Choosing a birth control method

With so many options available, choosing one method can be overwhelming. It is a very personal choice. One method may be ideal for one person, but not comfortable for another for various reasons.

Educating yourself about each type is important. It’s also important to gain the right knowledge about each from professionals who know each method well and can offer expert advice. There are many myths out there which can distort your view and cause misunderstanding with regards to fact and fiction.

Seek out expert information from your doctor or clinic, then weigh up the pros and cons of each method as it applies to your own lifestyle and future plans. For some, a combination of methods may offer the best means of protection against pregnancy and STIs / STDs.

The more you know, the more in control of your sexual health you can be.

Advantages and disadvantages of each birth control type

Birth control methods have been tested with care and those that are recommended as options are considered safe to use. It’s important to know what the pros and cons of each type are before deciding on the method best for you.

• Abstinence: This prevention method is completely free and has no health risks. One of the downsides is that it requires self-control. If you change your mind and decide to have sex, a birth control method of some kind is recommended. Another factor to consider is that an STD infection is still possible through oral sex and sometimes skin-to-skin contact (such as touching or rubbing others’ genitals).
• Intrauterine device (IUD): A copper IUD can last approximately 10 years and a hormonal IUD up to 5 years. For many this is high on the list of advantages. Other factors considered pros for this method are that you do not have to stop or interrupt sex to use it and it is completely undetectable during intercourse. Downsides are that it cannot protect against STDs, must be inserted by a doctor, can have a high upfront cost, or cause irregular bleeding or spotting (bleeding between menstrual periods or after sex). It rarely happens, but an infection can occur in some people when an IUD is inserted.
• Intrauterine Ball (IUB): The hormone-free device is designed to have a lifespan of 5 years and is thus a relatively reliable long-term birth control option. The risk of uterine perforation once the device has been inserted is lower than that of IUDs due to its spherical nature. Perforating insertion risk is also lower as the tip of the IUB device is flexible enough to turn (180 degrees) once separated from the insertion tube and not making contact with the uterine fundus (top of the uterus). The smaller diameter of the device helps to lower uterine wall irritation. The spherical shape also helps in this regard, further preventing mispositioning and distortion from occurring in the uterus. A woman’s fertility is expected to return to normal as soon as the device has been removed by a doctor. An IUB must be removed by a medical doctor after 5 years and can be replaced with another if desired.

On the downside, some discomfort can be expected during the insertion process if a woman’s cervix is a little tight. Should dilation of the cervix be necessary, a local anaesthetic may be used to help relax the muscles. Some abdominal discomfort similar to menstrual cramps may be experienced shortly after insertion. Discomfort is to be expected while the body adapts to the new, foreign object inside it, and typically subsides within a day or two. If discomfort persists or becomes painful, a woman should consult her doctor for an evaluation. A woman and her partner should not be able to ‘feel’ the device during sexual intercourse if it has been properly inserted. If removal strings / threads are bothersome, these can be trimmed. The device is not designed to protect against the contraction of HIV or other sexually transmitted diseases.

The IUB device is also not suitable for women who…

• Are already pregnant
• Have an abnormally shaped uterus
• Show signs and symptoms of PID (pelvic inflammatory disease)
• Frequently change sex partners
• Experience inexplicable vaginal bleeding
• Have uterine or cervical cancer
• Have an active infection of the uterus or cervix (or one following a pregnancy or abortion within the past 3 months)
• Have Wilson’s disease or any other diagnosed health condition which does not tolerate copper substances in the body
• Have a known allergy to any of the materials used in the device
• Already have an intrauterine device contraceptive inserted

• Implants: This method is effective for up to 3 years, is convenient and private. Upfront costs of an implant can be high as they must be inserted (and removed) by a doctor with specialised training. Other downsides include the possibility of infection at the site of insertion, an inability to protect against STDs, or changes in menstrual periods (irregular bleeding).
• Sterilisation: This method is permanent and is a good choice for men and women who do not want to conceive or have children. Men and women can have a sexually active lifestyle without risk of pregnancy. Sterilisation is a surgical procedure which must be done by a qualified medical professional. It does not protect against STDs, has a high upfront cost (if you do not have health insurance or a plan that will cover the procedure cost) and typically carries risks associated with the surgery.
• Injection: Shots are required 4 times a year (every 12 weeks – this is when effects begin to wear off). This method is not detectable to anyone else and can reduce the risk of endometrial cancer. In some cases, women may stop having menstrual periods altogether. Downsides include a lack of protection against STDs, each shot requires a visit to your doctor, irregular bleeding or spotting and a possible decrease in the strength of your bones (due to a lowering of the body’s natural oestrogen levels).
• Patch: This method is easier to use than birth control pills, does not cause any interruptions to sexual activity and only needs to be changed once a week. Downsides can be that you will need to remember to change your patch once a week, a prescription is required, and it cannot protect against STDs. A patch may also cause irregular bleeding or spotting and should never be used if a person has a blood clotting disorder.
• Vaginal ring: These are reversible, do not cause any interruptions to sexual activity and can also help a woman’s menstrual periods become more regular, lighter and less painful. In some instances, it has been noted that a vaginal ring can play a role in clearing up acne (because of the hormones released into the body). Vaginal rings should not be used if you have a blood clotting disorder. Other disadvantages are that it does not offer protection against sexually transmitted infections, must be acquired via prescription from a doctor and must be both inserted and removed by yourself every month (many are not comfortable with this).
• Birth control pills (oral contraceptives): This popular method is a reversible form of contraception and is often favoured because it can reduce menstrual cramps, help make menstrual periods regular and lighter, reduce problems with acne, lower a woman’s risk of ovarian cancer and endometrial cancer, as well as ovarian cysts. Other pros are the variety of different types and dosages available for women to choose from, and a low monthly cost (which is covered by some health insurance plans). The downsides are that birth control pills can interfere with other medications you may be taking, or may be rendered ineffective by these, and can cause mood changes and other minor side effects. Most minor side effects will go away within the first few months of use. Pills do not protect against STDs and must be taken every day at the same time. A prescription from a doctor is required. 
• Condoms: Barrier protection via condoms are easy to purchase over-the-counter without a prescription. Condoms are inexpensive and are often free at a family planning clinic. Another advantage is that condoms do provide some protection against sexually transmitted infections and STDs. Liquid used to package condoms or the latex can cause an allergic reaction for some people. Other disadvantages include the perceived inconvenience of having to interrupt foreplay to put a condom on before having sex, or the changes in sensation during sex. Condoms are not at all effective if they break or tear during sex.
• Cervical barriers: This type is re-usable, protects against some STDs, does not use hormones which some people have adverse reactions to, and can be inserted 24 hours before sex (this can also be a disadvantage if planning ahead to insert the barrier properly is not always possible). It can happen that a person may be allergic to the barrier material or spermicide used with the barrier.
• Spermicides: These chemicals can provide some lubrication during sex, can be bought over-the-counter without a prescription and do not contain any hormones which will alter any functions in the body or influence a woman’s menstrual periods. Spermicides are also safe for breastfeeding women and smokers. Spermicides are not effective protectors against STDs, and may cause allergic reactions or irritation if used more than twice a day. Some may consider the use of spermicide an irritation if they have to interrupt sex to use.
• Birth Control Sponge: These can be bought over-the-counter without a prescription, are easy to insert and can be used for a 24-hour period (multiple times). Sponges contain no chemicals or hormones, but can still cause an allergic reaction if you have an allergy to a spermicide which is used. Sponges do not offer protection against sexually transmitted infections (STDs).
• Fertility tracking: Plus sides to tracking your levels of fertility during your cycle are that there are no health risks and no additional hormones or chemicals able to access your body. Fertility tracking can be tricky and you will need to learn how to check and record body signs from a trained expert. If this method is to work for you, it requires keeping a daily record. This can be done by means of mobile calendars, electronic devices or applications to help track changes. Tracking is a method that works best for women who have regular periods. It cannot protect you from sexually transmitted infections.