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Overview of Contraception

by Laura Sech, Penina Segall-Gutierrez, MD, MSc; Emily Silverstein; Daniel R. Mishell, Jr., MD

Among contraceptive users in the US, the most commonly used methods are oral contraceptives (OCs—28%), female sterilization (27.1%), male condoms (16.1%), male sterilization (9.9%), intrauterine devices (IUDs—5.5%), withdrawal (coitus interruptus—5.2%), progestin injections (3.2%), vaginal contraceptive rings (2.4%), subdermal progestin implants (< 1%), contraceptive transdermal patches (< 1%), fertility awareness methods (periodic abstinence—< 1%), and female barrier methods (< 1%— Comparison of Common Contraceptive Methods).

In the first year of use, pregnancy rates with typical use are

  • < 1% with methods unrelated to coitus and not requiring user involvement (IUDs, subdermal progestin implants, sterilization)

  • About 6 to 9% with hormonal contraceptive methods unrelated to coitus and requiring user involvement (oral contraceptives, progestin injection, transdermal patch, vaginal ring)

  • > 10% with coitus-related methods (eg, condoms, diaphragms, fertility awareness methods, spermicides, withdrawal)

Pregnancy rates tend to be higher during the first year of use and decrease in subsequent years as users become more familiar with the contraceptive method they have chosen. Also, as women age, fertility declines. For fertile couples trying to conceive, the pregnancy rate is about 85% after 1 yr if no contraceptive method is used.

Despite the higher pregnancy rate associated with condom use, experts recommend that condoms always be worn during intercourse because they protect against sexually transmitted diseases (STDs). Most importantly, they help protect against HIV. For most effective contraception, other birth control methods should be used with condoms.

If contraception fails, emergency contraception may help prevent an unintended pregnancy. Emergency contraception should not be used as a regular form of contraception.

Comparison of Common Contraceptive Methods

Type

Pregnancy Rate in First Year of Use

Pregnancy Rate With Continued Use

Requirements for Use

Selected Disadvantages

With Perfect Use

With Typical Use

Hormonal

Oral contraceptives (OCs)*

0.3%

9%

67%

Pill taken daily

Progestin-only pills: Taken at the same time of day

Fluid retention, irregular bleeding, breast tenderness, nausea and vomiting, headache, multiple drug interactions

Combination OCs: Increased risk of venous thromboembolism

Progestin-only OCs: Similar to those of contraceptive implants

Progestin injection

0.2%

6 %

56%

Injection q 3 mo

Amenorrhea, irregular bleeding, weight gain

Subdermal progestin implant

0.05%

0.05%

84%

Implant q 3 yr

Amenorrhea, irregular bleeding

Transdermal patch

0.3%

9%

67%

Weekly application and removal

Similar to OCs

Local irritation

Vaginal ring

0.3%

9%

67%

Monthly application (inserted vaginally) and removal

Similar to OCs

Barrier

Cervical cap with spermicide

8% (higher among parous women)

N/A

Must be used with each coital act

3 sizes (size chosen based on the woman's pregnancy history)

Should be left in the vagina for ≥ 6 h after intercourse

Possibly vaginal irritation or ulceration if left in place for > 48 h

Condom , male

2%

18%

43%

Must be used with each coital act

Requires cooperative partner

Allergic reactions

Condom, female

5%

21%

41%

Must be used with each coital act

Allergic reactions

Contraceptive sponge

(containing sustained-release spermicide)

9% for nulliparous women

20% for parous women

12% for nulliparous women

24% for parous women

36%

Must be used with each coital act

May be inserted 24 h before intercourse

Must remain in place for ≥ 6 h after intercourse

Allergic reactions, vaginal dryness or irritation

Diaphragm with spermicide

6%

12%

57%

Must be used with each coital act

Must be inserted ≤ 6 h before intercourse

May be left in place 6–24 h after intercourse

Occasionally vaginal irritation

Increased incidence of UTIs

Other

Intrauterine devices (IUDs)

Levonorgestrel-releasing IUDs: 0.3–0.5% (LNg14 [3-yr IUD]) or 0.2% (LNg20 [5-yr IUD])

Copper-bearing T380A IUDs: 0.6%

Levonorgestrel-releasing IUDs: Same as perfect use

Copper-bearing T380A IUDs: 8%

78–80%

Levonorgestrel-releasing IUDs: Insertion q 3 yr or 5 yr (depending on type)

Copper-bearing T380A IUDs: Insertion q 10 yr

Spontaneous expulsion, uterine perforation (rare)

Levonorgestrel-releasing IUDs: Irregular bleeding, amenorrhea

Copper-bearing T380A IUDs: Increased menstrual blood loss, pelvic pain

Fertility awareness–based methods (periodic abstinence)

0.45% or higher, depending on method

24%

47%

Training, effort, and multiple steps required for the more effective methods

No likely systemic or significant local adverse effects

Withdrawal method

4%

22%

46%

Must be used with each coital act

Requires cooperative partner

Sterilization, female

0.5%

Same as perfect use

100%

Requires a procedure (typically done in an operating room but sometimes in an office)

Considered permanent

Backup contraceptive method required while waiting for confirmation of sterility after office procedures (3 mo)

Sterilization, male

0.15%

Same as perfect use

100%

Requires a procedure (done in an office) and a local anesthetic

Considered permanent

Backup contraceptive method required while waiting for confirmation of sterility (3 mo)

*Oral contraceptives (OCs) have health benefits other than contraception.

Condoms protect both partners against sexually transmitted diseases.

N/A = not applicable.

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