Health Resources

Contact Us

Puyallup Office
Bonney Lake Office
Sunrise Medical Campus

Home

Health Resources

Forms To Print
SFM Newsletter
Health Links
Top Health Stories
Contraceptive Choices
How Often Do I See Doctor?
Immunization Schedule
SFM Press Releases

Contraceptive Choices

You've made the important decision to practice birth control and now you're faced with another: which method? As you'll see, there are several available, and with good reason; because no two people are alike, no one method is right for everyone.  This guide is designed to help you make an informed decision about reversible birth control methods. In it, you'll find an introduction to the many contraceptive options available to you.  Then, with your doctor's or health care provider's help, you'll be able to decide on one that works best with your lifestyle and your needs.

Whichever birth control method you choose, keep in mind that even the most effective and appropriate method can fail if you're not able to make a consistent, ongoing commitment to using it. Whether your regimen is something you'll take daily, like a pill, or use only as needed, like a diaphragm, its success depends on you. Make sure you fully understand how and when to use the method you and your doctor or health care provider have chosen. Remember, this guide is only an introduction; your doctor or health care provider can best answer any questions you might have. Be sure to keep in touch with her or him for regular checkups, your contraceptive choice.

Conception: What Happens?

A Look Inside
The uterus, or womb, is a muscular chamber about the size and shape of a pear.  This is where a fertilized egg can implant and develop into a baby.  The cervix is the opening of the uterus through which sperm enter to fertilize an egg and through which a baby usually leaves the uterus. The vagina is the passageway between the uterus and the outside of the body. This is the canal through which a baby is delivered and where the penis is inserted during sexual intercourse.

The ovaries are two walnut‑sized structures located on either side of the uterus. Each holds thousands of tiny egg follicles‑clusters of cells that contain an immature egg at their centers. The ovaries also produce hormones needed for reproduction.

The fallopian tubes connect the ovaries and the uterus. About 4 inches long, they each begin at an opening on either side of the uterus and end in a funnel that surrounds (but doesn't attach to) each ovary.

Ovulation & Conception
About once a month, the lining of the uterus begins to thicken in preparation to receive and nourish a fertilized egg. At the same time, several egg follicles begin to mature, but usually only one develops fully, with a mature egg inside. It moves to the surface of the ovary, and the follicle comes apart, releasing the egg into the fallopian tube. This process is called ovulation.

Over the next few days, the sides of the fallopian tube squeeze periodically to push the egg down to the uterus. If the egg is not fertilized during this critical time, it will disintegrate in the uterus.  And, since the thickened uterine lining is no longer needed, it will be shed over a period of 2 to 8 days. This discharge, containing blood, cells, and other secretions, is menstrual flow, or "a period."

The time interval from one period to the next is the menstrual cycle.  Just after ovulation, while the egg is on its way toward the uterus, it may be fertilized by a man's sperm, which is deposited during sexual intercourse. Several million sperm can be contained in the semen released from the penis; only one such sperm must reach the egg‑usually while it is still in the fallopian tube‑for pregnancy to occur. This process is called conception.  Once fertilized, the egg takes several days to travel down the fallopian tube to the uterus, where it implants in the uterine lining and begins to develop into a baby.

When Am I Most Likely to Conceive?
Every woman's cycle is different; it is possible to conceive on almost any day in your cycle. However, your greatest chance of conception occurs just before, during, and just after ovulation. For women with regular, 28‑day menstrual cycles, ovulation is likely to occur 14 days before the next menstrual period is expected.

Because sperm can survive in the fallopian tube for 2 or 3 days, the most fertile period begins 2 to 3 days before ovulation. Although the egg may be in the fallopian tube for 2 or 3 days, the fertile period usually ends by the time the unfertilized egg reaches the uterus. It's important to remember, however, that your fertile period may vary from the norm and may even change from cycle to cycle. If you're interested in determining your own cycle, consult with your doctor or health care provider.

BIRTH CONTROL OPTIONS

Oral Contraceptives (Birth Control Pills)
How Do Oral Contraceptives Work?
Oral contraceptives suppress the hormones that cause ovulation.  The process of ovulation is directed by hormones, chemicals made by the body. Some hormones signal for egg follicles to mature in the ovary, for example; others trigger the thickening of the uterine wall. Oral contraceptives consist of man‑made versions of two of these hormones; taken daily, they block the usual hormone "messages" that direct ovulation. No eggs are produced, so conception is prevented.

Other effects of oral contraceptives help prevent sperm from reaching the egg and reduce the chance of the egg implanting in the uterus.  Oral contraceptives are one of the most effective forms of reversible birth control currently available.

There are several types of oral contraceptives, with different levels and types of hormones.

Most pills contain a uniform combination of two hormones, progestogen and estrogen; they are called "combination oral contraceptives," or, simply, "the pill." Another type, "mini‑pills," contain only progestogen. Also available are "phasic contraceptives," or "multiphasics," which contain the two hormones progestogen and estrogen in varying doses. Every woman's cycle is different, and so are her needs in an oral contraceptive. Your doctor or health care provider can determine a type that's right for you.

What Do I Have to Do?
Combination birth control pills are probably the easiest birth control method to use--you only need to take them once daily, at the same time each day. Then, for 7 days each month, you stop taking the pills (or you take inactive, “placebo" pills). During this "time off," you will usually experience bleeding similar to a normal menstrual period.  When taking the active pills, you must take one every day in order to be protected.

Are Oral Contraceptives Right for Me?
Only your doctor or health care provider can determine if you’re a suitable candidate for birth control pills. When used correctly, the pill is 99% effective, making it the most popular method.  It is considered safe for most healthy nonsmokers, even past age 35. While the pill may reduce the risk of acute Pelvic Inflammatory Disease (PID), it offers no protection against other sexually transmitted diseases (STDs). 

Serious as well as minor side effects have been reported in women using oral contraceptives. You should discuss these risks with your doctor or health care provider. Birth control pills are one of the most effective reversible forms of contraception.

Injection
How Do Injections Work?
Contraceptive injections are given to you by your doctor as a hormone "shot" into the muscle of your upper arm. Once administered, a low dose of this hormone, progestin is released into your system over a period of 3 months. This progestin, similar to the progestin in birth control pills, suppresses ovulation and provides effective contraception for 3 months.

What Do I Have To Do?
Once your doctor gives you an injection there's nothing you have to do for 3 months. However, scheduling regular visits with your doctor or health care provider for an injection every 3 months is important to make sure you are protected.

Is an Injection Right for Me?
It's up to you and your doctor or health care provider to decide if the injection method is right for you. It may be appropriate if you want long‑term contraception without having to take birth control daily or use other contraceptive devices such as diaphragms, condoms, cervical caps, spermicides, or the sponge. However, the injection requires an office visit every 3 months, and immediate discontinuation is not possible. Menstrual irregularities, such as spotting and bleeding between periods, are common.

The Patch
How Does the Patch Work?
The patch is thin, beige, plastic patch that sticks to your skin. The patch is usually placed on the skin of the buttocks, stomach, upper arm, or torso the same day each week for three weeks in a row. No patch is used in the fourth week. The patch much like the pill releases synthetic estrogen and progestin into the blood stream.

What Do I Have to Do?
The patch is easy to use--you reapply the patch once a week. Then, for 7 days each month, do not reapply the patch. This is called "time off" where you may experience bleeding similar to a normal menstrual period.

Is the Patch Right for Me?
It's up to you and your doctor or health care provider to decide if the patch is right for you. It may be appropriate if you have trouble remembering to take a pill once a day. The patch is 99% effective with proper use. The patch offers no protection against other sexually transmitted diseases (STDs).

The Nuva Ring
How Does the Nuva Ring Work?
The Nuva Ring is a soft flexible ring that is approximately two inches in diameter and is worn in the vagina for three weeks. The ring contains a combination of estrogen and progestin hormones similar to the hormones used in the pill. The hormones contained within the ring are absorbed continuously, directly into the blood stream through the vaginal walls.

What Do I Have to Do?
The ring is convenient and easy to use. You insert one new ring into the vagina and keep it in place for three weeks in a row. Then remove it for one week in order to menstruate, much like the patch.

Is the Nuva Ring Right for Me?
Only your doctor or health care provider can determine if you’re a suitable candidate for the Ring. According to studies provided to the Food and Drug Administration (FDA) during the approval process, effectiveness ratings are listed at 99% when used according to labeled instructions. This is comparable to the patch and better than the Pill’s effectiveness ratings.

Diaphragm
How Does a Diaphragm Work?
The diaphragm must be fitted by your doctor or health care provider and always used with contraceptive jelly or cream. It forms a barrier to the uterus, preventing sperm from entering and fertilizing an egg.  A diaphragm is a soft rubber, latex, or silicon cup that is filled with contraceptive jelly or cream and inserted into the vagina to cover the opening at the bottom of the uterus, called the cervix.

The diaphragm works in two ways: it provides a physical barrier to semen, and it holds the contraceptive jelly or cream, which kills sperm before they can enter the uterus and fertilize an egg. When used properly--which means always using jelly or cream--the diaphragm is highly effective; if your partner uses a condom at the same time, its effectiveness is greatly enhanced.

What Do I Have to Do?
Spermicide is applied to the diaphragm, which is inserted into the vagina so that it covers the cervix and is held securely in place behind the pubic bone and rear wall of the vagina, If you have intercourse again, you need to add more contraceptive jelly or cream each time. This is inserted with a special applicator while the diaphragm is still in place.

The diaphragm should remain in place for 6 hours after intercourse and should be removed as soon as possible thereafter.  Each time you use your diaphragm, you should check it to make sure there are no holes or tears in it. It should be replaced every 2 years or sooner. Also, have your diaphragm size checked by your doctor or health care provider once a year or after you’ve had a pregnancy, or gained or lost more than 10 pounds.

Is the Diaphragm Right for Me?
Your doctor or health care provider can tell you if the diaphragm is a suitable birth control method for you. It requires substantial user involvement: applying spermicide, inserting, cleaning, proper storage. Use of a diaphragm may increase risk of urinary tract infections. Toxic shock syndrome (TSS) has been reported in some women using diaphragms. Consider it if you prefer a birth control method you only have to use when you need it and if you’re committed to following the procedures for using it properly. For many women, it’s an easy habit to get used to.

Condoms
How Do Condoms Work?
A condom is a thin shield that is fitted directly on a man’s penis. It traps the semen expelled from the penis during intercourse, preventing sperm from fertilizing an egg.  There are many types of condoms available; most are made of latex rubber, but some are made from animal tissue like lambskin (also called “natural” condoms). They may be lubricated or ribbed or treated with a spermicide.

Latex condoms, especially those that are treated with a spermicide, help prevent both partners from giving each other sexually transmitted diseases (STDs).  Condoms can be bought without a prescription.  A condom is worn on the penis. It collects semen and prevents sperm from entering the uterus.  Although condoms are quite effective, they may tear or slip off during intercourse.

What Do I Have to Do?
A man must put on a condom when his penis is erect but before intercourse.  Afterward, he should withdraw immediately to prevent leakage. It’s a good idea for you to use a backup form of birth control in case of leakage or breakage.  Possible choices: spermicide suppositories, jelly, cream, or foam; a diaphragm; or the contraceptive sponge.

Are Condoms Right for Me?
Virtually any male can wear a condom; it’s convenient, inexpensive, easy to obtain, and highly portable. The added protection against sexually transmitted diseases (STDs) makes it a good choice if you have more than one sexual partner. However, condoms can reduce sexual spontaneity and sensation, and may break or leak, posing a heightened risk of pregnancy.

Female Condoms
How Do Female Condoms Work?
The female condom is a lubricated plastic sheath with rings on each end, The ring on one end is open and remains outside the vagina, covering part of the labia. The ring on the other end is closed with the plastic and looks like a diaphragm. It's placed in the vagina so that it covers the cervix, preventing sperm from entering the uterus. The sheath between the two rings forms a pouch to line the entire vaginal area. Like the use of the male latex condom, female condoms are available without a prescription

What Do I Have to Do?
The female condom can be inserted up to 8 hours before intercourse. Follow the package directions for correct insertion. It's important that the closed ring section hugs the cervix. Additional spermicide may be used before and after the condom is in place. Since this condom is made from polyurethane rather than latex, oil‑based spermicides and lubricants will not damage it. The female condom should be removed immediately after intercourse, before you stand up. As with any condom, it is a one‑use‑only item, and should be properly disposed of after use.

Are Female Condoms Right for Me?
Like the male condom, the female condom offers protection against STDs as well as contraception. Additionally, the woman controls its use (unlike use of a male condom). However, the female condom is more cumbersome to use, more visible, and less comfortable than a male condom.

Intrauterine Device (IUD)
How Does the IUD Work?
The IUD is a small plastic device, containing copper or the hormone progesterone, that is placed by a doctor or health care professional inside the uterus for an extended length of time. In fact, the copper IUD may be used for up to 8 years. It is a highly effective contraceptive and is thought to work by preventing sperm from reaching or fertilizing the egg. The modern IUD is one of the most effective forms of birth control available.

What Do I Have to Do?
Your doctor or health care provider must insert an IUD; once it is in place, you should check the placement regularly, at least after each menstrual period. Schedule regular follow‑up visits with your doctor or health care provider, and have your IUD replaced as he or she directs.

Is an IUD Right for Me?
Your doctor or health care provider will help you determine if an IUD is an appropriate birth control method for you. It is appropriate for women who have had at least one child and are in a mutually monogamous relationship, since it does not protect against sexually transmitted diseases. Consider the IUD if you want sexual spontaneity, high degree of effectiveness, and a long‑term contraceptive.

Emergency Contraception
How Does Emergency Contraception Work?
If you have had sex without birth control or your birth control method has failed within the past 3 days, you can use Plan B to reduce your risk of pregnancy. If it has been longer than 3 days consult your physician. Plan B contains large doses of levonorgestrel that can be found in a single birth control pill.

What Do I Have to Do?
Plan B is an emergency contraception or back up method of birth control that can only be ordered and taken by women. A prescription from a doctor is NOT necessary to order this product and you can dispense Plan B at most big pharmacies.

Is Emergency Contraception Right for Me?
Plan be should never be used as a primary source of birth control, however it is available for a back up plan or last resort. Plan B will decrease your chances of getting pregnant up to 89%. The advantage to Plan B is that it is easily accessible to women years 18 or older without a prescription and it is more effective the sooner you take it.

Natural Family Planning
How Does Natural Family Planning Work?
Natural family planning is based on the fact that fertilization is most likely to occur just before, during, and just after ovulation. By carefully monitoring yourself daily, you may be able to determine when you are ovulating and thus predict when you are most fertile. At those times you could practice birth control just by avoiding intercourse. While more effective than no birth control at all, natural family planning has a high failure‑rate because even the most regular cycles can vary from month to month. It is perhaps the least effective birth control method.

What Do I Have to Do?
To monitor your ovulation schedule, you need to use a calendar daily for at least 3 months. You can note ovulation using two different methods: (1) basal body temperature (BBT) and (2) cervical mucus charting.

The BBT method is based on the fact that just before ovulation, your body temperature drops and then rises steadily for a few days. If you take your temperature daily for several months and plot it on a chart, you will probably be able to see a pattern. This pattern helps you predict your most fertile days and abstain from intercourse at those times.

Cervical mucus charting requires that you take a sample of any mucus (discharge) from your vagina daily. Close to or during ovulation, the mucus should become clear, elastic, and slippery. If you chart your cervical mucus findings over several months, you may see a pattern that will allow you to predict your next fertile period.

Is Natural Family Planning Right for Me?
Natural family planning is best used only by women with very regular, predictable cycles. Ask your doctor or health care provider if you are an appropriate candidate. Consider natural family planning if you choose not to use a birth control device and if you are willing to stick to a time‑consuming schedule of daily readings for several months. Overall, this is the least effective method.

How Do the Methods Compare?
Use this chart to compare the failure rates of the methods we've discussed.

Each is listed with its lowest expected failure rate‑that is, the percentage of pregnancies with the method if it is used properly‑and with its typical failure rate, or the percentage of pregnancies reported by average users.

Conclusion
With this guide in hand, you're well on your way to choosing the birth control method that's right for you. But it's just the first step. Now it's time to discuss your options with your doctor or health care provider. Be sure to ask any questions you might have, and make sure you thoroughly understand your choices. And, once you've used your method of choice, don't forget to follow the schedule of checkup visits outlined by your doctor or health care provider. It's the best way to ensure success with your contraceptive choice.

HOME  |  ABOUT US  |  EMPLOYMENT  |  PRIVACY STATEMENT  |  CONTACT WEBMASTER

©2007 SOUND FAMILY MEDICINE  |  LAST UPDATED: 06/05/2007