What are the available birth control options?

Available Birth Control Options

Multiple effective birth control options exist with varying effectiveness rates, side effects, and non-contraceptive benefits, with long-acting reversible contraceptives (LARCs) like IUDs and implants being the most effective methods at preventing pregnancy. 1

Contraceptive Methods by Effectiveness

Tier 1: Most Effective Methods (>99% effective)

• Long-Acting Reversible Contraceptives (LARCs)

  • Levonorgestrel IUD (Mirena): 0.1% failure rate with typical use
  • Copper IUD (Paragard): 0.8% failure rate with typical use
  • Subdermal implant (Nexplanon): 0.05% failure rate with typical use
  • Injectable (Depo-Provera): 0.3% failure rate with typical use

• Permanent Methods

  • Female sterilization: 0.5% failure rate
  • Male sterilization (vasectomy): 0.15% failure rate

Tier 2: Moderately Effective Methods (91-94% effective)

• Combined hormonal methods
  • Combined oral contraceptives (COCs): 5-9% failure rate with typical use
  • Vaginal ring: Similar failure rates to pills
  • Contraceptive patch: Similar failure rates to pills
• Progestin-only pills (POPs): 5-9% failure rate with typical use

Tier 3: Less Effective Methods (72-82% effective)

• Barrier methods
  • Male condoms: 14% failure rate with typical use
  • Female condoms: 21% failure rate with typical use
  • Diaphragm with spermicide: 20% failure rate with typical use
  • Cervical cap: 20-40% failure rate (higher in women who have given birth)
  • Contraceptive sponge: 20-40% failure rate (higher in women who have given birth)

Tier 4: Least Effective Methods

• Fertility awareness-based methods: 25% failure rate with typical use
• Withdrawal: 19% failure rate with typical use
• Spermicides alone: 26% failure rate with typical use

Special Considerations

Postpartum Contraception

Timing and method selection are important for postpartum women 1:

• Combined hormonal methods are generally not recommended within 21 days postpartum due to increased VTE risk
• IUDs can be inserted immediately after delivery of placenta or after 4 weeks postpartum
• Progestin-only methods can be started immediately postpartum

Emergency Contraception Options

• Copper IUD: Most effective emergency contraception when inserted within 5 days of unprotected intercourse
• Ulipristal acetate (Ella): More effective than levonorgestrel, especially after 72 hours and for women with higher BMI
• Levonorgestrel (Plan B): Available over-the-counter, most effective when taken within 72 hours

Method Selection Considerations

Medical Conditions

• Venous thromboembolism risk: Avoid estrogen-containing methods in women with history of VTE or multiple risk factors 1
• Breastfeeding: Progestin-only or non-hormonal methods preferred in first 6 months
• Hypertension: Non-hormonal or progestin-only methods may be safer options
• Migraine with aura: Avoid estrogen-containing methods

Side Effect Management

For users experiencing bleeding irregularities 1:

• Copper IUD users: NSAIDs for 5-7 days may help with heavy bleeding
• Implant users: NSAIDs, hormonal treatments, or antifibrinolytic agents may help with heavy bleeding
• Injectable users: NSAIDs may help with spotting or light bleeding
• Combined hormonal contraceptive users: A brief hormone-free interval may help with breakthrough bleeding

Common Pitfalls to Avoid

1. Inconsistent use: The effectiveness of many methods (especially pills, patches, rings) depends on consistent and correct use. Consider LARCs for patients who may have difficulty with daily adherence.

2. Improper management of missed doses:

   • For combined hormonal contraceptives, additional protection is needed if pills are missed for ≥48 hours 1
   • For injectables, additional protection is needed if >2 weeks late for next injection

3. Failure to consider drug interactions: Some medications (particularly certain antibiotics and anticonvulsants) can reduce contraceptive effectiveness.

4. Ignoring non-contraceptive benefits: Many hormonal methods offer benefits beyond pregnancy prevention, including reduced menstrual pain, improved acne, and reduced risk of certain cancers.

5. Not providing adequate counseling about side effects: Bleeding changes are common with hormonal methods and are a major reason for discontinuation. Proper counseling can improve continuation rates.

Remember that while condoms are not the most effective contraceptive method, they are the only method that also provides protection against sexually transmitted infections.