Dr. M.J. Bazos, MD Patient Handout


There are several different methods of preventing pregnancy available to couples. Many couples may have to try several methods of contraception to find out which method suits them. Lifestyle, frequency of sexual activity, and personal preference will affect one’s choice of contraception. Many couples will use different types of birth control throughout their life. Choice of birth control method may also depend on the reason a birth control method is desired. For example, a couple may desire to space out their children, or a couple may need a birth control method while either the woman or the man is taking a medicine.

How Pregnancy Occurs
It is helpful to understand how a pregnancy occurs, to understand how a pregnancy can be prevented. Every month, approximately 12–16 days after a woman’s period, the ovary produces an egg (this is called “ovulation”). The egg is released from the ovary and travels into the fallopian tube, which is connected to the uterus. Pregnancy occurs when the egg is fertilized by the sperm in the fallopian tube. Therefore, pregnancy can occur if intercourse
occurs around the time of ovulation. When the man ejaculates (or climaxes), sperm are released into the vaginal canal. The sperm travel through the cervix (the opening of the uterus) into the uterus, then into the fallopian tubes. If the sperm fertilizes the egg, pregnancy occurs. Pregnancy can be prevented in three ways:
1. Prevent ovulation (the production of an egg from the ovary).
2. Prevent the sperm from traveling to the egg in fallopian tube.
3. Alter the lining of the uterus (the “endometrium”) so it is not suitable for pregnancy.

Methods of Birth Control
Birth Control Pills
Birth control pills contain hormones that are very similar to the hormones produced by the ovaries. The hormones prevent ovulation, the release of an egg from the ovary each month. Because there is no egg that can be fertilized, pregnancy cannot occur. Birth control pills are the most commonly used birth control method. They are easy to use—one pill is taken daily—and the method is very effective. Also, for most women, birth control pills are safe and cause few side effects.Women that smoke, have high blood pressure, are obese, or have a family history of blood clotting disorders may have an increased risk of stroke, heart attack, or blood clot by taking birth control pills. These women should discuss their possible increased risks with their physician when deciding on an appropriate method of birth control. Possible side effects of birth control pills include mild nausea and mild headache in the first 3 months. However, in most women, after the first 3 months, these side effects resolve. Other side effects include weight gain or weight loss, breakthrough bleeding (bleeding in between periods), persistent headaches (after the first 3-month adjustment period), and depression. Birth control pills can be safely taken for years and stopped only 1 or 2 cycles before pregnancy is desired. Most women conceive easily after the pill is stopped.

Levonorgestrel Implants
Implants are one of the newer birth control methods in the United States. They are a safe, effective form of birth control that will last up to 5 years. Six slim capsules are inserted just under the skin on the inside of the upper arm. This procedure is performed under local anesthesia in the office. The capsules contain levonorgestrel, a synthetic progestin, which is released very slowly during the 5 years. This hormone prevents ovulation, in a manner similar to that of birth control pills. The advantages of the implants are that they are convenient to use, and that their effects are completely reversible by removing the implants at anytime. Most women will become pregnant as easily as women who never used this method. Possible side effects include irregular bleeding, headache, nervousness, nausea, dizziness, and removal difficulties.

Injectable Progesterone
Injectable progesterone is a progesterone-only form of contraceptive that is injected every 3 months. This hormone prevents ovulation in a manner similar to that of birth control pills and the implant contraception. It is very effective and safe for most women. Women who may choose this form of contraception are those who should not take estrogen, who would like a form of birth control that they do not have to take daily, or who would prefer not to insert any device before intercourse. Side effects include irregular bleeding. Most women who use this form of contraception will experience a change in their periods, such as irregular bleeding, spotting, and occasionally heavy periods. This irregularity will usually resolve for about 50% of users in 1 year, at which time the periods stop completely. Injectable progesterone may have a prolonged contraceptive effect even after the medication is discontinued. Therefore, it may take 10 months, on average, to get pregnant once the medication is discontinued.

Intrauterine Device (IUD)
The IUD is a small device that is inserted into the uterus by a health care provider. The IUD alters the endometrium, making it unfavorable for implantation of the fertilized egg, or creates a reaction that prevents fertilization of the egg in the fallopian tube. There are two types of IUDs currently available. The “Copper T” is a small T-shaped plastic device with copper wrapped around it. This IUD only has to replaced every 8 years. Another type of IUD secretes the hormone, progesterone. This IUD has to be replaced every year, but it may decrease menstrual flow and cramps, so it may be useful for some women. The IUD is often very useful for women who have had their family but do not want a permanent form of sterilization. The IUD is not recommended for women who have not had children, because they have an increased risk of pelvic infection from the IUD. The IUD may also increase menstrual flow and cramping, so women who already experience heavy periods and severe cramping may want to choose another form of birth control.

Barrier Methods
Barrier methods include (1) condoms, (2) diaphragms, and (3) cervical caps. All barrier methods should be used with a spermicide, otherwise the effectiveness of the method is decreased. The condom is a thin covering made of rubber or animal membrane that is placed on the penis before intercourse. The condom prevents the sperm from entering the vaginal canal. Condoms should always be used in conjunction with a spermicide such as vaginal suppositories or vaginal foam to increase the effectiveness of the condom. Condoms can help decrease the risk of contracting a sexually transmitted disease. The diaphragm is a rubber dome-shaped device that is placed into the vaginal canal over the cervix (the opening into the uterus). Spermicide jelly is place in the diaphragm before placing it in the vagina. The diaphragm helps to prevent the sperm from getting into the uterus, and it holds the spermicide jelly against the cervix so that any sperm that get past the diaphragm are inactivated by the spermicide. If the diaphragm method is used properly, it is a very effective method of birth control and it is very safe. Side effects from the diaphragm are rare. The cervical cap is a small rubber device that fits right on the cervix to prevent sperm from entering the uterus and to hold spermicide against the cervix. It prevents pregnancy in a manner very similar to that of the diaphragm. The advantages of the cervical cap are that it is smaller than the diaphragm, so some couples feel they have more sensation with the cervical cap, and the cap can be left in place for 48 hours. (The diaphragm is usually taken out 6–8hours after intercourse.) The disadvantages of the cap are that it is more difficult to learn how to correctly place the cap into the vagina on the cervix, and not all women can be fitted with a cap because it only comes in four sizes.

Permanent, Surgical Birth Control Methods
There are two “permanent” methods of birth control available currently. A tubal ligation (“tying the tubes”) can be performed in the woman, or a vasectomy can be performed in the man. Although theoretically both methods can be reversed surgically, these methods should be thought of as permanent procedures because reversal of the procedures does not work in many cases. A tubal ligation is performed by doing laparoscopic surgery. A very small (less than 1 inch) incision is made in or underneath the umbilicus (the belly button), and another incision is made just above the pubic bone. Instruments are placed that can either cauterize the fallopian tube or place a clip across it, thus closing it. This will prevent the egg from being fertilized by the sperm. The surgery is usually performed under general anesthesia, although sometimes it can be performed under local anesthesia. It is “day surgery,” so you come in and go home the same day. A vasectomy is a minor surgical procedure in which tubes in the testes are tied off so the sperm can not enter the ejaculate fluid. This procedure is often performed under local anesthesia in the office or in same-day surgery. Couples may choose tubal ligation or vasectomy when they are sure they do not desire any more children or do not desire any children in the first place. Sometimes the woman may have a medical condition that makes it dangerous to get pregnant, so she may desire a very effective, permanent form of birth control.

Periodic Abstinence/”Rhythm” Method
Pregnancy is avoided by not having intercourse around the time of ovulation (release of the egg). This method only works if the woman has fairly regular cycles (the time from one period to the next). Ovulation can be estimated by counting the days from the previous period, watching for changes in the cervical mucus, and watching for changes in body temperature (the “basal body temperature” must be taken). Statistically, this method is not very reliable. However, some couples are very successful in using it as their primary form of birth control.

Decision Making
Some couples may choose to use more than one form of birth control; for example, using the diaphragm to prevent pregnancy, but also using the condom to decrease the risk of transmitting sexually transmitted diseases. You may also use one form of birth control and then change to another type of birth control if desired. Many couples use different forms of birth control throughout their life depending on many factors. You may want to consider the following when choosing a birth control method:
• How each method is used.
• Your age and health.
• How frequently you are sexually active.
• Your partner’s feelings about birth control methods.
• How important it is that you avoid pregnancy. Finally, sometimes it can be difficult to find a birth control method that will suit you. However, if you
work with your health care provider and persist, most couples can find a birth control method that they can feel comfortable and safe with.