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Birth control and family planning

Contraception; Family planning and contraception; Coitus interruptus

Your choice of a birth control method depends on a number of factors, including your health, how often you have sex, and whether or not you want children.

Test Your Knowledge About Birth Control

Which of the following are birth control options for women?
A. Hormonal methods
B. IUDs
C. Condoms and diaphragms
D. Natural family planning
E. Sterilization
F. All of the above
The correct answer is all of the above. Your choice of birth control should depend on several factors, including your health, number of sexual partners, and desire to have children. Talk to your health care provider to select the best form of birth control for you.
How does birth control prevent pregnancy?
A. Prevents sperm from getting to an egg
B. Prevents the woman’s ovaries from releasing eggs
C. Kills sperm
D. Changes the lining of the uterus so the egg can’t attach
E. All of the above
The correct answer is all of the above. The goal of all types of birth control is to prevent a fertilized egg from attaching in the uterus. Talk to your doctor and your partner about which type of birth control is best for you.
Which form of birth control offers the most protection against pregnancy?
A. Birth control pills
B. The patch
C. IUDs
D. Vaginal ring
E. Condoms
The correct answer is IUDs. IUDs are 20 times more effective at preventing pregnancy than birth control pills, patches, or rings. Talk to your doctor to find out if this form of contraception is right for you.
Who should NOT use birth control pills?
A. Women who are over age 35 and smoke
B. Women who have heavy periods or endometriosis
C. Women who have PMS
D. Women who have acne
The correct answer is women who are over age 35 and smoke. Smoking greatly increases your risk of heart disease. Birth control pills can increase this risk even more. If you have endometriosis, PMS, or acne, you may notice fewer symptoms while you’re taking birth control pills. Ask your doctor which pill is right for you.
Certain types of birth control pills can get rid of your period almost entirely.
A. True
B. False
The correct answer is true. Extended cycle (or continuous use) medicines reduce, or even eliminate, monthly periods. Talk to your doctor about whether this option is right for you.
Which of the following is true about injected contraceptives (Depo-Provera).
A. You get a shot every 3 months.
B. You should not use it for longer than 2 years in a row.
C. You may gain 5 to 8 pounds.
D. You should not use it if you want to become pregnant within 2 years.
E. You may stop menstruating altogether after a year.
F. All of the above.
The correct answer is all of the above. Depo-Provera does a good job of preventing pregnancy. It also has side effects, including weight gain, menstrual cycle changes, headaches, and bone loss. It could cause infertility for up to 2 years after the last injection. Talk to your doctor about whether Depo-Provera is right for you.
Copper-releasing IUDs can stay in the uterus for up to 10 years.
A. True
B. False
The correct answer is true. Both copper-releasing (ParaGard) and progestin-releasing (Mirena, Kyleena, Liletta, and Skyla) IUDs do a good job of preventing pregnancy. ParaGard can remain in the uterus for up to 12 years compared to 3 to 8 years for progestin-releasing IUDs. Talk to your doctor about whether using an IUD is right for you.
Which natural family planning method works best?
A. Calendar (or rhythm)
B. Cervical mucus
C. Temperature
D. Symptothermal Method
E. Withdrawal (the man removes his penis from the vagina before ejaculation)
The correct answer is Symptothermal Method. This method combines the calendar, cervical mucus, and temperature methods. Because of the high risk of pregnancy, only couples who can't use or choose not to use other types of birth control should use this method. Talk with your doctor before using this approach to birth control.
You can use a diaphragm safely for 5 years.
A. True
B. False
The correct answer is false. Some women need to get a different-sized diaphragm after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 15 pounds (6.8 kg) or more. You should replace your diaphragm about every 2 years.
It's best to use emergency contraception within__ day(s) after having unprotected sex:
A. 1
B. 3
C. 5
D. None of the above
The correct answer is 1 day. Emergency contraception works best when you use it within 24 hours of having sex. However, it can prevent pregnancy for up to 3 days after you first had sex. One type may work up to 5 days later, but it's best to take it sooner. Emergency contraception should not be used as a routine form of birth control.
Which sterilization method works the best?
A. Male (vasectomy)
B. Female
C. They both work equally well
The correct answer is both work equally well. However, vasectomy carries fewer risks and is less expensive than female sterilization. Only you and your partner can decide which method is right for you. Consider your options carefully since it can be difficult to reverse sterilization.

Information

Here are some questions to consider when selecting a birth control method:

How well does the method prevent pregnancy? To tell how well a method works, look at the number of pregnancies in 100 women using that method over a period of 1 year.
What are your feelings about getting pregnant? Would an unplanned pregnancy create hardship or distress to a woman or her partner? Or would a pregnancy be welcomed if it occurred earlier than planned?
How much does a method of birth control cost? Does your insurance plan pay for it?
What are the health risks? Talk about these risks with your health care provider before believing what you hear from others.
Is your partner willing to accept and use a given method of birth control?
Do you want a method that you only need to use when you have sex? Or do you want something that is in place and always working?
Is preventing infections spread by sexual contact important? Many methods do not protect you from sexually transmitted infections (STIs). Condoms are the best choice for preventing STIs. They work best when combined with spermicides.
Availability: Can the method be used without a prescription, a provider visit, or, in the case of minors, parental consent?

BARRIER METHODS OF BIRTH CONTROL

CONDOMS:

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A condom is a thin latex or polyurethane sheath. The male condom is placed around the erect penis. The female condom is placed inside the vagina before intercourse.
A condom must be worn at all times during intercourse to prevent pregnancy.
Condoms can be bought in most drug and grocery stores. Some family planning clinics offer free condoms. You do not need a prescription to get condoms.

DIAPHRAGM AND CERVICAL CAP:

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A diaphragm is a flexible rubber cup that is filled with spermicidal cream or jelly.
It is placed into the vagina over the cervix before intercourse, to prevent sperm from reaching the uterus.
It should be left in place for 6 to 8 hours after intercourse.
Diaphragms must be prescribed by a woman's provider. The provider will determine the correct type and size of diaphragm for the woman.
About 5 to 20 pregnancies occur over 1 year in 100 women using this method, depending on proper use.
A similar, smaller device is called a cervical cap.
Risks include irritation and allergic reactions to the diaphragm or spermicide, and increased frequency of urinary tract infection and vaginal yeast infection. In rare cases, toxic shock syndrome may develop in women who leave the diaphragm in too long. A cervical cap may cause an abnormal Pap test.

VAGINAL SPONGE:

Vaginal contraceptive sponges are soft, and contain a chemical that kills or "disables" sperm.
The sponge is moistened and inserted into the vagina, to cover over the cervix before intercourse.
The vaginal sponge can be bought at your pharmacy without a prescription.

HORMONAL METHODS OF BIRTH CONTROL

Some birth control methods use hormones. They will have either both an estrogen and a progestin, or a progestin alone. You need a prescription for most hormonal birth control methods.

Both hormones prevent a woman's ovary from releasing an egg during her cycle. They do this by affecting the levels of other hormones the body makes.
Progestins help prevent sperm from making their way to the egg by making mucus around a woman's cervix thick and sticky.

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Types of hormonal birth control methods include:

Birth control pills: These may contain both estrogen and progestin, or only progestin.
Implants: These are small rods implanted beneath the skin. They release a continuous dose of hormone to prevent ovulation.
Progestin injections, such as Depo-Provera, that are given into the muscles of the upper arm or buttocks once every 3 months.
The skin patch, such as Ortho Evra, is placed on your shoulder, buttocks, or other place on the body. It releases a continuous dose of hormones.
The vaginal ring, such as NuvaRing, is a flexible ring about 2 inches (5 centimeters) wide. It is placed into the vagina. It releases the hormones progestin and estrogen.
Emergency (or "morning after") contraception: This medicine can be bought without a prescription at your drugstore.

IUD (INTRAUTERINE DEVICE):

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The IUD is a small plastic or copper device placed inside the woman's uterus by her provider. Some IUDs release small amounts of progestin. IUDs may be left in place for 3 to 10 years, depending on the device used.
IUDs can be placed at almost any time.
IUDs are safe and work well. Fewer than 1 out of 100 women per year will get pregnant using an IUD.
IUDs that release progestin may be for treating heavy menstrual bleeding and reducing cramps. They may also cause periods to stop completely.

PERMANENT METHODS OF BIRTH CONTROL

These methods are best for men, women, and couples who feel certain they do not want to have children in the future. They include vasectomy and tubal ligation. These procedures can sometimes be reversed if a pregnancy is desired at a later time. However, the success rate for reversal is not high.

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BIRTH CONTROL METHODS THAT DO NOT WORK VERY WELL

Withdrawal of the penis from the vagina before ejaculation can still result in pregnancy. Some semen often escapes before full withdrawal. It can be enough to cause a pregnancy.
Douching shortly after sex is not likely to work. The sperm can make their way past the cervix within 90 seconds. Douching is never recommended because it can cause infections in the uterus and tubes.
Breastfeeding: Despite the myths, women who are breastfeeding can become pregnant.

Open References +

References

American College of Obstetricians and Gynecologists website. ACOG Practice Bulletin No. 206: Use of hormonal contraception in women with coexisting medical conditions. Obstet Gynecol. 2019;133(6):1288. Erratum for: Obstet Gynecol. 2019;133(2):e128-e150. PMID: 31135757 pubmed.ncbi.nlm.nih.gov/31135757/.

Committee on Adolescent Health Care. Committee Opinion No 699: Adolescent pregnancy, contraception, and sexual activity. Obstet Gynecol. 2017;129(5):e142-e149. PMID: 28426620 pubmed.ncbi.nlm.nih.gov/28426620/.

Curtis KM, Jatlaoui TC, Tepper NK, et al. US selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(4):1-66. PMID: 27467319 pubmed.ncbi.nlm.nih.gov/27467319/.

Harper DM, Wilfling LE, Blanner CF. Contraception. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 26.

Jatlaoui TC, Ermias Y, Zapata LB. Contraception. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 143.

Rivlin K, Davis AR. Contraception and abortion. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

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The cervical cap - illustration

The cervical cap is a flexible rubber cup-like device that is filled with spermicide and self-inserted over the cervix prior to intercourse. The device is left in place several hours after intercourse. The cap is a prescribed device fitted by a health care professional and is more expensive than other barrier methods such as condoms.

The cervical cap

illustration

The diaphragm - illustration

The diaphragm is a flexible rubber cup that is filled with spermicide and self-inserted over the cervix prior to intercourse. The device is left in place several hours after intercourse. The diaphragm is a prescribed device fitted by a health care professonal and is more expensive than other barrier methods such as condoms.

The diaphragm

illustration

The female condom - illustration

The female condom, like the male condom, is a barrier contraceptive made of latex or polyurethane. The condom has a ring on each end. The ring that is placed inside the vagina fits over the cervix, while the other ring, which is open, rests outside of the vagina and covers the vulva. The female condom is sold over-the-counter.

The female condom

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Intrauterine device - illustration

The intrauterine device shown uses copper as the active contraceptive, others use progesterone in a plastic device. IUDs are very effective at preventing pregnancy (less than 2% chance per year for the progesterone IUD, less than 1% chance per year for the copper IUD). IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexually transmitted disease. IUDs are prescribed and placed by health care providers.

Intrauterine device

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Side sectional view of female reproductive system - illustration

The female reproductive system includes the vagina, cervix, and uterus shown here in cut section.

Side sectional view of f...

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The male condom - illustration

The male condom is a barrier contraceptive made of latex or polyurethane. The condom must be fitted over the erect penis. The condom is sold over-the-counter and when used properly is an inexpensive, effective barrier to pregnancy and sexually-transmitted disease.

The male condom

illustration

Hormone-based contraceptives - illustration

The pill works in several ways to prevent pregnancy. The pill suppresses ovulation so that an egg is not released from the ovaries, and changes the cervical mucus, causing it to become thicker and making it more difficult for sperm to swim into the womb. The pill also does not allow the lining of the womb to develop enough to receive and nurture a fertilized egg. This method of birth control offers no protection against sexually-transmitted diseases.

Hormone-based contracept...

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Vaginal ring - illustration

The vaginal ring is a flexible ring about 2 inches in diameter that is inserted into the vagina. It releases progestin and estrogen into the body to avoid pregnancy. The woman inserts it herself and it stays in the vagina for 3 weeks. Then, she takes it out for one week to have her period. Like other hormone methods, a prescription from a doctor is required.

Vaginal ring

illustration