What are the recommended options for birth control?

Recommended Birth Control Options

The most effective birth control options are long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) and implants, with failure rates of less than 1% per year. 1, 2

Birth Control Methods by Effectiveness

Tier 1: Most Effective (>99% effective)

• Long-Acting Reversible Contraceptives (LARCs)
  • Levonorgestrel IUD (0.1% failure rate)
    • Provides 71-95% reduction in menstrual blood loss 3
    • Safer than combined hormonal contraceptives for women with thrombosis risk factors 3
    • Effective for 3-7 years depending on type
  • Copper IUD (0.6-0.8% failure rate)
    • Non-hormonal option
    • Effective for up to 10 years
  • Subdermal implant (0.05% failure rate)
    • Effective for 3-5 years
• Permanent methods
  • Female sterilization (0.5% failure rate)
  • Male sterilization/vasectomy (0.15% failure rate)

Tier 2: Very Effective (91-94% typical use)

• Hormonal methods
  • Combined hormonal contraceptives (pill, patch, ring) - 5-9% typical failure rate
    • Contain estrogen and progestin
    • Require consistent use for maximum effectiveness
  • Progestin-only pills - 5-9% typical failure rate
  • Injectable contraception (Depo-Provera) - 0.3% perfect use, 3-6% typical use

Tier 3: Moderately Effective (70-85% typical use)

• Barrier methods
  • Male condoms (14% typical failure rate)
  • Female condoms (21% typical failure rate)
  • Diaphragm with spermicide (20% typical failure rate)
• Fertility awareness methods (25% typical failure rate)
• Withdrawal method (19% typical failure rate)

Key Considerations for Method Selection

1. Effectiveness

• LARCs (IUDs and implants) have the highest effectiveness with failure rates <1% per year 2
• Combined oral contraceptives have typical use failure rates of 4-7% per year 2

2. Safety Profile

• Estrogen-containing methods (combined pills, patch, ring):

  • Increase risk of venous thrombosis from 2-3 to 7-10 events per 10,000 women-years 2
  • Contraindicated in women with certain medical conditions (history of thrombosis, migraine with aura, etc.)

• Progestin-only methods (implant, progestin IUD, mini-pill):

  • Associated with fewer serious risks 2
  • Suitable for women with contraindications to estrogen

3. Non-Contraceptive Benefits

• Combined hormonal methods can improve:

  • Acne
  • Endometriosis symptoms
  • Premenstrual dysphoric disorder
  • Menstrual regularity 2

• Levonorgestrel IUD is particularly effective for:

  • Heavy menstrual bleeding
  • Dysmenorrhea management 3

4. Common Side Effects

• Hormonal methods may cause:
  • Irregular bleeding in first 3-6 months of use 1, 3
  • Amenorrhea (which is not harmful) 3
  • Other side effects like headache, nausea, breast tenderness

Special Considerations

Emergency Contraception Options

• Emergency contraceptive pills (taken within 72 hours after unprotected intercourse)
  • Reduce pregnancy risk by at least 75% 4, 5
• Copper IUD (inserted within approximately 1 week after unprotected intercourse) 5

Extended or Continuous Use of Combined Hormonal Contraceptives

• Can be used to reduce frequency of withdrawal bleeding
• Unscheduled spotting/bleeding common in first 3-6 months 1
• If unscheduled bleeding persists and is unacceptable:
  • Consider a 3-4 day hormone-free interval (not during first 21 days of use)
  • Not recommended more than once per month as it may reduce effectiveness 1

Common Pitfalls to Avoid

1. Inconsistent use of user-dependent methods (pills, patches, rings)

   • Missing pills, especially in the first week of the cycle, significantly increases pregnancy risk
   • If pills are missed, follow specific instructions for taking missed pills and consider backup contraception 1

2. Not considering medical contraindications

   • Estrogen-containing methods should be avoided in women with risk factors for thrombosis
   • Thorough evaluation of cardiovascular risk factors is essential before prescribing combined hormonal contraceptives

3. Inadequate counseling about side effects

   • Irregular bleeding is common in first 3-6 months of hormonal contraceptive use
   • Enhanced counseling about expected bleeding patterns reduces method discontinuation 1

4. Failure to consider long-term needs

   • Consider the woman's reproductive life plan and need for contraception duration
   • LARCs provide long-term protection with minimal user intervention

By selecting the appropriate contraceptive method based on effectiveness, safety profile, and individual needs, women can effectively prevent unintended pregnancy while potentially gaining additional health benefits.