discuss all available options with a healthcare provider. (See Permanent sterilization procedures for women and Vasectomy.)
Tubal ligation is a sterilization procedure for women that surgically cuts, blocks, or seals the fallopian tubes to prevent pregnancy. The procedure is usually done in an operating room as a day surgery. Women who have recently delivered a baby can undergo tubal ligation before going home. The procedure may be done at another time as well. A separate article discusses tubal ligation. (See Permanent sterilization procedures for women.)
Essure is a permanent birth control method in which tiny coils are placed into a woman’s fallopian tubes. The tissue within the fallopian tubes grows into the coil, blocking them three months after placement in most women. The procedure can be performed in the doctor’s office under local anaesthesia (medicine is injected into the cervix to prevent pain). A back up method of birth control (eg, pills, condoms) is needed until you have a test confirming that the fallopian tubes are completed blocked; this is usually performed three months after coil placement.
Vasectomy is a sterilization procedure for men that cuts or blocks the vas deferens, the tubes that carry sperm from the testes. It is a safe, highly effective procedure that can be performed in a doctor’s office under local anaesthesia. Following vasectomy, you must use another method of birth control (eg, condoms) for approximately three months, until testing confirms that no sperm are present in the semen. A separate article discusses vasectomy. (See Vasectomy.)
Some women and their partners cannot or choose not to use the birth control methods mentioned above due to religious or cultural reasons. Fertility-awareness based methods for preventing pregnancy are based upon the physiological changes during the menstrual cycle. These methods, also called “natural family planning,” involve identifying the fertile days of the menstrual cycle using a combination of cycle length and physical manifestations of ovulation (change in cervical secretions, basal body temperature) and then avoiding sexual intercourse or using barrier methods on those days.
Emergency contraception refers to the use of medication after unprotected intercourse to prevent pregnancy. Types of emergency contraception include the intrauterine device (IUD) or pills. You can use emergency contraception if you forget to take your birth control pill, if a condom breaks during sex, or if you have unprotected sex for other reasons (including victims of sexual assault). An IUD can be inserted for use as emergency contraception, and is much more effective at preventing a pregnancy than pills. It is the best choice for emergency contraception and you can continue to use it as your ongoing method of birth control. The other options are morning after pills. Detailed information on emergency contraception is available separately. (See Emergency contraception (morning after pill).)
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