What are the available methods of contraception (birth control)?

From the Guidelines

Birth control methods should prioritize long-acting reversible contraceptives, such as hormonal IUDs, which are over 99% effective and last 3-7 years, as they provide the best outcomes in terms of morbidity, mortality, and quality of life. The most effective methods are long-acting reversible contraceptives like hormonal IUDs (Mirena, Kyleena, Skyla) and the copper IUD (Paragard) which lasts up to 10 years 1. Hormonal methods include the pill (taken daily, containing estrogen and progestin or progestin-only), the patch (Xulane, changed weekly), the vaginal ring (NuvaRing, inserted for 3 weeks), and the injection (Depo-Provera, given every 3 months) 1. Barrier methods include male condoms, female condoms, diaphragms, and cervical caps, which physically block sperm. Emergency contraception like Plan B One-Step can be taken within 72 hours after unprotected sex. Permanent methods include tubal ligation for women and vasectomy for men. Natural family planning involves tracking fertility cycles to avoid intercourse during fertile periods. Some key points to consider when choosing a birth control method include:

• The effectiveness of the method in preventing pregnancy
• The potential side effects and risks associated with the method
• The individual's health factors, lifestyle, and pregnancy prevention goals
• The need for backup contraception when initiating or switching methods 1
• The potential interactions with other medications, such as antiretroviral agents 1 It is essential to discuss contraception and pregnancy planning with women of reproductive age and counsel them regarding efficacy and safety 1. The best method depends on individual health factors, lifestyle, and pregnancy prevention goals. Most hormonal methods work by preventing ovulation and thickening cervical mucus to block sperm, while barrier methods physically prevent sperm from reaching an egg.

From the Research

Types of Birth Control Methods

• Oral contraceptive pills are the most commonly used reversible method of contraception, comprising 21.9% of all contraception in current use 2
• Long-acting methods, such as intrauterine devices and subdermal implants, have failure rates of less than 1% per year and are increasingly popular, with usage rising from 6% in 2008 to 17.8% in 2016 2
• Estrogen-containing methods, such as combined oral contraceptive pills, increase the risk of venous thrombosis, whereas progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks 2

Effectiveness and Risks of Birth Control Methods

• The effectiveness of birth control methods is determined by a combination of drug or device efficacy, individual fecundability, coital frequency, and user adherence and continuation 2
• Combined oral contraceptive pills are effective if taken correctly, have a relatively low risk of venous thromboembolism, and are listed on the Pharmaceutical Benefits Scheme 3
• The use of combined oral contraception confers a number of significant non-contraceptive benefits to users, including protection against ovarian and endometrial carcinoma, and improvement in medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 2, 4, 5

Considerations for Choosing a Birth Control Method

• Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences 2
• Contraceptive decision-making should include consideration of both the risks and benefits of a given method versus the real consequences of unintended pregnancy 4
• Prescribing a pill with the lowest effective dose of oestrogen and progestogen, such as pills containing levonorgestrel or norethisterone in combination with ethinyloestradiol 35 microgram or less, is considered first-line 3