Contraception and Birth Control – An Overview

In our day and age, men and women can choose from a wide range of effective and safe forms of contraception preventing unwanted or unplanned pregnancy. Some of the barrier methods also offer protection against sexually transmitted infections such as Chlamydia, genital herpes or HIV. Below is a brief guide to the most common contraceptive methods and how effective they are. To determine which one is right for you, please visit a GUM or family planning clinic for confidential advice and detailed information.

Which forms of contraception can I choose from?

1. Barrier Methods

The Male Condom

A very thin sheath is placed over the man’s erect penis prior to sexual intercourse. This prevents sperm from entering the vagina and uterus which could potentially lead to the fertilisation of an egg. Condoms are made from latex or natural rubber and polyurethane for those allergic to latex. Some condoms are made from animal intestine although these are not as widely used. The male condom offers protection against a range of STIs. It should be discarded after one use and needs to be handled with care as sharp objects or finger nails, heat exposure or oil-based lubricants can perforate, rip or tear the condom making it ineffective. A wide selection of condoms is available over the counter in pharmacies, drugstores or supermarkets. If used correctly, the male condom is 98% effective, i.e. 15 out of 100 women will get pregnant when using the male condom for contraception.

The Female Condom

This barrier method is designed to line the inside of the vagina to prevent sperm from reaching the uterus. A thin plastic tube similar to a small bin liner in appearance is inserted into the vagnia prior to intercourse with a small ring that stays outside the vagina holding it in place. Female condoms offer effective protection against sexually transmitted diseases and unwanted pregnancy if used correctly, which can sometimes be a bit tricky as care needs to be taken to not push out the condom during intercourse by accident. Compared to other contraceptives, they are not very widely used and some couples find their use interruptive. The Femidom can be bought over the counter at most pharmacies. If used correctly, the female condom is 79% effective, i.e. 21 out of 100 women will get pregnant when using the female condom for contraception.

The Diaphragm

This soft and flexible dome-shaped cap is made of latex or silicone and available in different sizes depending on the woman’s anatomy.The correct size is determine by a doctor or trained nurse, so you will need to visit a family planning clinic in order to obtain it. The diaphragm is inserted into the vagina prior to vaginal intercourse and used together with a spermicidal gel or cream which also has a contraceptive effect. The cap closes the entrance to the uterus (womb) and forms a cervical barrier thus preventing sperm from reaching an egg which could potentially lead to fertilisation. It may take some practice to learn how to use the diaphragm properly and it can cause irritation due to the spermicide or also cystitis in some women. According to research, the diaphragm may protect against certain STIs, however clinical evidence is not conclusive so you should always use a male condom additionally. If used correctly, the diaphragm is 84% effective, i.e. 16 out of 100 women will get pregnant when using the diaphragm for contraception.

2. Hormonal Contraception

At present, hormonal contraception is only available to women. Research has been undertaken in a bid to develop a male hormonal contraceptive, ‘The Male Pill’, however as it stands, no such contraceptive will be available in the foreseeable future. All hormonal contraceptives are reversible and normal fertility ususally returns a few weeks to a few months after coming off the contraceptive. All hormonal contraceptives contain either one or two synthetic versions of naturally occuring female sex hormones, which overrides the natural menstrual cycle and prevents ovulation. Hormonal contraceptives do not offer any protection against sexually transmitted infections. They are discrete and non-invasive and the main form of contraception in many countries. Hormonal contraceptives offer high protection against unwanted pregnancy with all of them being more than 99% effective.

The Combined Oral Birth Control Pill (The Pill, COCP)

The Pill is the most common type of female contraceptive. An estimated 3.5 million women in Britain take the Pill. One tablet needs to be taken regularly for either 21 or 28 days. This dosaging scheme mimicks a natural 4 week menstrual cycle. During the last 7 days, a withdrawal bleed similar to a menstrual period will occur. The Pill can also relieve other medical conditions such as painful periods (dysmenorrhoea), very heavy periods or acne. It is a very non-invasive contraceptive, however correct use is crucial and its effectiveness can be impaired by certain medicines such as antibiotics. For further detailed information please visit our dedicated guide to The Pill.

The Progestogen-only Pill (Mini Pill)

Contrary to common misconception, this is not a low-dose version of the COCP. The mini pill contains one type of hormone, a progestogen and does not contain any estrogen. Due to this hormonal change, the consistency of the cerival mucus thickens which prevents sperm from getting into the uterus. Periods may stop, become lighter or more while taking the mini pill and unlike the COCP which does have certain risk factors, the progestogen-only pill is suitable for women over the age of 35 or smokers. The mini pill needs to be taken at the exact same time every day.

Contraception

The Contraceptive Implant (Implanon)

This subdermal implant has been on the market for just over 10 years and is currently the most effective form of reversible contraception with a rate of effectiveness of 99.9%. It measures about the size of a small matchstick and gradually releases a low dose of progestin (porogestogen) over the course of three years, after which it needs to be replaced. The implant is inserted into the upper arm under local anaesthetic by a doctor. It is invisible and the procedure is quick and painfree. A major advantage of Implanon is the fact that you do not need to worry about taking a pill every day.

The Contraceptive Depot Injection (Depo-Provera)

A synthetic version of a female sex hormone of the progestogen type is injected intravenuously every three months. You do not need to think about contraception on a daily basis which can be beneficial, especially if you have trouble remembering to take a pill, if you work shifts or if you travel a lot. It takes about 3 months for the hormone to be completely broken down by the body, so once you come off the depot injection, it will most likely take a few months before normal fertility is restored.

The Intrauterine System IUS (Mirena)

The IUS is not to be confused with the IUD as the Mirena device also contains a low dose of hormones, again of the progestin class of hormones. The small plastic T-shaped device is fitted by a doctor and inserted into the womb during a simple procedure where it remains for up to five years. Due to the hormones, periods may become light or stop altogether which can be a benefit to women suffering from very heavy or painful periods. The IUS can easily be removed at any time and has the advantage that you do not need to think about contraception for up to a few years.

The Vaginal Contraceptive Ring (NuvaRing)

This small, bendy ring is made from plastic. It is inserted into the vagina and worn for three weeks during which it gradually releases a combination of two hormones of the same kind as the ones found in the combined oral contraceptive pill. After three weeks, the ring is removed for one week before a new NuvaRing is inserted. The method is convenient and easy, you do not need to worry about contraception every day and the woman can insert and remove the ring herself easily. For further details, side effects and precautions of this contraceptive, please read our NuvaRing guide.

The Contraceptive Patch (Evra)

Another relatively new form of hormonal contraception is this light pink square transdermal patch. It is applied to one of several areas on the body where it will stick for three weeks during which a combination of synthetic hormones preventing pregnancy are released and absorbed via the skin. The patch is to be changed every week for three weeks before you’ll have a seven day break during which you will experience a withdrawal bleed. The Evra patch is not suitable for overweight women. Further useful information on this contraceptive can be found on our dedicated page discussing the Evra patch.

3. Surgical Methods

Sterilisation is irreversible hence you should think very carefully whether you wish to be permanently infertile. Usually one of two partners in a stable long term couple will undergo the procedure once family planning has been completed and the couple are certain that they do not want any more children. While the operation is supposed to be permanent in both sexes, the procedure may be reversible in some people. In very rare cases, sterilisation proves to be ineffective, however this will only become apparent in a pregnancy, so if you are missing a period despite you or your partner being sterilised, take a pregnancy test.

Vasectomy

The man’s spermatic ducts which transport the sperm from the testicles into the penis are severed (hence the colloquial name ‘the snip’) before being either tied off or sealed. As a result, the seminal fluid expulsed during ejaculation no longer contains sperm. The operation is quick and easy and carried out under local anaesthetic – a hospital stay is not required.

Female Sterilisation

This minor surgical procedure which generally requiresd spending one day at hospital is now becoming increasingly popular in the UK and in fact worldwide. The fallopian tubes which connect the ovaries (where the egg is released) and the womb (the uterus, where the egg travels to after ovulation and where it will nest if fertilised successfully) are cut or sealed off with a small clip or ring. As a result, the egg released from one of the ovaries every month can no longer get into the uterus hence fertilisation is no longer possible. The operation can be reversed however success rates are very small. If you change your mind and would like to have a child despite being sterilised, IVF would be an option however you should not rely on this and only go ahead with the operation if you are absolutely certain that you do not want any, or any more children.

4. Chemical Methods

Spermicides are over the counter creams, jellies, gels, tablets or suppositories contain a chemical agent killing sperm. The product is applied to the vagina internally prior to sexual intercourse. Some ingredients, such as Nonoxyl-9 which is commonly used, can irritate the vagina or penis. Some condoms are coated in Nonoxyl-9 as an additional contraceptive. If you know that you are allergic or sensitive to this chemical, refrain from using any product containing it. Spermicides arou 71% effective in preventing pregnancy, which means 29 out of every 100 women using spermicides will get pregnant. Due to this high failure rate, spermicides should not be used alone, but combined with another contraceptive such as the male condom or the diaphragm. Spermicides do not protect against STIs.

5. Natural Birth Control

This method is often referred to as ‘natural family planning’. It consists of a number of methods used to identify the different stages of the woman’s mentrual cycle and determine the most fertile days during which the woman will abstain from vaginal sex. Natural birth control involves observing the consistency of the cervical mucus, measuring basal body temperature and the so-called calendar method to determine when ovulation is likely to occur. Ovulation tests or a special device testing your urine called Persona can be bought over the counter. Natural family planning is not recommended for women with irregular periods or for women for whom pregnancy would be an absolute disaster.

6. Other

The Intrauterine Device IUD (Coil)

Contraceptive IUDs have been used since the 1960s, Back then, their appearance resembled a coil hence the nickname. A flexible T-shaped plastic device with a copper spindle is inserted into the womb in a simple procedure by a trained doctor. The exact contraceptive action of the IUD is not yet fully understood, however among other effects, the copper wire affects the mobility of sperm. The IUD can stay in place for up to 5 years after which it needs to be replaced. Two thin flexible plastic strings allow the woman to check herself regularly to ensure that the device is still in place correctly. There is a chance that the device is expulsed and periods may become heavier or more painful which may not make it a suitable contraceptive for women suffering from very heavy or painful periods.

Coitus Interruptus – Withdrawal

The pull-out method requires the man to withdraw his penis from the vagina just before ejaculation. This is a very risky method and the failure rate is quite high as pre-ejaculatory fluid released from the penis can contain sperm and it is not always easy to detect the right point in time to withdraw.

Contraception in the UK

To give you a better idea of how popular the different contraceptives outlined above are in the UK, please have a look at the following ranking:

1. The Pill including the mini-Pill - 27 %
2. Male condom - 22 %
3. Vasectomy - 11 %
4. Female sterilisation - 9 %
5. IUD (the coil) - 4 %
6. Withdrawal method – 3 %
7. Natural family planning – 3 %
8. Depot injection – 2 %
9. IUS (Mirena) – 2 %
10. Evra patch – 1 %
11. Diaphragm – 1 %
12. Femidom – less than 1 %

Contraception