What are the available contraceptive options?

From the Guidelines

Long-acting reversible contraceptives (LARCs) such as hormonal IUDs and implants are the most effective birth control options, with effectiveness rates of over 99%. Hormonal methods include combined oral contraceptives ("the pill") containing estrogen and progestin, which prevent ovulation and are about 91% effective with typical use 1. Progestin-only pills, patches, vaginal rings, and injections like Depo-Provera (effective for 3 months) are also available. Implants such as Nexplanon, placed under the skin of the upper arm, provide protection for up to 3 years. Barrier methods include male and female condoms, diaphragms, and cervical caps, which physically prevent sperm from reaching eggs. Emergency contraception options include Plan B (taken within 72 hours) and ella (effective up to 5 days after unprotected sex). Permanent methods include tubal ligation for women and vasectomy for men.

Key Considerations

• The best choice depends on individual health factors, lifestyle needs, and future pregnancy plans, so consulting with a healthcare provider is recommended to find the most suitable option 1.
• For women with certain medical conditions, such as congenital heart disease, the individualized benefits and risks of each contraceptive therapy must be determined based on the patient’s anatomy and physiology in consultation with a gynecologist 1.
• Post-bariatric surgery patients should postpone pregnancy until weight has stabilized and consider long-acting reversible contraceptive methods such as IUDs 1.

Switching from Another Contraceptive Method

• If switching from an IUD, a healthcare provider may consider advising the woman to retain the IUD for at least 7 days after the new method is initiated and return for IUD removal, or to abstain from sexual intercourse or use barrier contraception for 7 days before removing the IUD and switching to the new method 1.

From the FDA Drug Label

INDICATIONS AND USAGE 1. Indications. Progestin-only oral contraceptives are indicated for the prevention of pregnancy. NuvaRing® is indicated for the prevention of pregnancy in women who elect to use this product as a method of contraception.

The available birth control options include:

• Progestin-only oral contraceptives with a first-year failure rate of 0.5% if used perfectly and 5% with typical use 2
• NuvaRing with pregnancy rates between one and two per 100 women-years of use 3
• Emergency Contraceptive Pills which reduce the risk of pregnancy by at least 75% if used within 72 hours after unprotected intercourse 2 3
• Lactational Amenorrhea Method (LAM), a highly effective temporary method of contraception 2 3
• Other methods such as IUDs, Depo-Provera, Levonorgestrel Implants, Female Sterilization, and Male Sterilization with varying effectiveness 2 3

From the Research

Birth Control Options

• There are various birth control options available, including patches, pills, and intrauterine devices (IUDs) 4, 5, 6.
• A study comparing a low-dose levonorgestrel and ethinyl estradiol contraceptive patch with a combination oral contraceptive found that both methods had similar efficacy and safety profiles 4.
• Another study found that desogestrel-ethinylestradiol, an oral monophasic contraceptive, had a contraceptive efficacy of 100% and minimal side effects, with a significant increase in high-density lipoprotein-c (HDL-c) 5.
• However, hormonal contraception has been associated with an increased risk of venous thrombosis (VT), with users of oral contraception with levonorgestrel having an increased risk of VT by a range of 2.79-4.07 6.
• The risk of VT also varies with different types of hormonal contraception, with levonorgestrel intrauterine devices not increasing the risk, while etonogestrel/ethinyl estradiol vaginal rings and norelgestromin/ethinyl estradiol patches increase the risk of VT by 6.5 and 7.9, respectively 6.

Types of Birth Control

• Patches: a low-dose levonorgestrel and ethinyl estradiol contraceptive patch has been found to have similar efficacy and safety profiles to a combination oral contraceptive 4.
• Pills: desogestrel-ethinylestradiol, an oral monophasic contraceptive, has been found to have a contraceptive efficacy of 100% and minimal side effects 5.
• Intrauterine devices (IUDs): levonorgestrel intrauterine devices do not increase the risk of VT 6.
• Vaginal rings: etonogestrel/ethinyl estradiol vaginal rings increase the risk of VT by 6.5 6.
• Patches: norelgestromin/ethinyl estradiol patches increase the risk of VT by 7.9 6.

Risks and Side Effects

• Venous thrombosis (VT): hormonal contraception has been associated with an increased risk of VT, with users of oral contraception with levonorgestrel having an increased risk of VT by a range of 2.79-4.07 6.
• Blood clots: the risk of fatal VT is increased in women aged fifteen to twenty-four by 18.8-fold 6.
• Other side effects: desogestrel-ethinylestradiol, an oral monophasic contraceptive, has been found to have minimal side effects, with no noticeable changes in body weight and minimal headaches 5.