Contraception Methods & Options

Methods and types of contraception: your questions answered.

The ability to control our own reproductive potential has had far reaching effects for women. It has promoted self-sufficiency, expanded educational opportunities, improved earning capacity, broadened political power, and generally increased the status of women. Providing safe and effective contraception is one of the most fundamental functions of practitioners in women’s health.

Most women spend about a third of their lives trying to avoid pregnancy. It is important to make contraceptive choices that meet your needs and fit your lifestyle. While there is no ideal method of contraception, there are a number of very good options. Boulder Gynecology can help you find one that’s right for you.

Barrier methods
Barrier methods of contraception include male and female condoms, diaphragm, and cervical cap. All barrier methods work by preventing sperm from reaching the egg. Condoms are also effective in preventing sexually transmitted infections and are advised for anyone not in a mutually monogamous relationship. Failure rates of these methods are variable (2 to 15 percent per year). The success of barrier methods is highly dependent on correct and consistent use.

Hormonal contraception
Hormonal contraception most commonly used includes combination oral contraceptives, the Ortho Evra® patch, and the NuvaRing®. The development and widespread use of hormonal contraception has represented a major breakthrough in fertility regulation in the 20th century. Pills today are of a much lower dose and are much safer than those originally introduced in the 1960s. Hormonal contraception works by preventing ovulation and thickening cervical mucus. There are many other benefits to hormonal contraception, including less monthly bleeding, improvement or resolution of menstrual cramps, and control over when bleeding occurs. Long term use (>10 years) is associated with an 80 percent reduction ovarian cancer and a 50 percent reduction in endometrial (uterine) cancer. When used correctly, failure rates of hormonal contraception are very low (less than 1 percent per year).

Long-term birth control methods
Women are increasingly choosing long-term contraceptive methods that will protect them from pregnancy for 3 to 5 years. The most common long-term methods are the ParaGard® intrauterine device (IUD), the Mirena® intrauterine system (IUS), the Skyla® intrauterine system (IUS) and the Nexplanon® implantable hormonal contraceptive rod. All three are among the most effective methods of contraception available today with extremely low failure rates.

Intrauterine devices or systems
Intrauterine devices or systems work by creating a sterile inflammatory reaction within the uterus. This sterile inflammation kills sperm as it enters the uterine cavity. The ParaGard® IUD contains copper and can be used for up to 10 years. The Mirena® and Skyla® IUS contain a small amount of a (female) progestin hormone that can also be helpful in minimizing menstrual bleeding.  The Mirena® IUS can be left in place for up to 5 years while the slightly smaller Skyla® IUS can be left in place for 3 years. The choice of which intrauterine device or system to used is based on patient preference and characteristics. Some women prefer no hormones and so opt for the ParaGard IUD. Women best suited for the ParaGard IUD do not normally experience heavy menstrual bleeding or cramping. While the Mirena® and Skyla® IUS contain a hormone, the blood level is much lower than with other hormonal contraceptive methods. The advantage of the Mirena® and Skyla® intrauterine systems is that, because of the progestin acting within the uterus to thin the endometrial lining, the monthly bleeding and cramping is much less.

Some prior IUDs in the 1970s were associated with severe pelvic infections. As a result, IUDs have remained an underused method of contraception in the United States. However, the ParaGard® IUD and Mirena® IUS have proven to be very safe and effective.  The Skyla® is new on the market but, given its similarity to the Mirena®, it is likely to also be very safe and effective.

Implanon is hormonal contraceptive implant that has been used by nearly 3 million women worldwide since 1998. However, Nexplanon® only became available in the U.S. in 2006. Nexplanon® is a small matchstick size rod that is easily inserted under the skin of the upper arm and can be left in place for 3 years. Nexplanon® contains a progestin hormone that, like other hormonal contraception methods, works by preventing ovulation and thickening the cervical mucus. The major side effect of  Nexplanon® is mild unpredictable vaginal bleeding. Women often wonder if Nexplanon®  or other birth control options are known to cause weight gain. Nexplanon® has an advantage over Depo-Provera, another progestin based hormonal contraception, in that women do not need to return every three months for injections and there is no significant associated weight gain or temporary bone loss.

Permanent birth control
Permanent birth control is an excellent option for women who are certain they do not ever want to bear more (or any) children. While partner vasectomy is the least expensive and least invasive approach to permanent birth control, this is not always an option. There are two methods currently available for female sterilization, laparoscopic tubal ligation, and hysteroscopic tubal occlusion or Essure®.

Laparoscopic tubal ligation
Laparoscopic tubal ligation is an outpatient procedure performed in an operating room using general anesthesia. During the procedure, a slender scope with a tiny camera at the end is placed into the abdomen through an incision in the belly button. Each fallopian tube is then cauterized or occluded to prevent sperm from reaching the egg. After the procedure, women will need a few days of less-than-usual activity level but recovery is generally prompt. Laparoscopic tubal ligation is not reversible, so a woman must be absolutely certain about her decision before proceeding with this permanent birth control.

Hysteroscopic tubal occlusion, Essure®
Hysteroscopic tubal ligation, or Essure®, is an outpatient procedure performed in an operating room or an office setting. During hysteroscopic tubal ligation, a very thin scope with a tiny camera at the end is placed into the vagina and through the cervix into the uterus. Like with laparoscopic tubal ligation, each fallopian tube is occluded to prevent sperm from reaching the egg. However, with Essure®, there is no abdominal incision. In addition, for the appropriate candidate, hysteroscopic tubal ligationcan even be performed in the office with pain medication rather than general anesthesia. After the Essure® procedure, the woman must use another form of contraception for three months and then have a dye test called hysterosalpingogram, performed to ensure that both tubes are adequately blocked. Like laparoscopic tubal ligation, Essure® is not reversible, and a woman must be absolutely certain about her decision before proceeding with this permanent birth control.