Contraception (birth control) is a method to prevent pregnancy. A survey by the National Center for Health Statistics found 98 percent of sexually active women have used/continue to use some form of contraception. The most common form of contraception is the birth control pill. In 2002, 11.6 million American women 15 to 44 were using birth control pills. The second most common form of birth control for women is sterilization, chosen by 10.3 million women.

Birth Control Methods

Sterilization permanently prevents pregnancy. Women who want to retain their ability to become pregnant have several alternatives. Joshua Holden, M.D., Obstetrician-Gynecologist at Columbia Eastside, divides the options into two broad categories: hormonal and non-hormonal.

Hormonal Options

Hormonal options prevent pregnancy by changing hormone levels in the body. Some common alternatives are the pill, injection, implant, vaginal ring and skin patch.

The first birth control pill was approved by the FDA in 1960. The original pill contained high doses of estrogen and progestin and was associated with side effects like weight gain, breast tenderness, bloating and acne. Many of the birth control pills offered today have much lower doses of estrogen. Some contain only progestin. One of the newest options, Lybrel (Wyeth), currently awaiting FDA approval, is the first continuous use (no break) low-dose oral contraceptive. Although the birth control pill is a popular option, Holden says women with certain medical conditions may want to consider other alternatives because the pill can increase the risk of blood clots. The National Cancer Institute also reports women who use oral contraceptives may have a slightly elevated risk for breast cancer.

Depo-Provera® is an injectable form of contraception. It is given every three months. Since it only contains progestin, Depo-Provera may be an option for women who can't take estrogen.

Contraceptive implants are small, thin rods that are implanted under the skin of the upper arm during an in-office procedure. They continually release the hormone, progestin, for an extended period of time. The first implant used in the U.S., Norplant®, was withdrawn from the market due to unexpected side effects. A newer implant, IMPLANON™ (featured in our story), was approved by the FDA in July of 2006. It's designed to last for up to three years.

The vaginal ring, NuvaRing®, is a soft, flexible ring containing estrogen and progestin. The ring is inserted into the vagina and worn continuously for three weeks, then removed for one week.

The birth control patch, OrthoEvra®, contains estrogen and progestin. It is applied to the skin like a bandage and left in place for one week. The hormones are gradually released and absorbed through the skin into the bloodstream. A new patch is placed on the skin once a week for three weeks. During the fourth week, no patch is used.

Non-hormonal Options

Non-hormonal birth control options prevent pregnancy by creating a barrier to sperm, inhibiting the movement of sperm and/or killing the sperm. Some popular choices include: the IUD, sponge, cervical cap, diaphragm and condom.

The IUD (Intrauterine device) is making a come-back in the U.S. The first non-hormonal IUD to be approved by the FDA is the ParaGard® (featured in our story). It's a T-shaped piece of copper-wrapped, soft plastic that's placed into the uterus. ParaGard lasts up to 10 years, but can be removed sooner if a woman wants to become pregnant. A newer IUD system, called Mirena®, contains the hormone, progestin, but not estrogen. It is designed to be used for up to five years.

The Today® Sponge was first introduced into the U.S. in 1983, but was discontinued by the manufacturer in 1994. In 2005, another manufacturer received FDA approval to bring the Today Sponge back to market. The sponge contains the spermicide, Nonoxynol-9, designed to kill sperm. It also acts as a barrier to trap sperm and prevent their passage through the cervix. Once inserted into the vagina, it provides pregnancy protection for up to 24 hours.

The cervical cap is a thimble-shaped latex device that is inserted through the vagina and fitted over the cervix. It is held in place through suction, acting as a barrier and preventing sperm from passing into the uterus. The cervical cap is designed to be used in conjunction with a spermicide. Two devices are available in the U.S. - Lea's Shield® and FemCap.

The diaphragm is a shallow, rubber dome that is covered with a spermicide and placed over the cervix. It is held in place by the muscles in the vagina. A woman must be measured and fitted by a health care professional to get a properly sized diaphragm.

A popular option for many couples is the condom. Condoms are currently the best method of protection against sexually transmitted diseases. Male condoms are considered to be convenient (no prescription needed, sold in many different places) and inexpensive. A female condom (Reality Female Condom) is made of thin polyurethane and placed inside the vagina.

A woman's birth control needs may change over time. Holden says when women are looking at contraceptive options, there are many things to consider. Some women can't take hormones. Others want a convenient method that doesn't require planning or daily use. Women should talk with their health care providers to discuss available options and decide which birth control method is best.

If you have any questions about your personal options for birth control talk with your health care provider.

For general information:

Association of Reproductive Health Professionals

Food and Drug Administration