Common condition
Contraception is used to prevent pregnancy. The medications, devices, and procedures used for contraception are also referred to as birth control.
Types of Contraceptive Methods
Contraception is designed to reduce the chance of pregnancy after sexual intercourse. The most common forms of contraception are:
Birth control pills
Hormonal contraceptive pills are taken orally and release a small amount of synthetic hormone into the body in order to prevent ovulation, reduce the movement of sperm, or inhibit the implantation of eggs. They prevent you from becoming pregnant.
There are numerous types of contraceptive pills on the market that suit the needs of different patients who made need lower doses of hormones or want to skip periods. Most birth control pills are taken every day. However, they do not require you to interrupt intercourse to take them.
It's important to note that oral contraceptive pills do not protect against sexually transmitted infections (STIs). If you are looking for protection from pregnancy and STIs, it's typically recommended that you pair hormonal birth control with a barrier method, such as condoms.
Barrier methods
Condoms are considered barrier methods of birth control and can be up to 98% effective when used correctly. Condoms serve as a barrier between the egg and sperm so that pregnancy cannot occur. Because they typically block the exchange of some bodily fluids, they can also reduce your chances of transmitting or contracting an STI from your partner. However, they must be used according to their instructions, or else they can fail or break.
While a condom must be put in place before sex, it does not require a daily commitment like birth control pills do. Male condoms are more common; however, female condoms do exist and can be up to 95% effective at preventing pregnancy.
Hormonal contraceptive devices
In addition to pills, hormonal contraception is available in the form of patches, injections, rings, and implants (aka intra-uterine devices, or IUDs). These devices use either a combination of the synthetic hormones estrogen and progestogen or progestogen alone in order to stop ovulation (by stopping the egg from leaving the ovaries) or thickening the cervical mucus to prevent sperm from reaching the egg, or thinning the lining of the womb so that a fertilized egg cannot implant and cause pregnancy.
Preventing pregnancy when contraceptives fail
If you forget to take birth control pills or a condom breaks, emergency contraception (EC) can also be used to prevent pregnancy. Also called the "morning after pill," EC is taken orally as soon as possible after unprotected sex.
If a fertilized egg has already implanted in the lining of the uterus (in other words, if pregnancy has occurred), emergency contraception will not be effective. It can only help prevent pregnancy by delaying ovulation or preventing the implantation of a fertilized egg.
Levonelle (levonorgestrel) and EllaOne (ulipristal acetate) are the most popular EC pills and must be taken within 72 hours and 120 hours, respectively, in order to be maximally effective.
Emergency contraception may be available by prescription or over the counter. It is not a replacement for regular birth control.
More details about the contraceptive pill
Oral contraception (aka "the pill") is a tablet taken each day (ideally around the same time of day) that prevents pregnancy. By releasing synthetic hormones such as estrogen and progestogen, different pills prevent pregnancy in one of three ways:
- By preventing the release of an egg from the ovaries (ovulation) so that it cannot be fertilized by sperm.
- By changing the cervical mucus (typically by thickening it) to stop sperm from reaching an egg.
- By making the womb inhospitable so that a fertilized egg cannot implant into the lining of the uterus.
Contraception FAQ
How effective are contraceptive pills?
Pills that contain both estrogen and progestogen (the combined pill) are 99% effective in preventing pregnancy if they are taken correctly. In some cases, this requires taking them at the same time each day and using a backup method for days or weeks if a pill is missed.
For those with hypertension or who would otherwise benefit from fewer hormones, the "mini-pill" is also available. This pill only contains progestogen and, when taken correctly, is 95% effective in preventing pregnancy.
Emergency contraception usually contains a greater concentration of hormones and must be taken within three days (sometimes less, depending on the brand) to prevent pregnancy. Once an egg is implanted in the uterine lining, it cannot terminate the pregnancy.
What are the benefits of oral contraception?
Oral contraceptive pills prescribed by a doctor are typically safe to use with few side effects. Besides preventing unwanted pregnancy, other benefits of birth control pills may lead patients who are not sexually active to take them.
Some of the benefits of oral contraceptives include:
- The convenience of taking a pill and not having to worry about barrier contraception during intercourse (as long as you are not concerned about sexually transmitted infections)
- Their effectiveness (which ranges from 95% to 99.99%)
- Lighter periods
- Less cramping and bloating during menstruation
- The ability of some pills to be taken continuously to delay or prevent menstruation
- Reduced risk of pelvic inflammatory disease
- A reduction in the occurrence of hormonal acne
What are the side effects of birth control pills?
Rarely, birth control pills can cause severe side effects that require discontinuation of the pill and a doctor's immediate attention, including:
- Blurred vision
- Severe headache
- Swelling or aching in the legs
- Abdominal pain
The most common side effects of birth control pills are mild and go away with continued use. These side effects can include:
- Nausea
- Weight gain
- Sore or swollen breasts
- Spotting between periods
Who should not use birth control pills?
People with a history of blood clots or breast cancer and those who are pregnant or smoke should not use birth control pills. You should also use a different form of contraception if you have a history of heart disease.
How to choose the best contraceptive pill
Oral contraceptive pills require a prescription from a medical professional. After giving your doctor your medical history and sharing insight into your lifestyle, they can help you choose the type and brand of pill that's right for you. For example, some pills should be avoided if you cannot agree to take them at a specific time each day.
You will also need to check in with your doctor annually to share your experiences with your birth control pills and ensure your prescription is appropriate.
Types of contraceptive pills
There are two major types of birth control pills - combined and progestogen-only pills. There are four categories of combined oral contraceptives: monophasic 21-day and 28-day preparations and phasic 21-day and 28-day preparations.
Monophasic 21-day pills include both estrogen (also called oestrogen) and progestogens, and each pill contains the same amount of hormone. Different brands will include ethinylestradiol, mestranol, or estradiol in addition to norethisterone, gestodene, desogestrel, drospirenone, levonorgestrel, norgestimate, dienogest, norelgestromin, nomegestrol, or etonogestrel.
- These pills require taking one pill for 21 consecutive days and a 7-day break, during which you will have your period.
- You will start a new pack of pills on the 8th day.
Monophasic 28-day pills are also referred to as "everyday" pills and are similar to the 21-day preparation, except that they contain 28 pills. However, only 21 of these pills are "active," and you will still get your period during one of the seven days during which you take the "inactive" pills.
- You will begin taking a new pack of pills as soon as you finish the previous pack.
Phasic 21-day pills may be biphasic or triphasic and attempt to mimic the body's natural hormone fluctuations.
- These pills are color-coded, and you'll start at the beginning of the pack and move through 21 pills before taking a 7-day break.
- You will have your period during your break and begin retaking the pills on day eight.
Phasic 28-day pills are similar to the 21-day preparations but have seven inactive pills.
Progestogen-only pills only contain a progestogen hormone. They typically need to be taken within a 3- hour window each day for 28 days before starting a new pack. If you miss a pill, you will need a backup method of birth control.
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