Family planning or birth control is not a new concept and now the options are more varied than ever before. Each option has both advantages and disadvantages and not every method is right for every patient. The best contraceptive option is the the one that is safest, most effective and easiest to use for that particular patient. It should be noted that no form of birth control is 100% effective. Failure rates are also related to suboptimal patient usage. Each woman should discuss her contraception options with her health care provider. This month’s article includes the different types of contraception and next month’s article will discuss the side effects, risks and benefits of the different methods.

How does birth control work?
Birth control works in various ways. These include actual destruction of the sperm, prevention of the release of an egg, blockage of the sperm and egg, altering the uterine lining thereby preventing egg implantation and thickening of the cervical mucus to reduce passage of the sperm.

Birth Control Options
Options include hormonal, intrauterine devices, barrier, natural family planning and sterilization.

Hormonal Birth Control
Hormonal contraception provides a synthetic form of the hormones that are naturally produced by the ovaries. These synthetic hormones shut down the naturally produced ones. These hormones prevent ovulation (release of an egg), alter the uterine lining so as to decrease the likelihood of an egg implanting and change the cervical mucus making it more difficult for sperm to enter the uterus.

Oral Contraceptives (Birth Control Pills)
Most birth control pills contains two hormones--estrogen and progestin in combination. One type of pill has only progestin. Birth control pills are a very popular form of contraception. In order to be effective they must be taken daily. They estrogen and progestin can come in different forms and a patient may have to find the combination that is right for her needs.

Depot Injections (Depo-Provera)
One injection of Depo-Provera provides protection for three months, therefore only four injections are needed annually. This highly effective means of contraception consists of progestin only and is a good method for patients with difficulty remembering to take a pill every day.

Vaginal Ring (NuvaRing)
One of the newest members of the hormonal arsenal is the vaginal ring being on the market since 2001. The ring is made of plastic and is placed into the upper vagina and releases estrogen and progestin continuously. This highly effective method stays in place for 21 days and is removed for 7 days. During the 7 days a patient will have her menses. A patient will then place a new ring after the 7 days.

Skin Patch (OrthoEvra)
The skin patch delivers a specific amount of estrogen and progestin through the skin for 7 days. The patch is changed every 7 days for three weeks and no patch is worn during the fourth week. The hormones are absorbed through the bloodstream and the patches can be worn on the buttocks, abdomen, upper outer arm and upper torso (excluding the breasts).

Intrauterine Devices (Paragard or Mirena)
The IUD is a plastic T-shaped device that is implanted into the uterus to prevent pregnancy. There are two types available in the U.S.--one which contains copper and the other which contains a progestin. Both are very effective. The copper IUD may remain in the uterus for up to 10 years, while the progestin-containing IUD is effective for five years. This method is an excellent choice for women who don’t want to remember to use contraception since it is strictly health care provider driven.

Barrier Contraception
Barrier options include spermicides, condoms, the diaphragm and the cervical cap. Barrier methods must be used with each act of intercourse. Spermicides act by killing the sperm. There are two types of condoms--male and female. While the male condom fits over the penis, the female condom is a pouch that fits inside the vagina. The diaphragm is a rubber dome that fits inside the vagina and covers the cervix preventing sperm passage into the uterus. The cervical cap is a thin rubber or plastic device that covers the cervix like a thimble. It functions like a diaphragm by preventing sperm passage into the uterus. Barrier methods can be used in combination for more effective protection.

Natural Family Planning
Natural family planning requires no drugs and is based upon the theory that there is a "safe" period in which pregnancy is less likely to occur. The success of this method depends on a patient knowing when she is fertile or ovulating. These methods include taking the body temperature, monitoring the consistency of cervical mucus and keeping a menstrual diary or calendar.

Sterilization
Sterilization options are available for both men and women. These methods should be considered permanent and are for people who desire no further child bearing. The option for men is a vasectomy where the tube (the vas deferens) from the semen producing glands to the penis is severed so that sperm are not present in his ejaculate. The vasectomy is an in-office procedure.

Sterilization for women can be done in the hospital or in a doctor’s office. Hospital procedures include blocking the fallopian tubes by burning, clipping, tying or banding the tube so that an egg cannot travel through. This is often done under general anesthesia. A new procedure involves the passage of springs into the fallopian tubes through the vagina and can be done in the office. This procedure requires a three month waiting period to allow the fallopian tubes time to become blocked and another method of contraception should be used during this time.

The options for contraception are numerous. Next month’s article will discuss the side effects, pregnancy rates, risks and health benefits of the methods of contraception.

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