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Comparison of birth control methods

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Different types of birth control methods have large differences in effectiveness, actions required of users, and side effects.

Ease of useEdit

Different methods require different actions of users. Barrier methods, spermicides, and withdrawal must be used at every act of intercourse. The male condom may not be applied until the man achieves an erection. Other barrier methods (cervical barriers, contraceptive sponge, and female condom) may be placed several hours before intercourse begins. Spermicides, depending on the form, may be applied several minutes to an hour before intercourse begins.

Oral contraceptives, periodic abstinence methods, and the lactational amenorrhea method (LAM), require some action every day. Other hormonal methods require less frequent action - weekly for the patch, monthly for the vaginal ring, and every twelve weeks for the injection Depo-Provera.

Intrauterine methods require clinic visits for removal and replacement (if desired) only once every few years (3-10, depending on the device). Sterilization is a one-time, permanent procedure - after the surgery, no action at all is required of users.

Side effectsEdit

Different forms of birth control have different potential side effects. Not all, or even most, users will experience side effects from each method.

Minimal or no side effects are possible with withdrawal, periodic abstinence, and LAM. Some forms of periodic abstinence encourage examination of the cervix; insertion of the fingers into the vagina to perform this examination may cause changes in the vaginal environment. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices.

Barrier methods have a risk of allergic reaction. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example. Barrier methods are also often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, and urinary tract infection.

Sterilization procedures are generally considered to have low risk of side effects, though some persons and organizations disagree.[1][2]

Intrauterine methods often cause pain and changes in bleeding patterns.

Because of their systemic nature, hormonal methods have the largest number of possible side effects.

Effectiveness calculationEdit

Failure rates may be calculated by either the Pearl index or a life table method. A "perfect-use" rate is where any rules of the method are rigorously followed, and (if applicable) the method is used at every act of intercourse.

Actual failure rates are higher than perfect-use rates for a variety of reasons:

  • mistakes on the part of those providing instructions on how to use the method
  • mistakes on the part of the method's users
  • conscious user non-compliance with method.

For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not bother to go to the pharmacy on time to renew the prescription.

User dependenceEdit

Different methods require different levels of diligence by users. Methods that require a clinic visit less than once per year are said to be non-user dependent. Intrauterine methods and sterilization fall into this category. For methods that are not user dependent, the actual and perfect-use failure rates are very similar.

Both the hormonal methods of birth control, and LAM require a moderate level of thoughtfulness. For hormonal methods, clinic visits must be made every three months to a year to renew the prescription. The pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. The rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are occasionally used incorrectly (rarely going longer than 4-6 hours between breastfeeds, a late pill or injection, or forgetting to replace a patch or ring on time). The actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.

Higher levels of user commitment are required for other methods. Barrier methods, withdrawal, and spermicides must be used at every act of intercourse. They do not provide any protection from pregnancy if they are not used. Periodic abstinence methods require daily tracking of the menstrual cycle. They also do not provide any protection from pregnancy if incorrectly used. The actual failure rates for these methods are much higher than the perfect-use failure rates.

Effectiveness of various methodsEdit

  • The table below color codes the Perfect-use failure rates as:
Green under 1% lower risk
Yellow up to 5%
Orange up to 10%
Red over 10% higher risk

Many methods may be combined for higher effectiveness rates. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users.[3] If a method is known to have been ineffective (such as a condom breaking), emergency contraception may be taken up to 72 hours after sexual intercourse.

Comparison tableEdit

This table demonstrates the chance of pregnancy during the first year of use.

Birth control method Type Typical failure rate (%) Perfect-use failure rate (%)
Jadelle (low-dose synthetic progestogen implant) Hormonal 0.05 0.05
Implanon (medium-dose synthetic progestogen implant) Hormonal 0.05 0.05
IntraUterine System (e.g. Mirena) Intrauterine & Hormonal 0.1 0.1
Male sterilization Sterilization 0.15 0.1
Combined oral contraceptive pill
("COCP" estrogen/progestogen, "The Pill")
Hormonal 8 0.3
Depo Provera (synthetic progestogen injection) Hormonal 0.3 0.3
Female sterilization Sterilization 0.5 0.5
Progestogen only pill ("POP", "minipill") Hormonal 5 0.5
Intrauterine device (e.g. Copper T) Intrauterine 0.8 0.6
Contraceptive patch ("The Patch") Hormonal 1-2 1
Lactational amenorrhea method ("Ecological Breastfeeding")2
Natural 2 0.5
NuvaRing Hormonal 2 1
Male latex condom Barrier 15 2
Fertility awareness1
(basal body temperature, cervical, post-ovulation)
Natural 3-25 1-3
Withdrawal (coitus interruptus) Natural 19 4
Female condom Barrier 21 5
Diaphragm and spermicide Barrier 20 6
Lea's shield Barrier 15 3 4.44
Cervical cap and spermicide used by nulliparous5 Barrier 16 9
Vaginal sponge and spermicide used by nulliparous5 Barrier 16 9
Rhythm Method Periodic abstinence 25 9
Gel / foam / suppository / film Spermicide 29 18
Vaginal sponge and spermicide used by parous6 Barrier 32 20
Cervical cap and spermicide used by parous6 Barrier 32 26
None (unprotected intercourse) N/A 85 85

Note 1: This term is sometimes used interchangeably with the term "natural family planning" (NFP), though NFP usually refers to use of periodic abstinence in accordance with Catholic beliefs.
Note 2: Pregnancy rate is for first six months of use (method becomes less effective when used beyond six months post-partum), or until first postpartum menstruation (method is no longer effective after menstruation resumes).[4]
Note 3: There exists only a clinical trial with a sample of 59 women (17% nulliparous), with spermicide.[5]
Note 4: Same data, if population is standardized in terms of parity (this rate is lower because of low index of nulliparous women in the study)[6]
Note 5: Nulliparous: those who have not given birth to a child.
Note 6: Parous: those who have given birth to a child.

ReferencesEdit

  • Trussell, James (2004). "Contraceptive Efficacy" in Hatcher, Robert A.; Trussell, James; Stewart, Felicia H.; Nelson, Anita L.; Cates Jr., Willard; Guest, Felicia; Kowal, Deborah Contraceptive Technology, 18th rev. ed., pp. 773-845, New York: Ardent Media. ISBN 0-9664902-6-6.

FootnotesEdit

  1. Bloomquist, Michele Getting Your Tubes Tied: Is this common procedure causing uncommon problems?. MedicineNet.com. WebMD. URL accessed on 2006-09-25.
  2. Hauber, Kevin C. If It Works, Don't Fix It!. URL accessed on 2006-09-25.
  3. Kestelman P, Trussell J. Efficacy of the simultaneous use of condoms and spermicides.. Fam Plann Perspect 23 (5): 226-7, 232. PMID 1743276.
  4. Comparison of Effectiveness. Planned Parenthood. URL accessed on 2006-08-12., which cites Hatcher.
  5. Birth Control Guide. FDA Consumer. U.S. Food and Drug Administration. URL accessed on 2006-08-12.
  6. FDA Approves Lea's Shield. The Contraception Report. Contraception Online. URL accessed on 2006-08-13.


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