This is the gynaecologist’s ultimate guide to the best birth control methods out there

Choosing a birth control method that suits you is very important to ensure you avoid an unplanned pregnancy. Hence, we got a doctor to rank the best birth control options.
birth control methods
Birth control methods are not a one-size-fits-all. Image courtesy: Shutterstock
Sonakshi Kohli Updated: 13 Oct 2023, 17:07 pm IST
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For a sexually-active woman, having to choose a suitable method of contraception is like having to choose from a rack of a thousand inviting dresses. You just don’t understand which one to choose simply because there are multiple birth control options that promise to keep an unwanted pregnancy at bay.

If you too seem to be stuck in this situation and simply cannot make up your mind about picking up the right contraception method, we’ve brought some help for you. We asked Dr. Uma Vaidyanathan, senior consultant, obstetrics and gynaecology, Fortis Hospital, Shalimar Bagh; to weigh in on all the birth-control options so you can make a decision that suits you the best.

Take a look at everything available and decide:

1. Barrier methods
These are birth-control methods that involve a physical barrier that is used before and during sexual intercourse to block the entry of sperm into a woman’s uterus. Dr. Vaidyanathan mentions the following options of barrier methods that are commonly available:

i) Male and female condoms: While a male condom can be worn over an erect penis and is 98% effective when used properly, a female condom can be placed inside the vagina and is 95% effective when used properly. Both create a barrier and prevent the entry of sperm inside the uterus.

birth control methods
Meet condom, your sex buddy. Image courtesy: Shutterstock

ii) Diaphragms: A diaphragm is a flexible cup made of soft silicone that contains spermicides and can be placed over the cervix before sex and left in place for at least six hours after sex. It is known to be 94% effective against an unwanted pregnancy—provided it is used and placed properly.

iii) Cervical cap: The cervical cap fits over the cervix and blocks the sperm from entering the uterus through the external orifice of the uterus. It is known to be almost 71% effective.

iv) Contraceptive sponge: This is a soft, disk-shaped sponge containing spermicide. It is inserted in the vagina before having sex and is known to be 88% effective when it comes to preventing an unwanted pregnancy.

2. Short-acting hormonal methods
These include birth-control methods that have to be used on a daily/weekly/monthly basis and Dr. Vaidyanathan mentions the following options for it:

i) Oral contraceptive pills (OCPs): There are four types of oral contraceptive pills:

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  • Progestogen-only pill: A.K.A. mini-pill, the progestogen-only pill simply thickens the cervical mucous, making it unfriendly for the sperm to ascend up post intercourse into the female genital tract. These pills usually have to be taken every day at the same time continuously for around 21 days by a woman to prevent pregnancy.
  • Combined OCP: This is the most commonly prescribed type of OCP and uses progesterone to prevent ovulation and to thicken the mucous as well as the estrogen to control menstrual bleeding.
  • Continuous or extended-use pill: While mini pill and combined OCPs are taken continuously for 21 days followed by a 7-day pill-free break, continuous or extended-use pills are either taken continuously every day without any breaks or are simply taken continuously for more than 21 days, reducing the number of pill-free days.

Effectiveness: Usually, combined OCP’s are prescribed by health practitioners to women, who are either suffering from a hormonal imbalance or are looking to avoid an unwanted pregnancy. However, according to Dr. Vaidyanathan, sometimes these hormonal pills can have side-effects such as nausea, headaches, abdominal cramping, breast tenderness, and an increase in vaginal discharge or a decreased libido. But, most of these side effects are mild and disappear with continued use of the pill. However, if they don’t, then switching on to a pill with a different estrogen-progesterone ration or to the mini pill can help.

Dr. Vaidyanathan also warns that if OCP’s are taken after a gap of more than 24 hours, it could affect their efficiency. Hence, if a woman misses 1 to 2 pills, she is advised to have the missed pill as soon as she remembers and use a barrier method as well to avoid pregnancy.

Also, OCPs should not be used in women with uncontrolled hypertension, diabetes, women with a history of venous thromboembolism (VTE), known ischemic heart disease, migraines with auras, active or history of breast or endometrial cancer and valvular heart disease. In this case, other methods may be considered.

  • Emergency contraception: Also known as the ‘morning-after’ pill, it is supposed to be taken within 72 hours of having unprotected sex so as to avoid an unwanted pregnancy.
birth control methods
Take birth control pills with proper prescription. Image courtesy: Shutterstock

Effectiveness: It can reduce the risk of pregnancy by up to 87% but has too many side effects involved. Thus, it must be used only in case of an emergency—just as the name suggests.

ii) Vaginal ring: The vaginal ring is a hormonal birth control (contraceptive) device for women. It’s a flexible, latex-free plastic ring that’s inserted into the vagina. It contains the hormones estrogen and progesterone which are released over a three-week period. It is worn for three weeks and then removed, allowing for menstruation to occur. A new ring is inserted after a week’s gap.

Effectiveness: “Vaginal rings act in a way similar to that of oral contraceptive pills but with little effect on the other body systems. They’re are comfortable and easy to use and eliminate the need to remember taking a daily pill and are generally very well-tolerated, but can cause spotting, vaginal infection or irritation in certain patients,” Vaidyanathan says.

If used correctly, they’re known to be 99% effective.

iii) Hormonal patches: “These are patches contain estrogen-progesterone for weekly application over the skin and are similar to oral contraceptive pills in terms of mechanism of action, benefits, and side effects. Their main advantage is that they need to be changed only once a week. This avoids the problem of missed doses with oral pills.

Effectiveness: Though its effect starts immediately after application, additional contraception is advised for the first 7 days after sticking the patch. They’re known to be more than 99% effective if used correctly. However, they do not protect a woman from AIDS or other sexually transmitted diseases.

3. Long-acting hormonal methods
Long-acting hormonal methods of contraception usually last for 3 to 10 years after insertion, depending on the device, or until you decide to have the device removed. Take a look at some of the options:

i) Intrauterine devices: “Intrauterine devices (IUDs) are copper or hormone impregnated devices placed inside the uterus to prevent the contact of sperm with the egg, usually, by thickening the cervical mucous, which inhibits a pregnancy. It is one of the most popular and effective methods of birth control.

Effectiveness: Even though copper IUDs are 99.9% effective, but they can cause an inflammatory reaction for the lining of the uterus. There’s a very small risk of expulsion when the IUD is implanted and some women complain of excessive bleeding, pain, discomfort or continued spotting during the first few months. In fact, IUDs are not the best choice for women who are at a high risk of contracting a sexually transmitted infection (STI).

birth control methods
Safe sex means zero tension! Image courtesy: Shutterstock

ii) Birth control shots: These are progesterone injections in depot form. They’re injected in the muscle every 12 weeks and begin to work as birth control immediately if you get it within the first 5 days of your menstrual period. The action involves inhibition of the ovulation process and making the lining of the uterus inhospitable for a pregnancy.

Effectiveness: This is not to be used in women with liver diseases, unexplained vaginal bleeding, breast cancer, or history of clotting disorders. It can have side-effects such as irregular menses or no menses, weight gain, headaches, weak bones, acne and depression. However, they’re known to be around 94% effective in avoiding an unwanted pregnancy. Needless to say, they also don’t protect against an STI.

iii) Contraceptive implant: The contraceptive implantation method usually involves implanting a flexible plastic rod under the skin of your upper arm. It releases progesterone hormone into your bloodstream and avoids an unwanted pregnancy for around 3 years.

Effectiveness: It is more than 99% effective but can have side-effects such as irregular or no periods at all and must be removed immediately if the patient shows any other side effects after the implant.

4. Fertility awareness method
This focuses on staying aware of the fertile period of your cycle based on your basal body temperature and cervical mucus. Ovulation kits are available which give an idea about the fertile days. Intercourse is either avoided during these days or barrier method of contraception is used.

Effectiveness: Though the probability of getting pregnant after studying your fertility cycle is less, there’s still a high risk involved in this method.

So, which one is the best for you?
“The best contraception method is not decided by the doctor, but by the ‘eligible’ couple seeking contraception. For every couple, the criteria may be different,” says Dr. Vaidyanathan.

Some factors that may help to take this decision are mentioned below by her:

i) Age of the couple and associated health history: If the couple is elderly, with associated co-morbidities like diabetes or hypertension or a strong family history of breast or ovarian cancers, then hormonal methods of contraception may not be correct to use.

ii) Reproductive goals: If contraception is needed for spacing out pregnancies, a long-acting method such as IUD works better.

iii) Relationship factors: Considering important relationship factors such as marital status, number of sexual partners, risk of sexually transmitted infections, and frequency of intercourse are also important to decide the right method of contraception. In this case, a non-invasive method such as a barrier method would be safer for both partners.

Now you know everything! We hope it helps you make the right choice.

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