What is the right birth control for you?

Making choices about birth control isn’t easy. There are many factors that come into play: your overall health, how often you have sex, the number of sexual partners you have and possible side effects.

Birth control or contraception is a collection of methods used to prevent pregnancy. Most birth control methods are quite effective if used properly. However, contraceptives can fail for several reasons, including incorrect use and failure of the medication, device, or method itself. Let’s go through the different options:

Natural methods

1. Abstinence generally means not having vaginal sex. There are many ways of being sexual without having vaginal sex. The benefits of abstinence are that it’s cheap, readily available and protects against HIV and other STIs. But it takes discipline.

100% effective
Side effects: none 

2. Withdrawal (coitus interruptus) is a form of birth control that some people call “pulling out”. The man pulls his penis out of his partner before sperm comes out.

97% effective
Side effects: none

ALSO READ: How long do you have to wait to have sex after having a baby?

3. The “safe” period/fertility awareness method. When using this method, you track when you are “fertile” or most likely to fall pregnant. Fertilisation only occurs when intercourse takes place around the time of ovulation. Ovulation usually occurs 14 days before the next menstruation. If you avoid having unprotected sex while you are fertile, you are less likely to get pregnant.

95% effective
Side effects: none

4. Lactational amenorrhoea. Breastfeeding can be used as an effective form of birth control. In the breastfeeding woman, suppression of ovulation occurs because of high prolactin levels. You can use this method for the first six months after giving birth by only nursing your baby from the breast (no pumping!).

99% effective
Side effects: none

Barrier methods

1. Male condoms are one of the most commonly used methods of contraception. Apart from preventing pregnancy, the condom protects against HIV and other STIs. Like all birth control methods, condoms work better when used correctly. So, read the instructions!

98% effective with perfect use
82% effective with typical use
Side effects: must be used every time 

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2. Female condoms are made from thin, soft plastic called polyurethane. It is a sac with a wide ring that fits over the outside of the vagina, and with a looser inner ring that fits over the cervix. When used correctly during vaginal sex, they help to protect against pregnancy and STIs.

95% effective with perfect use
79% effective with typical use
Side effects: must be used every time

3. Diaphragm with spermicidal jelly. The diaphragm is a flexible rubber cup that’s inserted into the vagina and fits over the cervix. A spermicidal agent consisting of sperm-killing chemicals are added to enhance the efficacy. Unfortunately, the spermicidal agent does not protect against STIs.

94% effective with perfect use
88% effective with typical use
Side effects: can cause irritation

4. Hormonal methods prevent pregnancy by inhibiting ovulation, thus fertilisation. There are a few different forms of hormonal methods, each with its own pros and cons.

• The Pill, or oral contraception, is a medication that you take every day to prevent pregnancy. There is the combined oral contraception pill (containing oestrogen and progesterone) and the progesterone-only pill, also known as the Mini Pill. Benefits of the pill include protection against benign breast growths, ovarian cancer and endometrial cancer, and your periods will also become lighter and less painful. The pill is not suitable for all women. You should not take the pill if you are a smoker, older than 35, overweight, have a history of blood clots, heart problems or liver disease. This may increase your risk for blood clots. It’s best to speak to your doctor to find out if the pill is safe for you.

99% effective with perfect use
91% effective with typical use
Side effects: nausea, mood swings, low libido and spotting 

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• The injection contains progesterone. This hormone will prevent ovulation and increase the thickness of the cervical mucus to block the sperm from getting to the uterus. There are two contraceptive injections – Depo Provera (lasts for 12 weeks) and Nur Isterate (lasts 8 weeks). The main advantages of the injection are: it’s very effective and it lasts 8 to 12 weeks, so you don’t have to remember to take the pill every day.

99% effective with perfect use
94% effective with typical use
Side effects: irregular bleeding, low libido, bone thinning 

• Implant (Implanon NXT). Implanon is a small, flexible contraceptive implant that your doctor places under the skin of your inner, upper arm, providing three years of protection. It contains progesterone, working the same way as the injection.

99% effective
Side effects: irregular bleeding 

• Vaginal ring. NuvaRing is a small plastic ring that you place inside your vagina. After it’s inserted, it stays in place for 3 weeks. Then it is removed for a 1-week break during which you’ll have your period. The ring releases oestrogen and progesterone, working the same way as the pill. The advantages and disadvantages are similar to the pill – the only difference is not having to remember to take a pill every day.

99% effective with perfect use
91% effective with typical use
Side Effects: irregular bleeding, nausea

• The Patch (Evra) is a small, sticky patch that is similar to a nicotine patch. It is placed on the skin once a week for three continuous weeks, delivering oestrogen and progesterone. This is followed by a week without a patch to allow menstruation.

99% effective with perfect use
91% effective with typical use
Side effects: skin irritation and can be visible to others

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• Intrauterine device and system 

An Intrauterine device (IUD) is a small T-shaped copper device that is inserted into the uterus. It releases a small amount of copper, which prevents the sperm from reaching the egg. The IUD is a long-acting reversible contraceptive, lasting for 5 to 10 years. Complications associated with the IUD include perforation of the uterus, infection, expulsion (the IUD falls out) or irregular bleeding. Luckily these complications are rare.

99% effective
Side effects: irregular, heavy bleeding

An Intrauterine system (IUS), or hormonal IUD, goes by the brand name Mirena. It releases progesterone into the uterus. The lining of the uterus becomes thinner and the cervical mucus becomes thicker, which makes it harder for sperm to enter the uterus. The Mirena contains no oestrogen, so it can be used by women who can’t use the pill. Unlike the IUD, the IUS decreases the amount of menstrual bleeding and works for 5 years.

99% effective
Side effects: spotting

I hope this makes the choice a bit easier! If you’re still not sure about which method is right for you, please make an appointment with your women’s health professional to discuss the various options available to you.

The original version of this article can be found on Dr Jireh Serfontein’s blog page.