Common Birth Control and Contraceptive Options

The pill is the common name for oral contraception. It's one of the safest, most effective, and popular methods of birth control. The pill is made up of synthetic forms of the hormones progestin and estrogen. One of the ways the pill works is by stopping the action of the hormones that trigger ovulation. The pill comes in two forms: combination pills and progestin-only pills. The pill must be taken daily to sustain the hormone levels needed to prevent ovulation.

The Depo Provera shot, also known as DMPA, is an injectable form of progestin (medroxyprogesterone acetate), so it is considered to be a progestin-only method (there is no estrogen). The shot must be given every 3 months (12 weeks) and will only provide optimal pregnancy protection for that amount of time. There are two versions available — the Depo Provera shot and the Depo-subQ Provera injection. The Depo-subQ Provera 104 injection is also FDA approved for the treatment of endometriosis-related pain.

The ring is a small, flexible circle about 2 inches in diameter. You insert it into your vagina once a month and leave it in place for 3 weeks. Then, you take it out for the remaining week. The ring secretes synthetic estrogen and progestin to protect against pregnancy for one month. It works like other combination hormonal methods. This method may be more prone to error than some of the other prescription options (due to misuse, misplacement, and not staying where it should).

The Ortho Evra Patch is a thin, beige, plastic patch and is stuck to the skin of the stomach, buttocks, upper outer arm, shoulder, or upper torso once a week, for 3 weeks in a row. It works best when it is changed on the same day of the week for the 3 weeks, and it is not applied during the fourth week. The patch releases synthetic estrogen and progestin that provides weekly protection against pregnancy. This method may also be subject to more user error especially if the patch becomes loose or falls off or if it is not replaced each week.

The diaphragm is latex or silicone, dome-shaped cup with a flexible rim and does not contain any hormones. It is inserted securely in the vagina and becomes a barrier which covers the cervix. Before insertion, the diaphragm and its ring should be covered with spermicidal jelly or cream. It is put in place before intercourse and needs to be left there for 6 to 8 hours after ejaculation. Additional spermicide must be applied before another act of intercourse. A doctor must measure the woman's vagina to determine the correct type and size of diaphragm. The diaphragm blocks the opening to the uterus while the spermicide hinders the sperm's movement.

An IUD is a small, plastic device shaped like a T. The ParaGard (Copper T 380A) is the only non-hormonal IUD available in the US. This IUD has copper (which acts as a spermicide) coiled around it. The IUD irritates the lining of the uterus, which makes it harder for implantation. It also serves as an irritant, so white blood cells migrate to the inflamed uterus and can help to destroy sperm. The IUD is inserted into the uterus by a doctor and has 2 filament strings which hang down into the vagina. A woman can feel the strings to make sure the IUD is still in place. ParaGard can be left in place for up to 10 years.​

The Mirena IUD is a small, T-shaped flexible piece of plastic. It continuously releases a small amount of progestin. Due to the progestin, it is a little more effective than the ParaGard. Besides changing the lining of the uterus, Mirena also thickens cervical mucus (serving as a barrier to sperm), and in some cases, it may suppress ovulation. The Mirena is inserted into the uterus by a doctor and has strings which hang down through the cervix into the vagina. The strings can allow for the woman to check that the IUD is still in place and for the doctor to use to remove the IUD. Mirena is effective for 5 years. Mirena is also the only FDA-approved contraceptive to treat heavy menstrual bleeding.

Kyleena and Liletta are the newest IUDs available. Kyleena contains 19.5 mg of the progestin levonorgestrel and offers pregnancy protection for up to five years. Each day, about 14 mcg of this hormone is released. This rate gradually decreases to 5 mcg per day after three years. Liletta contains 52 mg of levonogestrel and is approved for up to six years.

Nexplanon is the next generation of Implanon. This progestin-only contraceptive implant is made of soft, medical polymer. Insertion into the skin of the upper arm requires a local anesthetic and only takes a few minutes. Nexplanon is radiopaque, so this means that the implant can be seen in an x-ray. It also has a preloaded applicator made to lower the chances of insertion errors. Nexplanon is good for three years of protection and can be removed at any time during that three-year time frame. If properly inserted, Nexplanon boasts an impressive 99.9 percent effectiveness rate making it one of the most effective long-acting, reversible methods of contraception.

A Cervical Cap (like FemCap) is a silicone or latex cup. It is similar to a diaphragm but is made to fit onto the cervix. Unlike a diaphragm, the cervical cap can be left in place for up to 24 hours without additional spermicide. It still uses spermicidal cream/jelly but in lower amounts. It needs to be left in place for 6-8 hours after ejaculation and has to be fitted by a doctor. This device blocks the opening to the cervix while the spermicide impedes the sperm's movement. The Lea's Shield (a similar device) is also a silicone cup but has an air valve and a loop to aid in removal.