Overview

Is this topic for you?

Sometimes a woman may not use birth control, or her method may fail. If this happens to you, you may still be able to prevent pregnancy if you act quickly. For more information, see the topic Emergency Contraception.

What is birth control?

Birth control is any method used to prevent pregnancy. Another word for birth control is contraception (say "kon-truh-SEP-shun").

If you have sex without birth control, there is a chance that you could get pregnant. This is true even if you have not started having periods yet or you are getting close to menopause.

The only sure way to prevent pregnancy is to not have sex. But finding a good method of birth control you can use every time can help you avoid an unplanned pregnancy.

What are the types of birth control?

There are many different kinds of birth control. Each has pros and cons. Learning about all the methods will help you find one that is right for you.

• Hormonal methods include birth control pills, shots (such as Depo-Provera), the skin patch, the implant, and the vaginal ring. There is also a hormonal IUD (such as Mirena) that releases a small amount of hormone. Birth control that uses hormones is very good at preventing pregnancy.
• Intrauterine devices (IUDs) are inserted into your uterus. IUDs work very well and are very safe. There are two main types of IUDs: the copper IUD (such as ParaGard) and the hormonal IUD (such as Mirena).
• Barrier methods include condoms, diaphragms, and sponges. In general, these do not prevent pregnancy as well as IUDs or hormonal methods do. Barrier methods must be used every time you have sex.
• Natural family planning (also called fertility awareness) can work if you and your partner are very careful. You will need to keep good records so you know when you are fertile. And during times when you are fertile, you will need to skip sex or use a barrier method.
• Permanent birth control (sterilization) gives you lasting protection against pregnancy. A man can have a vasectomy, or a woman can have her tubes tied (tubal ligation). But this is only a good choice if you are sure that you don't want any (or any more) children.
• Emergency contraception is a backup method to prevent pregnancy if you forget to use birth control or a condom breaks.

For hormonal or barrier methods to work best, you have to use them exactly the way your doctor or the package instructions say. Even then, accidents can happen. So it is a good idea to keep emergency birth control on hand as backup protection. You can buy "morning-after pills," such as Plan B, in most drugstores if you are 17 or older.

How do you choose the best method?

The best method of birth control is one that protects you every time you have sex. And with many types of birth control, that depends on how well you use it. To find a method that will work for you every time, some things to think about include:

• How well it works. Think about how important it is to you to avoid pregnancy. Then look at how well each method works. For example, if you plan to have a child soon anyway, you may not need a very reliable method. If you don't want children but feel it is wrong to end a pregnancy, choose a type of birth control that works very well.
• How much effort it takes. For example, birth control pills may not be a good choice if you often forget to take medicine. If you are not sure you will stop and use a barrier method each time you have sex, pick another method.
• When you want to have children. For example, if you want to have children in the next year or two, birth control shots may not be a good choice. They can make it hard to get pregnant for several months after you stop them. If you never want to have children, natural family planning is not a good choice because it often fails.
• How much the method costs. For example, condoms are cheap or free in some clinics. Some insurance companies cover the cost of prescription birth control. But cost can sometimes be misleading. An IUD costs a lot up front. But it works for years, making it low-cost over time.
• Whether it protects you from infection. Latex condoms can help protect you from sexually transmitted infections (STIs), such as HIV. But they are not the best way to prevent pregnancy. To avoid both STIs and pregnancy, use condoms along with another type of birth control.
• If you've had a problem with one kind of birth control. Finding the best method of birth control may involve trying something different. Also, you may need to change a method that once worked well for you.

If you are using a method now that you are not happy with, talk to your doctor about other choices.

What health issues might limit your choices?

Some birth control methods may not be safe for you, depending on your health. To make sure a method is right for you, your doctor will need to know if you:

• Smoke.
• Are or could be pregnant.
• Are breast-feeding.
• Have any serious health problems, such as heart disease, high blood pressure, migraine headaches, or diabetes.
• Have had blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), or have a close family member who had blood clots in the legs or lungs.
• Have ever had breast cancer.
• Have a sexually transmitted infection.

How can you get birth control?

You can buy:

• Condoms, sponges, and spermicides in drugstores without a prescription.
• Emergency contraception in most drugstores without a prescription. But you do need proof that you are 17 or older.

You need to see a doctor or other health professional to:

• Get a prescription for birth control pills and other methods that use hormones.
• Have an IUD inserted.
• Be fitted for a diaphragm or cervical cap.

Frequently Asked Questions

Learning about birth control:	What is birth control? What are the different methods of birth control? How well do the different methods work? What methods help prevent sexually transmitted infections (STIs)? What is emergency contraception?
For teens only:	How does pregnancy happen? How does birth control prevent pregnancy? What are common myths about sex and pregnancy? What should I do if I miss or skip a birth control pill?
Using birth control:	What should I know about: Condoms (male and female)? Female barrier methods (diaphragm, cap, or sponge)? Fertility awareness (natural family planning)? Combination estrogen plus progestin methods (pill, patch, or ring)? Progestin-only method (pill or shot)? Intrauterine device (IUD)? Tubal ligation and tubal implants for permanent birth control? Vasectomy for permanent birth control? Emergency contraception after unprotected sex?
Advantages and disadvantages:	What are the pros and cons of hormonal birth control?
How-to questions:	How do I use a condom? How do I use a female condom? How do I use a hormonal skin patch? How do I use a hormonal vaginal ring?
Ongoing concerns:	What should I do if I miss or skip a birth control pill? For a planned pregnancy, how long do I wait after stopping birth control to try to become pregnant?

Teens and Birth Control

Whether you are male or female, your life can suddenly be changed forever by pregnancy or a sexually transmitted infection (STI). Think for a moment what this would be like for you.

The most dependable way to prevent pregnancy and STI infection is not to have sexual intercourse. This is called abstinence.

If you do not choose abstinence and are sexually active, always be prepared. To protect yourself and your future, think ahead about birth control methods and STI protection. Never have sex without protection. Using condoms will reduce your risk of getting an STI.

Even a single act of sexual intercourse can lead to pregnancy or an STI infection.

Take charge of your health and your future

Even if you plan not to have sex until you're older, take a little time to learn and decide about:

• Which birth control methods are available.
• Which birth control methods you know you would be able to count on every time you'd need one.
• How to use a condom to avoid getting or spreading a sexually transmitted infection, including HIV. (Some STIs can be spread through oral sex as well as through intercourse.) If you are sexually active, male or female, always have a condom with you. Don't ever depend on someone else to have a condom when you need it.
• How to use a combination of methods for the best protection against pregnancy and sexually transmitted infections.

It may not be easy to talk about sexual activity and birth control, but it is important that you know how to practice safer sex. Hopefully, you have a parent, school or church counselor, or health professional that you feel comfortable talking to. Organizations such as Planned Parenthood are private, confidential resources for learning how to be both sexual and responsible. See the Planned Parenthood website for teens at www.teenwire.com, or check your telephone listings for the Planned Parenthood office near you.

The best birth control methods for you are those that are easy for you to use (or are already in effect) each time you have intercourse. Follow up regularly with a health professional to make sure that your birth control method is working effectively for you. And if you have any side effects that are making it hard for you to use the method as directed, choose a different method.

If you have a long-term (chronic) illness or a disability, talk to a health professional about which birth control choices are best for you.

For teen boys and girls

Protect yourself and your partner from sexually transmitted infections and pregnancy.

• Consider the benefits of abstinence.
• If you have sex, use a condom.
• If your partner is not comfortable with using a condom, don't have sex.
• To prevent pregnancy, use another method of birth control (such as birth control pills) along with the condom.

For teen girls

Some teenage girls are worried about visiting a health professional for birth control.

• Don't be shy about protecting yourself from sexually transmitted infections by having a condom on hand and asking your partner to use it. Or you can use a female condom.
• If you are concerned about having a pelvic exam or keeping your health information private, talk to your health professional or a family planning clinic counselor.
• If you have not been sexually active before now, a pelvic exam is not necessary.
• If you have been sexually active, it's very important that you are screened for STIs every year. Some STIs can be screened for with a urine test.
• Have emergency contraception on hand or know how to get it if a condom breaks.

Before choosing and using a birth control method, be honest with yourself. If it failed and you started a pregnancy, what would you do? Are you ready to raise a child? Is an abortion an acceptable option for you? Answering these questions can help you know how committed you are to preventing a pregnancy. For most sexually active teens, it is worth it to use the most effective birth control methods possible.

When choosing a birth control method, also consider protecting yourself against sexually transmitted infections. Condoms give the most effective STI protection for both partners, no matter what other birth control method you are using. But as birth control, condoms used alone are not highly dependable.

Birth control methods for teenagers

Method	Consideration
Abstinence	Not having sex is the most effective method of birth control and STI prevention.
Barrier methods	Condoms are more likely to prevent pregnancy if you use them with a spermicide or another birth control method. If the condom breaks, you will need to use emergency contraception. Male condoms are inexpensive and easy to get without a prescription. Male condoms give teen boys control over their STI risks and lower the risk of becoming a parent. Female condoms cost more than male condoms and can be difficult to use properly. A diaphragm or cervical cap with a spermicidal cream, foam, or jelly can be difficult to use without first learning how from your health professional.
Hormonal pill, skin patch, or vaginal ring	These are the most popular methods used by teenage girls. You must remember to take a pill every day at about the same time. Talk to your health professional about any side effects. Another type of hormonal birth control may be better for you if side effects are a problem. After stopping birth control pills (at the end of a full pack), you can become pregnant in the next month. The patch is changed every week, which you may prefer to taking a pill each day. The vaginal ring is a foldable, flexible ring of plastic that stays in the vagina for 3 consecutive weeks. Using a condom with these methods will help lower the risk of getting an STI.
Hormonal implants	The hormonal implant is an extremely effective method of birth control. The implant, which is about the size of a matchstick, is inserted under the skin on the inside of your upper arm. This releases hormones that prevent pregnancy for about 3 years. This method is convenient and does not require use every day or with each act of intercourse. With this method, you only need a new implant every 3 years. This method doesn't protect you from sexually transmitted infections. The most common side effect is irregular bleeding. Menstrual cycles also become shorter or stop completely.
Birth control shot	This method is convenient and does not require use every day or with each act of intercourse. This method requires that you see your health professional every 3 months. Side effects of weight gain and irregular bleeding may be bothersome. The shot causes mild bone thinning when it is used for 2 or more years. This is of special concern during the teen years, when young women are normally building bone strength. Be sure to get enough daily calcium and weight-bearing exercise. And discuss with your health professional your bone health and birth control options after 2 years of using the shot.
Intrauterine device (IUD)	The IUD can be used by women under 20. There are side effects that you should discuss with your health professional. Starting an IUD isn't an option for a woman who has a pelvic infection or a sexually transmitted infection. Inserting an IUD can carry infection up into the uterus, leading to pelvic inflammatory disease (PID).
Fertility awareness	This is not recommended, especially for teenagers, because it: Often leads to pregnancy, even with careful planning and not having sex on fertile days. Doesn't protect you from sexually transmitted infections.

Emergency contraception

Emergency contraception can be used if you have had unprotected sex or you think your birth control method may have failed. The pills can prevent a pregnancy when taken up to 5 days after unprotected sex, although they are most effective when used within 72 hours. A copper IUD is sometimes used as emergency contraception and can prevent pregnancy if it is inserted within 5 to 7 days after you have had unprotected sex.

If you have had unprotected sexual intercourse or you think your birth control method may have failed, emergency contraception is a backup to prevent a pregnancy.

It's a good idea to have emergency contraception on hand or a prescription for emergency contraception in case you ever need it. Talk to your health professional or a family planning clinic about this.

If you do use emergency contraception, be sure to follow up with your health professional to find an effective, ongoing method of birth control.

For more information, see the Emergency Contraception website at http://ec.princeton.edu/.

Birth Control Methods

There are many methods of birth control. Learn about the different kinds of birth control to help you choose the best one for you. When making your choice, also consider that only a condom will help protect you from sexually transmitted infections (STIs). To protect yourself and your partner against STIs, use a condom (along with your chosen birth control method) every time you have sex.

Hormonal methods

Hormonal methods are very reliable means of birth control. Hormonal methods use two basic formulas:

• Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills ("the Pill"), skin patches, and rings.
• Progestin-only hormonal methods include pills, also called "mini-pills"; shots (such as Depo-Provera); and implants (such as Implanon). If you can't take estrogen, a progestin-only method may be an option for you. There is also a hormonal IUD that releases a type of progestin.

Combination and progestin-only methods are prescribed for women for different reasons. Each type of method has its pros and cons.

• Combination pills may reduce acne, pain during ovulation, and premenstrual symptoms. Both types of pill reduce heavy bleeding and cramping. Unlike the combination pill, the progestin-only pill can be taken by almost all women, including those who are breast-feeding, although it must be taken at the same time each day to be effective. (Combination pills are also taken daily but without as much attention to the time of day.) When you first start taking either type of birth control pill, it is necessary to use a backup birth control method for the first week.
• Patches or vaginal rings are similar to combination pills, but they don't require taking a daily pill. The patch is changed weekly, and the ring is changed monthly (with 1 week off after 3 weeks of use).
• Some birth control pills reduce severe mood and physical symptoms that some women get before they start their monthly periods. These symptoms are called premenstrual dysphoric disorder (PMDD). There are birth control pills that are helpful for women who have migraines with their periods. There are also birth control pills for women who want fewer periods or who want to stop having periods.
• The birth control shot does not require taking a daily pill. Instead, you see your health professional once every 3 months for the injection.
• The hormone implant releases hormones that prevent pregnancy for about 3 years. It must be inserted and removed by a trained health professional. The actual implant is about the size of a matchstick and is inserted under the skin on the inside of the upper arm.

Intrauterine device (IUD)

An intrauterine device (IUD) is a small device that is placed in the uterus to prevent pregnancy. There are two main types of IUDs: copper IUDs (such as ParaGard) and hormonal IUDs (such as Mirena). When an IUD is in place, it can provide birth control for 5 to 10 years, depending on the type. Unlike IUDs that were used in the 1970s, present-day IUDs are small, safe, and highly effective.

The hormonal IUD typically reduces menstrual flow and cramping over time. On the other hand, the copper IUD can cause longer and heavier periods. But the hormonal IUD can have other side effects, including spotting, mood swings, and breast tenderness. These side effects occur less frequently than with other progestin-only methods.

Barrier methods

Barrier methods (including the diaphragm; cervical cap; cervical shield; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) prevent sperm from entering the uterus and reaching the egg. Typically, barrier methods are not highly effective, but they generally have fewer side effects than hormonal methods or IUDs. Spermicides and condoms should be used together or along with another method to increase their effectiveness. Barrier methods can interrupt sex, because they must be used every time you have sex.

Condoms (male or female) should always be used if you are at risk of getting or spreading a sexually transmitted infection, such as genital herpes, chlamydia, or HIV.

Fertility awareness (periodic abstinence or natural family planning)

Fertility awareness requires that a couple chart the time during a woman's menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a good choice if you need a highly effective form of birth control.

Breast-feeding may work as a form of birth control in the first 6 months after giving birth if you follow specific guidelines. For this method to work, you must breast-feed your baby every time. You can't use formula or other supplements. This is called the lactational amenorrhea method (LAM).

Permanent birth control (sterilization)

Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is one of the most effective forms of birth control. Sterilization is intended to be permanent, and although you can try to reverse it with another surgery, reversal is not always successful.

• Tubal ligation or implants. Tubal ligation is a surgical procedure where the fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked. A new nonsurgical sterilization technique uses a small metal coil, or tubal implant, inserted up into each fallopian tube. Over time, scar tissue grows around each tubal implant, permanently blocking the tubes. Most women are able to return home within a couple of hours after either procedure. You must use another form of birth control for 3 months after receiving tubal implants. At 3 months, you will need to have an X-ray taken to make sure that your tubes are closed.
• Vasectomy. In this minor surgery, the vas deferens, the tubes that carry sperm from the testicles to the seminal fluid (semen), are cut and blocked so that the semen no longer contains sperm. This does not interfere with a man's ability to have an erection or enjoy sex. Men must have a sperm count check after having a vasectomy before relying on this for birth control.

Female sterilization is more complicated, has higher risks of problems after surgery, and is more expensive than male sterilization.

Contraception following pregnancy

Birth control is an important consideration after you have had a child. Your ability to become pregnant again may return within 3 to 6 weeks after childbirth. Think about what type of birth control you will be using, and make a plan during your pregnancy. Most methods of birth control are safe and effective after delivery. But in the first couple of weeks after delivery or if you are breast-feeding, it's best to use a method that doesn't contain estrogen. Talk to your doctor about which type is best for you.

Choosing a Birth Control Method

With so many methods available and so many factors to consider, choosing birth control can be difficult. You may be able to decide on a method by asking yourself the following questions:

Might I want to have a biological child in the future?

One of your first considerations might be to determine whether you want permanent or temporary birth control. In other words, you should consider whether you want to conceive any (or more) children. This is a decision that will affect the rest of your life and can be made only after thinking it through carefully.

If you know that you will not ever want to conceive a pregnancy, tubal ligation or tubal implants for you or a vasectomy for your partner is a reasonable option to consider.

If you are not sure about the future even though you know how you feel now, a temporary method is a better choice. If you are young, have few or no children, are choosing sterilization because your partner wants it, or think it will solve money or relationship problems, you may regret your decision later.

How would an unplanned pregnancy affect my life?

If an unplanned pregnancy would seriously impact your plans for the future, choose a birth control method that is highly effective. Or if you have a stable relationship and income and plan to have children in the future anyway, you may feel comfortable using a less reliable method.

How effective are different types of birth control?

Consider how important it is to you to avoid pregnancy, and then look at how well each birth control method works. Hormonal methods and IUDs work very well. Barrier methods such as condoms, diaphragms, and spermicides are only moderately effective. Fertility awareness is even less effective.

Be honest about how much effort you are willing to put into birth control. To be effective, birth control pills require you to take a pill every day. Barrier methods have to be used before sex. Fertility awareness requires that you watch your temperature and other signs closely. You must also avoid sex on days when you could get pregnant. If you are not willing to put in the effort, choose another method of birth control.

Consider how comfortable you feel about using a particular method of birth control. If you are not comfortable with or might not consistently use a birth control method for any reason, that method is not likely to be reliable for you in the long run.

How can I prevent sexually transmitted infections?

Unless you know that your partner has no other sex partners and is free of sexually transmitted infections (STIs), you are at risk for STI infection. If you are at risk, protect yourself from infection every time you have sex. Use a condom in addition to any other birth control method you choose.

You can choose between a male or female condom to reduce your risk for HIV (the virus that causes AIDS), gonorrhea, syphilis, chlamydia, genital warts, herpes, pelvic inflammatory disease (PID), and other infections.

What health factors could limit my choice of birth control?

If you have health problems or other risk factors, some birth control methods may not be right for you.

• Smoking. If you smoke more than 15 cigarettes a day and are 35 or older or have high blood pressure, a history of stroke, a history of blood clots, liver disease, or heart disease, you may not be able to use combined hormonal methods.
• Migraines. If you have migraine headaches, talk to your health professional about whether you can try combined hormonal contraception.
• Diabetes. If you have advanced or long-standing diabetes, discuss the risks of taking hormonal birth control methods with your health professional.
• Breast-feeding. If you are breast-feeding, the estrogen in combined hormonal birth control can lower your milk supply. Progestin-only pills, an implant, both kinds of IUDs, or birth control shots do not affect your milk supply and are a good option for breast-feeding women.

Other health problems that might keep you from using a particular birth control method are relatively rare, especially in young women. But before using any method, talk with your health professional to see if it is safe for you.

What are some other considerations in choosing a birth control method?

Other things to consider when choosing a method of birth control include:

• Health benefits, such as decreased risk of sexually transmitted infections with condoms and reduced risk of ovarian cancer and uterine cancer with use of birth control pills for one year or longer.
• Convenience and ease of use. Birth control forms such as patches, shots, implants, IUDs, and vaginal rings are convenient for women who have trouble remembering to take a daily pill or couples who know they won't use a barrier method every time they have sex.
• Cost. Over time, the higher one-time cost of IUD insertion or sterilization surgery may be less than the continued costs of buying pills or condoms and spermicide.
• If you are planning to become pregnant in the future. It is best to have a full menstrual cycle before you try to conceive. The amount of time it takes for a woman's full fertility to return after stopping birth control varies for each woman and depends on the birth control method she is using.
• Risks and side effects of the method. Some birth control methods may have a greater risk of causing certain health problems. And some methods cause more side effects than others. For example, hormonal birth control usually has more risks and side effects than barrier methods. Talk to your doctor about the risks and side effects.

Thinking about the pros and cons of hormonal birth control methods may help you choose the one that is best for you.

After you have looked at the facts about the different methods and thought about your own values and needs, you can choose the method that will work best for you. Using condoms with any method may increase its reliability and helps to protect you from sexually transmitted infections (STIs).

Are you interested in what others decided to do? Many people have faced this decision. Personal stories may help you decide.

Emergency Contraception

You can use emergency contraception if a condom breaks, you've forgotten a pill, you are taking other medicines that may affect contraception medicines, or you have had unprotected sex. Emergency contraception does not protect against sexually transmitted infections.

For more information, see the topic Emergency Contraception.

When to Call a Doctor

For many methods of birth control, you'll need to see your doctor to get a prescription. If you want to start birth control, talk with your doctor about options that are right for you. And if you have problems with a birth control method, talk with your doctor. He or she may recommend another birth control method or help you solve the problem you are having.