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Birth Control

Birth control, also known as Contraception or Fertility control, is any method, medicine, or device used to prevent pregnancy. The type of birth control you use depends on your health, your desire to have children now or in the future, and your need to prevent sexually transmitted infections

Birth Control methods

Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability.

Birth control methods include

  • Barrier methods
  • Reversible methods
  • Permanent methods
  • Behavioural method
  • Emergency contraception

Barrier methods

Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus

Male condom: Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, and HIV and other STDs, as do the newer synthetic condoms. Typical use failure rate: 13%.

Female condom: Worn by the woman, the female condom helps keeps sperm from getting into her body. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%, and also may help prevent STDs. Simultaneous use of both the female and male condom is not recommended because they may adhere to each other, leading to slippage or displacement of either device.

Diaphragm or cervical cap: Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Typical use failure rate for the diaphragm: 17%.

Spermicides: These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. Typical use failure rate: 21%.

Reversible methods

Reversible contraception method is divided into:

  • Long Acting Reversible Contraceptives (LARC) : they provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs) and subdermal contraceptive implants.
  • Short Acting Reversible Contraceptives (SARC) :contraception is for only a short period of time. they include Combined pill, Progestogen-only pill (mini pill or POP), Contraceptive patch. Contraceptive vaginal ring.

Long Acting Reversible Contraceptives (LARC)

Intrauterine Contraception

  • Levonorgestrel Intrauterine Device (LNG IUD): The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 6 years, depending on the device. Typical use failure rate: 0.1-0.4%.
  • Copper T Intrauterine Device (IUD): This IUD is a small device that is shaped in the form of a “T.”Copper acts as a spermicide within the uterus. The presence of copper increases the levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids. Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure rate: 0.8%.

Implant:

The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate: 0.01%.

Injection or “shot”:

Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 4%.

Short Acting Reversible Contraceptives (SARC)

Combined oral contraceptives: Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%.

Oral contraceptive pills isolated on white realistic vector illustration

Progestin only pill: Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%

Patch:This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%.

Hormonal vaginal contraceptive ring: The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7%.

Permanent Methods

Female Sterilization—Tubal ligation or “tying tubes”: A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. Typical use failure rate: 0.5%.

Male Sterilization–Vasectomy: This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Typical use failure rate: 0.15%.

Behavioural Method

Coitus interruptus or withdrawal

Coitus interruptus involves withdrawal of the entire penis from the vagina before ejaculation. Fertilization is prevented by lack of contact between sperm and the egg. This method of contraception remains a significant means of fertility control in the developing world.

The failure rate is estimated to be approximately 4% in the first year of perfect use. In typical use, the rate is approximately 22% during the first year of use.

Lactational Amenorrhea Method

For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met:

  • amenorrhea (not having any menstrual periods after delivering a baby),
  • fully or nearly fully breastfeeding,
  • less than 6 months after delivering a baby. LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.

Abstinence

Sexual abstinence may be used as a form of birth control, meaning either not engaging in any type of sexual activity, or specifically not engaging in vaginal intercourse, while engaging in other forms of non-vaginal sex. Complete sexual abstinence is 100% effective in preventing pregnancy.

Fertility Awareness-Based Methods

Understanding your monthly fertility pattern can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. Failure rates vary across these methods. Range of typical use failure rates: 2-23%.

Emergency Contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed.  It can prevent pregnancy up to 3 to 5 days after sex, although the sooner you take it, the better. They work primarily by preventing ovulation or fertilization. Examples include

Emergency contraceptive pills

Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after a single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%).Ulipristal, when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel. Mifepristone is also more effective than levonorgestrel.

Copper IUD The Copper  IUD can be inserted as many as 5 days after unprotected sexual intercourse to prevent pregnancy. Insertion of the IUD is significantly more effective than either levonorgestrel or ulipristal acetate regimen, reducing the risk of pregnancy following unprotected intercourse by more than 99%.

Summary

Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ways:

  • Preventing sperm from getting to the eggs. Types include condoms, diaphragms and cervical caps
  • Keeping the woman’s ovaries from releasing eggs that could be fertilized. Types include birth control pills, patches, shots, vaginal rings, and emergency contraceptive pills.
  • IUDs, devices which are implanted into the uterus. They can be kept in place for several years.
  • Sterilization, which permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant

Your choice of birth control should depend on several factors. These include your health, frequency of sexual activity, number of sexual partners and desire to have children in the future. Your health care provider can help you select the best form of birth control for you.

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