Each method of birth control has advantages and disadvantages. The method that works for you depends on your situation and personality. What is best for a teenager is not necessarily right for an adult. Those in a long-term relationship with one person may need something different than someone with many partners. It is also important to feel comfortable with the method that is chosen. The birth control pill is not the best choice if it is hard to remember to take it each day. If a woman is not comfortable touching herself, the diaphragm or sponge will not be right for her.

Medications

The Oral Contraceptive Pill (the birth control pill, the pill). When taken as directed, the pill is the most effective form of non-permanent birth control. It is taken by a woman every day by mouth. There are two types: combination pills that contain both estrogen and progesterone, and mini pills that contain only progesterone. The pill is 99.9 per cent effective and can help regulate the length and timing of a period. For a woman approaching menopause it can reduce hot flushes and irregular periods. The mini pill can be taken while breastfeeding and can be used by smokers who are older than 35. Birth control pills are available by prescription only. The pill (especially the mini pill) should be taken at about the same time every day. It works by stopping the release of the egg and changing the mucous of the cervix. (The cervix is the opening to the uterus, where the baby develops.) This makes it more difficult for sperm to enter the cervix. The pill is much less effective if you take antibiotics or go on a cleansing diet that contains large amounts of broccoli or grapefruit. It cannot protect against sexually transmitted disease.

Depo-Provera™ is given as an injection every three months by a nurse or doctor. It is the second most effective method of non-permanent birth control. The injection contains only progesterone and is 99.7 per cent effective. This method can be used by breastfeeding mothers and by smokers over the age of 35. The advantages of this method are that the woman doesn't have to remember to take the pill every day and her periods may become lighter or stop altogether. However, some women find the injection makes their periods very irregular. It may take up to nine months after the last injection for their periods to become regular. Some women must wait for their periods to return to their regular pattern before they can become pregnant. Depo-Provera™ works in two ways. It stops the release of the woman's egg. It also changes the mucous of the cervix, making it more difficult for sperm to enter the cervix. Depo-Provera™ does not protect against sexually transmitted disease.

Emergency Contraception

Once in a while the birth control method being used either breaks, spills or shifts, or a couple realize they had intercourse without protection. If this happens there is a medication that can be taken for up to three days after intercourse, although the sooner it is taken the more likely it is to work. Emergency contraception works about 75 per cent of the time to prevent pregnancy. In Alberta, it can be obtained from a doctor or from a birth control clinic. Emergency contraception does not protect against sexually transmitted disease.

Barrier Methods

The Male Condom
A condom is a sheath that is rolled over an erect penis. Condoms are usually made out of latex, but non-latex condoms can also be bought. Condoms are 97 per cent effective. If a lubricant is used with a condom it should be water-based, such as K-YTM Jelly. A condom can protect against sexually transmitted disease. It is the one form of birth control where the male can take responsibility for pregnancy prevention. Condoms are used only at the time of actual intercourse and can be bought without a prescription. However, you must plan ahead and have a condom available each time intercourse occurs. It is also possible for a condom to break. If it is used with foam that kills sperm (spermicide), breakage is less likely to cause a pregnancy. If a condom does break it is important to get emergency contraception as soon as possible. Condoms work by preventing the sperm from reaching the egg.

The Female Condom
The female condom is made of polyurethane and looks somewhat like a baggie. It is put into the vagina before intercourse. The female condom is 95 per cent effective. Like the condom, it does not require a prescription and provides protection against some sexually transmitted diseases. It can also be used by breastfeeding women and by smokers. The condom works by preventing the sperm from entering the cervix. It does not protect against all sexually transmitted diseases.

The Diaphragm
The diaphragm is a latex cup that fits in the vagina (birth canal), over the cervix. It is used with spermicidal gel. When used consistently, the diaphragm is about 97 per cent effective. One advantage of this method is that it can be put into position before sexual activity; it should be left in for a few hours afterwards. Breastfeeding women and smokers over age 35 can use this method. However, the diaphragm does not protect against all sexually transmitted diseases. It must also be fitted by a doctor. The diaphragm works by preventing the sperm from reaching the egg.

The Cervical Cap
The cervical cap is somewhat like the diaphragm. It is a small latex cup that fits over the cervix. Like the diaphragm, it must be fitted by a doctor and used with spermicidal gel. Unlike the diaphragm it can be left in for a few days. The cervical cap is less effective than the diaphragm (94 per cent effective). The advantages and disadvantages are similar to those of the diaphragm.

Non-Barrier Devices

The Intrauterine Contraceptive Device (IUD)
The IUD is a T-shaped piece of plastic covered in copper wire that sits inside the uterus. The IUD is 98 per cent effective and must be inserted by a doctor. It can be left in place for up to five years, the woman doesn’t have to think about it every day and she can become pregnant as soon as it is removed. IUDs can be used by breastfeeding women and smokers over age 35. The disadvantage is that it can make a woman’s periods heavier and cause more cramps with menstruation. It should not be used by women with many sexual partners since it can increase the risk of developing pelvic inflammatory disease. The exact action of the IUD in preventing pregnancy is not known. It is thought that copper is slowly released into the uterus, affecting the movement of the egg and sperm. Newer IUDs on the market contain the hormone progesterone instead of copper. As it is released the progesterone affects the lining of the uterus, preventing a fertilized egg from attachment. The IUD does not protect against sexually transmitted disease.

Contraceptive Sponges
The sponge is a piece of foam containing spermicide. It is placed in the vagina before intercourse. When used in combination with the male condom, it is 98 per cent effective. One advantage of this method is that it is effective for up to twelve hours. As well, it does not need to be replaced if intercourse occurs more than once during that time. It can be bought without prescription from a drugstore and it can be used by breastfeeding women and smokers older than 35.The sponge is less effective if it is used without a male condom. Some women also experience recurrent yeast infections when using the sponge. This method works by killing the sperm before they reach the cervix. It does not protect against all sexually transmitted diseases.

Spermicide
Spermicide (nonoxynol-9) comes in a cream, a gel, a foam, a film or a suppository. Used alone it is only 79 per cent effective. It is usually used with another form of contraception, such as a condom, diaphragm, cervical cap, or lea device. Spermicide can help protect against chlamydia and pelvic inflammatory disease. However, it must be inserted just before intercourse (it is effective for only one hour) and can be messy. This method works by killing the sperm before they reach the egg. Spermicides do not protect against all sexually transmitted diseases.

Lea Contraception
The Lea contraception is a soft silicone oval shaped shield that is inserted into the vagina over the cervix. When used with a spermicide it is 91 per cent effective. Without spermicide it is only 87 per cent effective. The advantage is that it can be inserted up to eight hours before intercourse and does not require a prescription. The disadvantage is the high failure rate. The Lea contraceptive does not protect against sexually transmitted disease.

Other Methods

The Sympto-thermal Method
In this method of birth control the woman keeps track of her monthly cycles by taking her temperature with a basal body temperature thermometer. As well, she checks the thickness of the mucous of the cervix and the position of the cervix in the vagina. Once she knows the pattern of her cycles, she can predict when her egg is likely to be released and she will be fertile. During the fertile time, intercourse must be avoided to prevent a pregnancy. This method works best for women with regular cycles and lifestyle. It is 80 to 90 per cent effective. Since a woman learns to understand her body and its cycles better, this method can actually help her plan a pregnancy. The disadvantage is that the charting of temperature, thickness of the mucous and the cervix position must be done every day. There are times of the month when she can’t have intercourse. If she does, she must use a contraceptive. This method works by preventing egg and sperm from being in the uterus at the same time. It will not protect from sexually transmitted disease.

Abstinence
Abstinence means not having intercourse with penetration of the penis into the vagina. Semen (fluid from the penis that carries sperm) must also be kept away from the vagina and the opening of the vagina. There are many ways of enjoying a sexual relationship without penetration. The advantage of this method is that it is 100 per cent effective, with no need to remember to take something on a regular basis or have contraceptives handy. However, both partners must agree to abstinence.

Withdrawal (Coitus Interruptus)
In this method the penis is withdrawn from the vagina before ejaculation (when semen comes out of the penis). This method is only about 70 per cent effective. The advantage is that it requires no planning ahead. Be warned that there may be sperm in the fluid that comes out before ejaculation. It also takes a lot of self-discipline and concentration to pull out at the right time. This method does not protect against sexually transmitted disease.

Surgical Methods

Tubal Ligation
Tubal ligation is the procedure where the woman’s Fallopian tubes (tubes which connect the ovaries to the uterus) are cut, clipped or tied to prevent the egg travelling from the ovary to the uterus. This is a permanent method of pregnancy prevention and is very difficult to reverse. This method is 99.9 per cent effective, without the worry of remembering to use another contraceptive. The disadvantage is that it is permanent and requires surgery under an anesthetic. Tubal ligation does not protect against sexually transmitted disease.

Vasectomy
Vasectomy is the procedure where the man’s tubes carrying the sperm from the testicles (where sperm is made) to the penis are cut. This prevents the sperm from becoming part of the ejaculate (the fluid from the penis). Arousal and ejaculation are unchanged except that there are no longer sperm in the ejaculate. This is a permanent method of pregnancy prevention and is very difficult to reverse. This method is 99.9 per cent effective. Since there are still sperm in the ejaculate for up to three months after the vasectomy, another method of birth control must be used for a time. Vasectomy does not protect against sexually transmitted disease.
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Making the decision as to what method of birth control to use is not always easy but it is best to make the decision before having intercourse. A condom (either the male or female kind) should be used along with your chosen contraception if you have known your partner for less than six months, of both partners have not been tested for HIV and other sexually transmitted diseases, or if you have many sexual partners. This protects both of you from sexually transmitted diseases. The more unprotected sex and the more partners you have, the greater the risk of both pregnancy and getting a sexually transmitted disease. Sexually transmitted diseases can lead to problems with fertility. Your doctor can help you pick the best method of birth control for you and your partner.

Check out www.sexualityandu.ca or see the related Family Health Online article Contraception for more information on this topic.