The topic of birth control continues to make headlines, such as recent news in France offering free birth control to all women up to 25 years old starting next year. Yet, the different forms of birth control continue to remain a confusing topic for many women.
Contraception is still commonly used in the U.S., with 64.9% of the 72.2 million women aged 15-49 using a form of birth control, according to the CDC. It is easy to get confused with the many birth control options out there and which is best, but it’s important for everyone to understand the different common types and to determine which is better for each person.
Intrauterine Devices (IUDs) are currently the longest-lasting reversible forms of contraception. An IUD is a small device shaped like a “T” that a provider places inside the uterus to prevent pregnancy. They can be lined with or without hormones.
For instance, the two major IUD types are the copper IUD (no hormones) and the levonorgestrel IUD, which releases a small amount of a hormone called progestin each day to prevent pregnancy. These devices can provide years of protection; the copper IUD could last up to 10 years and the levonorgestrel IUD could last up to 3-6 years.
According to the CDC, IUDs have some of the lowest failure rates against pregnancy compared to other forms of reversible contraceptives and are removed by a provider if not desired anymore or to be replaced. Contrary to a TikTok trend of women removing their own IUDs, it is not recommended to remove an IUD without a medical professional in a health care setting.
Birth control pills
Birth control pills are an easy-to-use type of contraception, but one’s medical history should be considered. Oral contraceptives, or birth control pills, are prescribed by a provider and must be taken daily for its full effects. The type of pill that is best to use depends on a person’s medical history.
For instance, the combination estrogen and progestin pill may not be recommended for someone with a history of smoking, blood clots, or breast cancer. However, the progestin-only pill may be a good option for women who can’t take estrogen. Overall, it is necessary to discuss it with a provider to determine which form of the pill better suits you.
Hormonal contraceptives can take many forms, including implants, injections and patches. Using either the hormone progestin, or a combination of progestin and estrogen, these forms of birth control are administered either as an injection, a patch on the skin, a ring in the vagina or an implant in the arm.
The implant is a very small flexible plastic rod that is placed under the skin of the upper arm by a physician and can last for about three years during which the provider can remove or replace if desired by the patient. The injections, such as the Depo-Provera shot, are done every three months. The patch and the ring is used for three weeks and removed during the fourth week to allow for menstruation, similar timeline to the pill.
Of these hormonal options, implants in the arm have the lowest failure rate, according to the CDC, but all are effective in reducing the chance of pregnancy.
Some barrier methods provide protection that can help reduce the risk of Sexually Transmitted Infections (STIs). Methods such as male and female condoms are the only types of birth control that can help prevent STIs.
STIs such as chlamydia and gonorrhea have reached an all-time high for the sixth year in a row, making these barrier methods invaluable to use in combination with other forms of contraception. Importantly, a diaphragm or cervical cap, both types of barrier methods, do not prevent STIs.
As we know, barrier methods aren’t foolproof and still carry a risk of getting an STI or becoming pregnant. However, it is recommended that condoms be used in addition to another forms of birth control to effectively protect against STIs.
“Tying tubes” and vasectomy
“Tying tubes” and vasectomy are the permanent forms of birth control. The most common contraceptive method used by women in the U.S. was female sterilization, or “tube tying,” at nearly 19%. This procedure is done by a physician in a hospital or outpatient surgical center. The method is effective immediately, and afterwards women can typically resume their normal activities within several days.
The same is the case for a vasectomy in men. After the operation, the man follows up with a provider to test his sperm count and make sure it has dropped to zero, which can take a couple of months. Both are safe, routine procedures that also have very high success rates at preventing pregnancies.
Weighing the options
With a plethora of birth control options, the key is to discuss the ideal options with a provider to determine which is most practical and safe for you. Considering medical history and preference are all important factors in determining which option is best for you.
Alexis E. Carrington MD will be a dermatology resident at George Washington University Department of Dermatology. She completed her Internal Medicine Preliminary year at Mount Sinai Icahn School of Medicine Elmhurst Hospital Program in New York City, during the initial onset of the COVID-19 pandemic. She has interests in ethnic and medical dermatology, underserved and global health dermatology, and dermatologic surgery.