Which contraception method is right for you?
We believe that everyone deserves all information when it comes to choosing a contraceptive option that's right for them and their partner. We also know there's a lot of misinformation out there when it comes to contraception, so we want this to be a safe place to obtain that information. When it comes to birth control, I like to think of it in 3 categories - options available to you without a prescription, options that you get from a doctor that include hormones, and then options available from your doctor that don't involve hormones. Your choice of birth control may also change over time, so it's important for you to understand what you have available today but also what you could choose to use in the future.
Options Available Without A Prescription
The most accessible forms of contraception are available to you at your local pharmacy...or possibly your phone! Did you know we even have digital birth control now? Here are all the options available to you:
Condoms: Our oldest form of birth control, having been used for centuries. Historical versions were made out of animal intestines, while our current day versions are most commonly made of latex (although we also have polyurethane and polyisoprene as options, if you or your partner have a latex allergy). With perfect use, external male condoms are 98% effective at preventing pregnancy. Perfect use includes putting them on before any genital contact, checking the expiration date and package for damage, pinching the tip to leave room for semen, rolling the condom all the way down, and holding the base when withdrawing. Most importantly, never reuse a condom! This is also our only form of contraception that helps reduce the transmission of many STIs.
Spermicide: Likely right next to the condoms at the store, spermicide are creams, films, gels, or suppositories that use chemicals to immobilize sperm. It is most effective when used in combination with barrier methods like condoms. With perfect use, it is about 84% effective.
Opill: This is the first over-the-counter hormonal birth control pill available without need for a doctor's prescription! This is a progestin-only medication, and with perfect use (which means taking it at the same time every day, without missing a day), it is 98% effective. Because it does not contain estrogen like prescription oral combined pills, it is an appropriate option for most people (notably, a history of breast cancer, undiagnosed vaginal bleeding, and obviously pregnancy are contraindications for use). Many big box stores like Costco also sell these in larger packs, so you can have protection for months with just one stop at the pharmacy!
Fertility Awareness Methods: there are many ways to use your known fertility as a form of contraception, although some are better than others. Simple calendar methods and algorithm based period apps have a higher likelihood of being incorrect, while options like Natural Cycles, which uses your own personal biometrics to give you a fertility window, are more accurate (with perfect use, this can be up to 98% effective at preventing pregnancy). This is a great option for those who want to have a deeper understanding of their hormonal and menstrual cycles work, and can also be combined with non-hormonal options like condoms.
Hormonal Options from the Doctor
These options require an appointment with a clinician, and may require a procedure appointment for insertion. I recommend making a "problem visit" with your ObGyn or PCP to discuss!
Combined Oral Contraceptives: These are daily pills that have both estrogen and progestin in them. Not only are these an option for contraception, but we also often use these to help manage common hormone-mediated conditions like PMOS, endometriosis, and PMDD. With perfect use, they are 98% effective, just remember to take them every day! Common contraindications for these are a history of DVT or pulmonary embolism, breast cancer, and migraines with aura.
Hormonal IUD: this is the T shaped device that sits in your uterus that releases a small amount of progestin every day. We have several different options available, and they last for 3-8 years for pregnancy prevention depending on what size you get. These are also a great tool to help with abnormal uterine bleeding. Some people experience pain during insertion, so I encourage you to talk to your doctor about pain management options prior to the day of insertion! Hormonal IUDs are over 99% effective at preventing pregnancy.
Nexplanon: this is the small implant that goes in your arm, and is now effective for 5 years for pregnancy prevention! These also only release progestin, and are our most effective form of non-permanent long-acting contraception!
Depo Provera: this is a progestin that is injected at your doctors office every 3 months. With prolonged use, many patients experience amenorrhea, or no periods, which is a bonus for many. With perfect use, which means not missing an injection, depo provera is over 99% effective at preventing pregnancy.
Non-Hormonal Options from the Doctor
Non-Hormonal IUDs: these are the T-shaped devices that sit in your uterus, but they have copper on them, rather than a hormone sheath. This copper is toxic to sperm, and therefore acts as a spermicide. It is highly effective at preventing pregnancy (although technically, the hormonal IUD is better). It can be used for up to 10 years for preventing pregnancy! One major side effective that some people have is heavier menstrual bleeding.
Female Sterilization: this is in layman’s term's called "tying your tubes", even though technically, most of us are no longer tying your tubes, but removing them entirely (this is called a bilateral salpingectomy)! This is a surgery where you go to the operating room, go all the way to sleep under general anesthesia, and then your surgery performs surgery by placing 2-3 ports in your abdomen, and cuts the fallopian tubes off their attachments to the uterus. This is as close to 100% pregnancy prevention as it gets!
Male Sterilization: this is a vasectomy, and is most often performed in your doctors' office under local anesthesia. Don't forget though that this contraception takes several months until there is no sperm left in the body, and you need to do the confirmatory test. A wonderful option for partners who don't want (more) children.
I hope this gives you clarity on all of the contraception options we have available!
