What You Need to Know About Birth Control

Health Writer

**"I can't get pregnant - I just finished menstruating."

"I can't get pregnant - he didn't really penetrate me (deeply, that is)"

"I can't get pregnant - I'm nursing my newborn.'

'I can't get pregnant - this was my first time."

Which of these statements is true? Actually, none of them are correct. In each of these cases, the chances of getting pregnant are quite substantial. The latest research shows that nearly half of all pregnancies are unplanned. In fact, if we use the year 2001 as a guideline, there were 6.4 million pregnancies and 4 million births. There were 1.3 million abortions and 1.1 million miscarriages. The pregnancies were evenly divided between intended and unintended (no contraception or failed contraception). If no birth control is used, there is a 25% chance that intercourse will result in a pregnancy. So if you don't want to get pregnant, you need to be clear, very clear, on your choice of contraception, its success or failure rate, its possible negative side effects and most importantly, how to maximize its protection.

You first need to familiarize yourself with all the options available. You need to consider your personal medical history, your family medical history (since some birth control methods may put you at risk for conditions that are even more heightened if they run in your family), your lifestyle, your age, your insurance, even you professional and personal goals. If you are young, and have never been pregnant, some choices may not be offered since they can put you at risk for complications that can prevent pregnancy later on. Some methods of birth control are simply not dependable, so if you are young and unmarried, they would be poor choices.

Reversible methods of birth control include birth control methods that do not permanently alter or prevent pregnancy. If fertility is somehow impacted by the method, fertility returns shortly after the reversible method is discontinued (though time intervals can vary). There are a number of options under reversible methods.

Behavioral methods:

Abstinence, which requires strong resolve and an awful lot of self discipline. It means refraining from sexual intercourse and that means no penetration. It also means refraining from oral and anal sex.

Barrier methods:

The purpose of barrier methods is to place an actual physical blockade, so to speak, between the penis and the cervix, so that sperm cannot get to the women's eggs and fertilize them. Barrier methods are shared responsibility. They are more successful when used during every sexual encounter. Some are available over-the-counter, while some require sizing and a prescription. You want to keep them readily handy so that you have them when sexual activity is spontaneous and unplanned. These options include;

  • Male condom
  • Female condom
  • Diaphragm
  • Cervical cap
  • Spermicidal agents: Sponge, vaginal creams, foams, jellies, suppositories. (Combining a method like a diaphragm with a contraceptive jelly increases its efficacy)

If the barrier like a condom breaks or if you do not follow directions explicitly, you will significantly increase the likelihood of a pregnancy.

Hormonal methods:

These methods involve an amount of female hormone that will prevent ovulation and help to thicken the mucus inside the cervix so that sperm remains trapped and unable to enter the uterus. What's also important is that harmful bacteria can be trapped and prevented from entering the uterus, fallopian tubes and the ovaries but CAN still harm the cervix, vagina and spread to a male partner. When used properly, these methods can prevent pregnancies 98% of the time. They cannot however prevent STDs, which is why you should also choose to use a condom as well. Included in this group are;

  • The Pill (combination pill includes estrogen and progestin; the mini-pill contains only progestin)
  • The Skin Patch
  • IUD (Intra-uterine device)
  • Injectables
  • Implants (inserted under the skin and effective for a specific period of time)
  • NuvaRing vaginal ring

The pill poses certain risks including blood clots and a small but possible increased risk of breast cancer in women who have a strong family history of certain types of breast cancer. The mini-pill is ideal for women over 40 and those who are breastfeeding, since it only thickens the mucus wall - it doesn't prevent ovulation (which is less frequent or likely in these women). It's also a possible and safer option for women who smoke, women at risk for breast cancer and for women who cannot tolerate estrogen. The most common reason for women to abandon the pill (and especially the mini-pill is irregular menstrual bleeding). Be aware that there are over 20 different "pill" options with varying dosages of hormone, so you may have to try more than one to find a good option.

Norplant consists of 6 hormone-containing capsules that are placed in the upper arm of a woman. Norplant thickens the mucus in the cervix, alters the lining of the uterus and stops ovulation; it lasts for 5 years. Depo-Provera injections are high dose progesterone injections that are given every 3 months. The IUD is a T-shaped device about one and a half inches long that is placed in a woman's uterine cavity. It works by inhibiting sperm passage, preventing fertilization. One type of IUD lasts a year and contains a hormone that decreases menstrual flow; the other prevents pregnancy for ten years and may increase flow a bit.

Emergency contraception

There are times when you may need to take advantage of post coital or "after sex" contraception in order to prevent an unintended pregnancy. There is the "hormone-based option" or you may also be a good candidate for insertion of a copper IUD.

Hormonal treatments use either high dose combination of estrogen and progestin or just progestin and can be taken up to 5 days after sexual intercourse. Of course, the sooner the proper dose is taken, the more likely it will successfully prevent a possible pregnancy. Ovral, Alesse, Seasonale and Preven (comes as an emergency contraception prevention kit) are some examples. Norgestrel mini pill is a progestin only option and its schedule is for the woman to take 20 pills as soon as possible after sexual intercourse, and another 20 pills 12 hours later. In most cases, you will need a prescription for emergency contraception and there can be some rather uncomfortable side effects. The timing of your next menstrual flow may be affected and the combo pill may not be a good option for women at risk of a thrombus or thrombophlebitis, or for women who cannot take estrogen.

The copper IUD is a non-hormonal alternative that can be inserted up to five days post coitus. Once inserted, it can remain as your birth control for up to 10 years. It must be inserted by a health professional and is not considered suitable for anyone at high risk for STDs. Some gynecologists don't routinely recommend an IUD to a young woman who has not had children yet.

Of course, the best way to prevent an unplanned pregnancy is to plan ahead of time and share birth control responsibility with your partner.