Beyond the Pill
The patch is a highly effective, weekly hormonal birth control patch that is worn on the skin to prevent pregnancy. The patch is especially good for those who have a hard time remembering to take a pill each day. It is safe for use in healthy nonsmokers, from teens to women in their 40s. It is, in essence, the pill in patch form—the hormones are the same, but the delivery method is different, since the hormones are absorbed through your skin. It is worn for one week and replaced on the same day of the week for three consecutive weeks, with the fourth week "patch-free." The patch is a very thin, beige, smooth square that measures 1-3/4 inch on each of its four sides. It can be worn on the arms, buttocks or abdomen. It has the same health risks, benefits and side effects as the pill. A few women have mild skin irritation from the patch adhesive.
The Vaginal ring is a flexible ring worn in the vagina. It is folded and inserted high into the vagina, where it slowly releases estrogen and progestin. These hormones are absorbed into the bloodstream. Each ring is made of a type of vinyl and should be worn for three weeks out of the month. The ring is about two inches in diameter, and one size fits all women. The exact positioning of the ring within the vagina is not critical for it to work, because it is not a barrier method and therefore cannot be incorrectly inserted within the vagina. Like the patch, it is in essence the pill in ring form—the hormones are the same, but the delivery method is different, since the hormones are absorbed through your vagina. It has the same health risks, benefits and side effects as the pill. Additional side effects may include vaginal discharge, infection or irritation in small numbers of women.
IUDs are an excellent form of birth control for monogamous women who want a more long-term method that they do not have to think about every day. IUDs can last from 5-10 years depending upon the type you choose. IUDs got a bad rap in the '60s, when they were associated with pelvic infections and infertility. Today's IUDs are safer, and we have learned that Chlamydia was the real culprit in pelvic infections. Today's IUDs are safe for use as long as you are monogamous and therefore not at risk to acquire a sexually transmitted infection. They are inserted with a simple office procedure that takes only a few minutes. The IUD is a great method if you are done with childbearing, or do not want children, yet may not want permanent sterilization. It is also a good choice if you have medical contraindications to hormonal contraception, such as high blood pressure, heart disease, or a history of blood clots.
IUDs are small, T-shaped pieces of plastic, which contain either copper or a progesterone-releasing system that prevents pregnancy. Your health care provider puts the IUD in the uterus, where it can remain for five years or ten years depending on your preference and the type you and your healthcare provider select. The progesterone-releasing IUD may lessen cramps and bleeding during monthly periods, while the copper IUD may increase cramps and bleeding. The IUD is highly effect in preventing pregnancy, yet is fully reversible. You can start trying to get pregnant as soon as it is removed.You cannot use any type of IUD if you have recently been diagnosed with pelvic inflammatory disease (PID), an infection that affects the lining of the uterus, the fallopian tubes and/or ovaries.
Barrier Methods include condoms for males and females, diaphragms and cervical caps. Male and female condoms are available "over the counter," which means they can be bought at a store without a prescription. Your health care provider must prescribe the diaphragm and cervical cap.
The male latex condom protects against many sexually transmitted infections—called STIs for short—which are diseases, infections or illnesses that can spread from one person to another through sexual contact. Some examples of STIs are chlamydia, herpes, HIV, gonorrhea and syphilis.
Tubal ligation (getting your tubes tied) is a procedure in which each of your fallopian tubes, the passageway from the ovary to the uterus, is blocked. This can be done by removing the tube, tying it off so an egg cannot get to the uterus, or placing an object in the tube that closes it. Tubal ligation does not affect your sex drive. There are no hormonal changes that result from tubal ligation. After this procedure, all of your hormones will still be produced, your ovaries will still release an egg every month, and your menstrual cycles will follow their regular pattern. Tubal ligation is permanent; it is NOT reversible. Before making a permanent decision like this, you should consider possible changes in your life, such as divorce, remarriage or death of children, in which case you may want to have children or more children.
Laparoscopy is one of the two most common methods of sterilization. First the abdomen is inflated with an injection of harmless gas (carbon dioxide). This allows the organs to be seen clearly. Then the surgeon makes a small incision near the navel and inserts a laparoscope (a thin tube with a light and a viewing lens) for locating the tubes. The surgeon locates the tubes and then ties, clips or uses electrocautery (a small probe that has an electric current running through it, which cauterizes tissue) to block them off. Very little scarring occurs. The procedure takes 20 to 30 minutes and can be performed in outpatient surgical clinics. Women often go home the same day. They may have sexual intercourse as soon as they feel comfortable about it.
Mini-laparotomy is another common method of sterilization. It is often performed after childbirth. No gas or visualizing instrument is used. A small incision is made in the lower abdomen, just above the pubic hair. (If the operation takes place within 48 hours of delivery, the incision is made just below the navel.) The surgeon locates the tubes, then ties, clips or uses electrocautery to block them off. The incision is then closed. Women usually recover in a few days. Your health care provider will advise you about when may start having sexual intercourse again.
Vasectomy is permanent birth control for men. The tubes in the scrotum that carry sperm to the penis can be either tied or sealed so no sperm are in the semen. Sperm are the reproductive cells in men and semen is the fluid that carries sperm. Vasectomy does not affect sexual desire or sexual performance. A vasectomy does not affect ability to have and keep an erection or to ejaculate. The only difference is that the semen that is ejaculated no longer carries sperm.
Vasectomy is not effective immediately; sperm remain in the system beyond the blocked tubes. Couples must use other birth control until the sperm are used up. This usually takes from 15 to 20 ejaculations. Vasectomies are permanent. A few men will experience complications or side effects of the procedure, including swelling, bruising or infection.
There are several available vasectomy options. In conventional vasectomy, after the scrotum has been numbed with a local anesthetic, the doctor makes one or two small cuts in the skin and lifts out each tube in turn, cutting and blocking them so the sperm cannot reach the semen. Then the doctor stitches the cuts closed.
In a no-scalpel vasectomy, the doctor feels for the tubes under the skin and holds them in place with a small clamp. Instead of making two incisions, the doctor makes one tiny puncture with a special instrument. The same instrument is used to gently stretch the opening so the tubes can be reached. The tubes are then blocked using the same methods as conventional vasectomy.
A Fertility Awareness-Based method (sometimes referred to as natural family planning) is a way for a woman to find out what days during her menstrual cycle she is not likely to get pregnant. This is done by keeping track of the changes that occur in your body during the menstrual cycle. You should not have sexual intercourse on your fertile days, unless she or her partner uses a barrier birth control method, such as a diaphragm or condom.
Cervical Mucus Testing: With cervical mucus testing, a woman observes the changes in her cervical mucus to tell her when she may be fertile. Without this mucus, sperm die within an hour or two. A woman's mucus develops several days before ovulation (release of the egg from the ovary), telling the woman her fertile days have begun. If used correctly, it is about 97% effective. Most women notice some cervical mucus within a few days after your period has stopped. The mucus starts out as cloudy and feels sticky. A few days later, it becomes clear, stretchy, and slippery. You are most likely fertile from the time you start noticing cervical mucus until four days after you stop having the clear and slippery mucus.
The Calendar Rhythm Method: With the Calendar Rhythm Method, you keep track of the length of your menstrual cycles for 6-12 months to figure out the days when you are likely to get pregnant. It is probably at least 90% effective when used correctly, although more studies are needed on the effectiveness of this method.
Calculate the longest and shortest of your menstrual cycles. Subtract 18 from the number of days in your shortest cycle. This number will be the first fertile day of your current cycle. Subtract 11 from the number of days in your longest cycle. This number will be the last fertile day in your current cycle. Avoid unprotected intercourse from the first through the last day of your fertile time. You need to repeat this process with every cycle to find out your fertile days.
The Symptothermal Method: The Symptothermal Method teaches women to recognize their fertile days by tracking changes in their cervical mucus, body temperature (at rest), and the position of the cervix. When used correctly, this method is about 97%-98% effective in preventing pregnancy. Ask your health care provider for help in using this method. With this method, you take your temperature every morning before getting out of bed (known as basal body temperature). Each day, look at the color of your cervical mucus to see if it is cloudy, white, yellow, or clear, and feel the mucus to see if it is sticky or slippery and stretchy. Check the position of your cervix, which becomes more open when you are fertile (ask your health care provider to help you learn to do this). Record your temperature, cervical secretions, and the position of the cervix on a chart every day. You can find out when you are likely to be fertile by noticing changes in these three fertility signs.
Emergency contraceptive prevents pregnancy after unprotected sexual intercourse. Emergency contraception can be used when a condom breaks, after a sexual assault, or any time unprotected sexual intercourse occurs. It should not be used as your only protection against pregnancy. There are two types of emergency contraceptive pills (sometimes called the "morning after pill").
One type contains only the hormone called progestin. It is more effective than combination pills and the risk of nausea and vomiting is also lower. The other type of ECP uses a combination of hormones (estrogen and progestin) found in some kinds of regular birth control pills. Side effects can include nausea and vomiting.
The current treatment schedule is one dose within 72 hours after unprotected intercourse and a second dose 12 hours after the first dose. A recent large study found that ECPs should be taken as soon after unprotected intercourse as is practical. Most women can safely use emergency contraceptive pills, even if they cannot use birth control pills as their regular method of birth control.
IUDs can also be used as a form of emergency contraception. The copper-T intrauterine device (IUD) can be inserted up to five days after unprotected intercourse to prevent pregnancy. The IUD can then be left in place for up to 10 years if long-term contraception is desired.