Comparison of birth control methods
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Different types of birth control methods have large differences in effectiveness, actions required of users, and side effects.
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[edit] Ease of use
Different methods require different actions of users. Barrier methods, spermicides, and withdrawal must be used at every act of intercourse. The male condom may not be applied until the man achieves an erection. Female condom may be placed before intercourse begins, but must be properly used during intercourse. Cervical barriers such as diaphragms, caps, contraceptive sponge, and female condoms may be placed several hours before intercourse begins (note that when using the female condom the penis must be guided into place when initiating intercourse, and the condom should be removed before arising[1]). Spermicides, depending on the form, may be applied several minutes to an hour before intercourse begins.
The lactational amenorrhea method (LAM) requires some action every four to six hours.
Oral contraceptives and periodic abstinence methods require some action every day. Other hormonal methods require less frequent action - weekly for the patch, monthly for the vaginal ring or combined injectable contraceptive, and every twelve weeks for the injection Depo-Provera.
Implants are good for several years. Intrauterine methods require clinic visits for removal and replacement (if desired) only once every few years (5-10, depending on the device). Sterilization is a one-time, permanent procedure - after the success of surgery is verified, no action is usually required of users.
[edit] Side effects
Different forms of birth control have different potential side effects. Not all, or even most, users will experience side effects from a method.
The less effective the method, the greater the risk of the side-effects associated with pregnancy.
Minimal or no other side effects are possible with withdrawal, periodic abstinence, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.
Barrier methods have a risk of allergic reaction. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.
Sterilization procedures are generally considered to have low risk of side effects, though some persons and organizations disagree.[2][3]
After IUD insertion, menstrual periods are often heavier, more painful, or both - especially for the first few months after they are inserted.
Because of their systemic nature, hormonal methods have the largest number of possible side effects.
[edit] Effectiveness calculation
Failure rates may be calculated by either the Pearl index or a life table method. A "perfect-use" rate is where any rules of the method are rigorously followed, and (if applicable) the method is used at every act of intercourse.
Actual failure rates are higher than perfect-use rates for a variety of reasons:
- mistakes on the part of those providing instructions on how to use the method
- mistakes on the part of the method's users
- conscious user non-compliance with method.
- insurance providers sometimes impede access to medications (e.g. require prescription refills on monthly basis)[4]
For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not bother to go to the pharmacy on time to renew the prescription, or the pharmacy might be unwilling to provide enough pills to cover an extended absence.
[edit] User dependence
Different methods require different levels of diligence by users. Methods that require a clinic visit less than once per year are said to be non-user dependent. Intrauterine methods, implants and sterilization fall into this category. For methods that are not user dependent, the actual and perfect-use failure rates are very similar.
Many hormonal methods of birth control, and LAM require a moderate level of thoughtfulness.[citation needed] For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every few months. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly (rarely going longer than 4-6 hours between breastfeeds, a late pill or injection, or forgetting to replace a patch or ring on time). The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.
Higher levels of user commitment are required for other methods.[citation needed] Barrier methods, withdrawal, and spermicides must be used at every act of intercourse. They do not provide any protection from pregnancy if they are not used. Periodic abstinence methods require daily tracking of the menstrual cycle. They also do not provide any protection from pregnancy if incorrectly used. The actual failure rates for these methods are much higher than the perfect-use failure rates.[citation needed]
[edit] Effectiveness of various methods
The table below color codes the typical-use and perfect-use failure rates, where the failure rate is measured as the expected number of pregnancies per year per 100 women using the method:
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Blue under 1% lower risk Green up to 5% Yellow up to 10% Orange up to 20% Red over 20% higher risk Grey no data no data available
Some methods may be combined for higher effectiveness rates. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users.[5]
If a method is known to have been ineffective (such as a condom breaking), emergency contraception may be taken up to 120 hours after sexual intercourse. Emergency contraception should be taken as soon after intercourse as possible, as its efficacy decreases with increasing delay.
[edit] Comparison table
This table lists the chance of pregnancy during the first year of use.
| Birth control method | Brand/common name | Typical-use failure rate (%) | Perfect-use failure rate (%) | Type | Delivery | User action required |
|---|---|---|---|---|---|---|
| Implanon (medium-dose) | 0.05 | 0.05 | Progestogen | Subdermal implant | 5 years | |
| Jadelle (lower-dose) | 0.05 | 0.05 | Progestogen | Subdermal implant | 3 Years | |
| Vasectomy | "male sterilization" | 0.15 | 0.1 | Sterilization | Surgical | Once |
| Combined injectable | Lunelle, Cyclofem | 0.2 | 0.2 | Estrogen + progestogen | Injection | Monthly |
| IntraUterine System | Mirena | 0.2 | 0.2 | Intrauterine + progestogen | Intrauterine | 5 Years |
| Tubal ligation | "female sterilization" | 0.5 | 0.5 | Sterilization | Surgical | Once |
| Copper intrauterine device | Paragard | 0.8 | 0.6 | Intrauterine | Intrauterine | 5–12+ Years |
| LAM for 6 months only; not applicable if menstruation resumes3 | "ecological breastfeeding" | 2 | 0.5 | Behavioral | Breastfeeding | throughout day |
| Depo Provera | "the shot" | 3 | 0.3 | Progestogen | Injection | 3 Months |
| Lea's Shield and spermicide used by nulliparous1 4 | 5 | no data | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| Combined oral contraceptive pill | "the Pill" | 8 | 0.3 | Estrogen + progestogen | Oral | Daily |
| Contraceptive patch | Ortho Evra, "the patch" | 8 | 0.3 | Estrogen + progestogen | Transdermal patch | Weekly |
| NuvaRing | "the ring" | 8 | 0.3 | Estrogen + progestogen | Vaginal insertion | 1-3 Weeks |
| Progestogen only pill | "POP", "minipill" | 8 | 0.3 | Progestogen | Oral | Daily |
| Male latex condom | 15 | 2 | Barrier | Penile application | Every act of intercourse | |
| Lea's Shield and spermicide used by parous2 4 | 15 | no data | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| Diaphragm and spermicide | 16 | 6 | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| Prentif cervical cap and spermicide used by nulliparous1 | 16 | 9 | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| Today contraceptive sponge used by nulliparous1 | "the sponge" | 16 | 9 | Barrier + spermicide | Vaginal insertion | Every act of intercourse |
| Female condom | 21 | 5 | Barrier | Vaginal insertion + penile covering | Every act of intercourse | |
| Symptoms-based fertility awareness5 6 | basal body temperature, cervical mucus | 25 | 3 | Behavioral | Charting (fertility) | throughout day |
| Standard Days Method | 25 | 5 | Behavioral | Calendar-based | Daily | |
| Knaus-Ogino method | "the rhythm method" | 25 | 9 | Behavioral | Calendar-based | Daily |
| Coitus interruptus | "withdrawal method" | 27 | 4 | Behavioral | Withdrawal | Every act of intercourse |
| Spermicidal gel, foam, suppository, or film | 29 | 18 | Spermicide | Vaginal insertion | Every act of intercourse | |
| Today contraceptive sponge used by parous2 | "the sponge" | 32 | 20 | Barrier + spermicide | Vaginal insertion | Every act of intercourse |
| Prentif cervical cap and spermicide used by parous2 | 32 | 26 | Barrier + spermicide | Vaginal insertion | Every act of intercourse | |
| None (unprotected intercourse) | 85 | 85 | n/a | n/a | n/a | |
| Birth control method | Brand/common name | Typical-use failure rate (%) | Perfect-use failure rate (%) | Type | Delivery | User action required |
Note 1: The word nulliparous refers to those who have not given birth.
Note 2: The word parous refers to those who have given birth.
Note 3: The pregnancy rate applies until the user reaches six months postpartum, or until menstruation resumes, whichever comes first. If menstruation occurs earlier than six months postpartum, the method is no longer effective. For users for whom menstruation does not occur within the six months: after six months postpartum, the method becomes less effective.
Note 4: In the effectiveness study of Lea's Shield, 84% of participants were parous. The unadjusted pregnancy rate in the six-month study was 8.7% among spermicide users and 12.9% among non-spermicide users. No pregnancies occurred among nulliparous users of the Lea's Shield. Assuming the effectiveness ratio of nulliparous to parous users is the same for the Lea's Shield as for the Prentif cervical cap and the Today contraceptive sponge, the unadjusted six-month pregnancy rate would be 2.2% for spermicide users and 2.9% for those who used the device without spermicide.
Note 5: No formal studies meet the standards of Contraceptive Technology for determining typical effectiveness. The typical effectiveness listed here is from the CDC's National Survey of Family Growth, which grouped symptoms-based methods together with calendar-based methods. See Fertility awareness#Effectiveness.
Note 7: The term "fertility awareness" is sometimes used interchangeably with the term "natural family planning" (NFP), though NFP usually refers to use of periodic abstinence in accordance with Catholic beliefs.
[edit] References for effectiveness rates
- Combined injectable contraceptive: FDA Approves Combined Monthly Injectable Contraceptive. The Contraception Report. Contraception Online (June 2001). Retrieved on 2008-04-13.
- Jadelle: Sivin I, Campodonico I, Kiriwat O, et al (1998). "The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study". Hum. Reprod. 13 (12): 3371–8. PMID 9886517.
- Lea's Shield: Mauck C, Glover LH, Miller E, et al (1996). "Lea's Shield: a study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide". Contraception 53 (6): 329–35. PMID 8773419.
- Prentif cervical cap and Knaus-Ogino method:Trussell, James (2004). "Contraceptive Efficacy", in Hatcher, Robert A., et al: Contraceptive Technology, 18th rev. ed., New York: Ardent Media, pp. 773-845. ISBN 0-9664902-6-6.
All other methods: Trussell, James (2007). "Contraceptive Efficacy", in Hatcher, Robert A., et al: Contraceptive Technology, 19th rev. ed., New York: Ardent Media. ISBN 0-9664902-0-7.
[edit] References
- ^ Cates, Willard and Raymond, Elizabeth (2008). "Vaginal Barriers and Spermicides", in Hatcher, Robert A. et al. (eds.): Contraceptive Technology, 19th ed., New York: Ardent Media Inc.. ISBN 1-59708-001-2.
- ^ Bloomquist, Michele (May 2000). Getting Your Tubes Tied: Is this common procedure causing uncommon problems?. MedicineNet.com. WebMD. Retrieved on 2006-09-25.
- ^ Hauber, Kevin C.. If It Works, Don't Fix It!. Retrieved on 2006-09-25.
- ^ James Trusell, LL Wynn (January 2008). "Reducing unintended pregnancy in the United States". Contraception 77.
- ^ Kestelman P, Trussell J. "Efficacy of the simultaneous use of condoms and spermicides.". Fam Plann Perspect 23 (5): 226–7, 232. doi:. PMID 1743276.
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