Research-backed

How To Avoid Pregnancy: Know Your Options

Image: Shutterstock

IN THIS ARTICLE

There is a probability of getting pregnant each time you have sex without proper contraception. This may include the first time you have sex too. Unintentional pregnancy can be avoided by using hormonal or non-hormonal contraceptive medications or devices as well as natural methods (1).

Read this MomJunction post to know more about the methods to prevent pregnancy and the benefits and risks of each of these methods.

Hormonal Ways To Prevent Pregnancy

Pregnancy can be avoided using hormonal contraceptives. These are medications or implants that release synthetic hormones to prevent ovulation. They also thicken the cervical mucus, making it difficult for the sperm to reach the egg cell (2).

All hormonal contraceptives, except emergency contraceptive pills, require a doctor’s prescription.

Hormonal contraceptives to prevent pregnancy include:

1. Implants

These are tiny hormone-releasing devices implanted under the skin of the woman’s upper arm.

Norplant (6 implants), Jadelle (2 implants), and Nexplanon (formerly Implanon; 1 implant) are some common brands of hormonal implants. These implants release etonogestrel or desogestrel hormones that suppress ovulation. Currently, nexplanon is the worldwide available brand as it consists of only a single implant (compared to Norplant and Jadelle). Thus, it is easier to place and remove.

  • They start to prevent pregnancy within 24 hours upon insertion within the first week of the menstrual cycle.
  • If implanted after five days of the menstrual period, you should use condoms for up to seven days to prevent pregnancy (or abstain from sexual intercourse). If sexual intercourse occurs within these first five days, an emergency contraception is indicated.

An implant generally works for three years, and you can remove and place a new implant on the same day if you would like to continue with hormonal contraception. It has only a 0.01% failure rate in three years, if appropriately inserted, making it the most effective form of hormonal contraception (1) (3).

2. Birth control patches

Birth control patches (also called combination patches, transdermal patches, or skin patches) prevent pregnancy by releasing estrogen and progesterone into the bloodstream; thus suppressing ovulation and changing the consistency of cervical mucus.

It is recommended that you use the patch for 21 days to avoid pregnancy. Patches are replaced once a week for three weeks, and it is advised to change the location of the patch to prevent skin irritation.

You may have to check the patch to make sure that it is in place. It can be placed on the underarm, abdomen, or buttocks. It has a failure rate of 7% with typical use (less than 1% with perfect use)  (1) (4).

3. Contraceptive injections 

Also called contraceptive shots, contraceptive injections release hormone progestin to your bloodstream and suppress ovulation to prevent pregnancy. These are available under the brand names Depo-Provera, Sayana Press, or Noristerat.

  • Depo-Provera and Sayana Press give you protection from pregnancy for up to 13 weeks, whereas Noristerat protects you from pregnancy for up to eight weeks.
  • Contraceptive injections are immediately effective if taken within the first five days of the menstrual cycle.
  • If you received an injection after five days of the menstrual cycle, you have to use condoms for seven days to avoid pregnancy (or abstain from sexual intercourse). If sexual intercourse occurs within these first five days, an emergency contraception is indicated.
  • Injections can be chosen as a way to prevent pregnancy after a miscarriage, an abortion, or after childbirth. This method, as with any hormonal contraception that contains progestins without estrogen, can start immediately after any of these events.

It is a highly effective method of contraception with a failure rate of just 0.3% (1) (5) .

4. Hormonal vaginal contraceptive rings

The small, flexible plastic rings can be placed in your vagina to avoid pregnancy. They release synthetic estrogen and progestin hormones to the bloodstream. They suppress ovulation, and you may observe changes in the thickness of cervical mucus.

Nuvaring is one of the famous brands. It can be used for three weeks and has a 7% failure rate with typical use (1) (6) .

The vaginal ring may cause headaches and vaginal irritation or discharge in some women.

5. Progestin-only oral contraceptives

Also called mini-pills, progestin-only oral contraceptives are recommended for women who are breastfeeding and women with contraindications to estrogen use. Norgestrel, Norethindrone, and Drospirenone are the different formulations of mini pills. These tablets suppress ovulation and thicken cervical mucus.

  • You may start taking them from the fifth day of your menstrual cycle and on a daily basis.
  • If you miss a pill, take it as soon as you remember, and continue to maintain the same schedule from the next day.
  • If the tablet is taken more than three hours from the scheduled time, you should use backup contraception for the next 48 hours to avoid pregnancy. If you are using pills containing Drospirenone, a backup method is indicated if the pill is taken more than 12 hours.

These pills are 99% effective if taken on schedule. However, if you miss pills, the effectiveness falls to 91%.

Women can return to fertility immediately after discontinuation of this pill. It may cause adverse effects such as nausea, breast tenderness, headache, or menstrual irregularities. (7) (8).

6. Combination oral contraceptives

Combination oral contraceptives contain synthetic estrogen and progesterone hormone. These pills are effective if taken regularly at a scheduled time and have a 7% failure rate with typical use (1).

Combination oral contraceptives are classified into three groups (9):

  • Monophasic 21-day pills: These are the most common type. They are taken for 21 days, followed by a seven-day break. All the pills contain the same amount of hormone. Microgynon, Marvelon, Yasmine, and Cilest are some of the popular brands of monophasic tablets.
  • Phasic 21-day pills: These are taken for 21 days, followed by no pills for seven days. They contain different amounts of hormones, come in different colors, and should be taken in a prescribed order. Logynon is one of the popular phasic pill brands.
  • Every day (ED) pills: These come in a pack of 21 hormonal pills and seven placebo (inactive) tablets. The pills should be taken every day in the prescribed order. Microgynon ED is a popular brand of ED pills.

7. 91-day combination oral contraceptives 

These birth control pills contain estrogen and progesterone. These hormonal pills are for 12 weeks and seven estrogen-only (hormone-free) pills for the last week. Seasonale is a popular brand of 91-day combination pills (10).

Hormonal ways to prevent pregnancy may not be recommended for obese women, smokers, women who are older than 35 years, and women with a history of blood clots. These are also not recommended for women who experience (11):

  • Unexplained vaginal bleeding
  • Significant liver disease
  • Breast or uterine cancer

Side effects: These contraceptives may cause headaches, acne, hair loss, nausea, painful menstruation, increased risk of blood clots, or breast pain in a few women (2).

Advantages of hormonal methods: These have higher efficacy compared to other methods. You can go back to fertility after discontinuing hormonal contraceptives.

Disadvantages of hormonal methods: Hormonal implants do not protect you from sexually transmitted diseases.

Emergency Contraception

Emergency contraception, also known as emergency postcoital contraception, is the use of a drug or device to avoid pregnancy after unprotected sex. Taking an emergency contraceptive pill within 72 hours after unprotected sex can help prevent pregnancy.

Emergency contraceptives include (12):

  1. Copper T380 intrauterine device: It can be placed up to seven days after unprotected intercourse to prevent pregnancy.
  1. Progesterone-only emergency contraception: The progestin levonorgestrel tablet is most effective in the first 72 hours and can be taken up to 120 hours after unprotected sex.
  1. Progesterone agonist/antagonist: Available under the name ulipristal, it should be used 120 hours after unprotected sex. In case you vomit within three hours after taking a tablet, you have to take one more.
  1. Combined hormone emergency contraception:Also known as the Yuzpe regimen, it involves the use of ethinyl estradiol and levonorgestrel at a higher dose compared to regular contraception.

Ella or Ellaone is a non-hormonal, morning-after pill, containing 30mg of ulipristal acetate. It is an effective pill to avoid pregnancy after unprotected sex. You may require a prescription to buy this pill. However, according to the American College of Obstetricians and Gynecologists, a copper intrauterine device (IUD) is the most effective form of emergency contraception (13). It has a failure rate of only 0.09%.

The adverse effects of emergency contraceptive pills include:

  • Nausea
  • Vomiting
  • Minor changes in menses
  • Breast tenderness
  • Fatigue
  • Headache
  • Abdominal pain 

Disadvantages: Emergency contraceptives do not protect you from sexually transmitted diseases.

Note: Emergency contraception may be used more than once in the same cycle if indicated. However, it is not a regular method of contraception and should not be used continuously because it is significantly less efficient than regular contraception. You may consider other methods of contraception with the guidance of your physician (14).

Intrauterine Devices To Prevent Pregnancy

The use of an intrauterine device (IUD) is one of the most effective methods to prevent pregnancy. An IUD can be a copper-releasing or hormone-releasing type.

  1. A copper-releasing IUD is a T-shaped device that damages the sperm and reduces its motility to prevent fertilization. It can prevent pregnancy for up to 12 years.
  1. Mirena, Liletta, Skyla, and Kyleena are intrauterine hormonal devices that contain levonorgestrel to prevent pregnancy.

You shouldn’t use IUDs in the following cases:

  • Abnormalities of the uterine cavity
  • Genital bleeding of unknown cause
  • Uterine or cervical cancers
  • Wilson disease (for copper-containing IUDs)
  • Pregnancy
  • Cervical infections
  • Endometrial infections.

IUDs produce no adverse systemic effects, and their advantages are:

  • Reduced ectopic pregnancies
  • Decreased menstrual blood loss and dysmenorrhea
  • Decrease in risks of pelvic inflammatory disease
  • Decrease in risks of synchronous endometrial and ovarian cancer (SEOC)

Disadvantages of IUDs: The insertion of IUDs is associated with a 1% risk of uterine perforation. They do not protect against sexually transmitted infections (15).

Barrier Ways To Prevent Pregnancy

Barrier ways of contraception prevent the sperm from coming into contact with the ovum. Mechanical barriers prevent direct contact, and chemical barriers destroy the sperm.

Barrier ways to avoid pregnancy include:

14. Male condom

A male condom is a thin latex or polyurethane sheath that is placed over the penis to prevent the passage of semen to the vagina.

  • Male condoms have a 13% chance of failure rate (1).
  • They are easily available and cost-effective.
  • They help prevent unintentional pregnancy and sexually transmitted diseases (16).

In rare cases, condoms may fail to prevent pregnancy. Inappropriate use of condoms may result in pregnancy. Read the manufacturer’s instructions, and always check the expiry date of condoms before using them.

15. Female condom

A female condom is made of polyurethane sheath. It can be placed in the vaginal canal for birth control.

  • It acts as a barrier to prevent contact of semen with the vagina.
  • It is not recommended to use both female and male condoms at the same time as it may lead to damage or displacement of the condoms.
  • It has a 21% failure rate (1).
  • It may help to prevent sexually transmitted diseases.
  • It can be inserted eight hours before intercourse. However, if you wear the condom for a prolonged period, you may end up having a urinary tract infection (17).

16. Diaphragm

A diaphragm is a shallow latex cup that can be placed in the vagina to act as a barrier to prevent pregnancy.

  • It can be placed before intercourse, as it is free of hormones.
  • Spermicide is applied to the inside of its dome.
  • The diaphragm provides protection for up to a few hours if you use the exact size.
  • You should wait a minimum of six hours after sex to remove the diaphragm.
  • A diaphragm has a 17% failure rate in typical use (1).

A diaphragm may cause urinary tract infections if used for a long duration. It does not protect you from sexually transmitted diseases (18).

17. Cervical cap

A cervical cap is placed above the base of the cervix to prevent pregnancy. It is advised to fill one-third of the cap with spermicide before insertion. It can be inserted eight hours before intercourse and can be left in the cervix for up to 48 hours.

  • It acts as a mechanical and chemical barrier when used with spermicide.
  • It has a 17% failure rate (1).
  • The cervical cap provides contraception until its duration of use.
  • It may cause cervical erosion and vaginal bleeding.
  • It is not recommended for women who have positive PAP test results, and a high failure rate is seen in obese women due to displacement.
  • Placing it more than 48 hours inside your body can result in toxic shock syndrome.

It is 71% effective in preventing pregnancy but does not prevent sexually transmitted diseases (19).

18. Contraceptive sponge

It is a soft, disk-shaped polyurethane device containing spermicide. It kills sperm and prevents pregnancy if placed deep in the vagina. It can be placed 24 hours before intercourse.

  • It is recommended to remove the sponge at least six hours after sex. The sponge may cause infection if you keep it for more than 24 hours in the vagina.
  • It does not protect you from sexually transmitted infections.

It has a 14% failure rate among women who have never been pregnant and a 27% failure rate in women who have had a baby (1) (20).

19. Spermicidal agents

These are chemical barriers containing surfactants that damage the sperm cell membrane. They should be applied to the vagina before sex to avoid pregnancy.

These are available as:

  • Vaginal foams
  • Suppositories
  • Jellies
  • Films
  • Foaming tablets
  • Creams

The chemical, spermicide, may destroy bacteria and viruses, thus decreasing the risk of infections. However, clinical data are limited regarding the efficacy of spermicide in the prevention of HIV.

These may destroy normal bacteria in vaginal flora. Escherichia coli colonization is shown to increase after the use of spermicide and may lead to urinary tract infections in a few women. They have a 21% chance of failure rate (1) (20).

Advantages of barrier contraceptives: They are easily available and inexpensive. They can be used by breastfeeding mothers or anyone with health problems such as hypertension.

Disadvantages of barrier contraceptives: They may cause interruption during intercourse. They have a higher failure rate than hormonal methods.

Permanent Ways To Prevent Pregnancy

Sterilization is an effective and permanent way to avoid pregnancy. It is a surgical technique to prevent fertilization. It can be done for both women and men.

20. Female sterilization

Female sterilization is achieved by surgery, the ligation of fallopian tubes, or rarely, if required, due to other reasons by hysterectomy (removal of the uterus). The fallopian tube is cut, sealed, clipped, and tied on each side to prevent fertilization (21).

The Essure system is a permanent birth control for females. The sterilization process involves placing small metal and fiber coils in the fallopian tubes to create scar tissue in the fallopian tube and prevent fertilization (22). However, the option has become limited due to some after-placement concerns and the product is no longer manufactured.

It has a failure rate of 0.5% (1).

21. Male sterilization

Vasectomy is a permanent way of sterilization for males. In this method, the vas deferens are ligated or fulgurated (destroy the growth of tissue with diathermy). This procedure prevents sperm from reaching the urethra.

Hematoma, infection, and sperm granulomas are possible complications of the male sterilization procedure. There is a 0.15% chance of failure in this procedure (1).

Advantages of sterilization: It does not involve hormones, and there is no evidence indicating any effects on the libido, menstrual cycle, or lactation.

Disadvantages of  sterilization: It does not prevent you from contracting sexually transmitted diseases (21).

Natural Methods Of Contraception

These are the most common ways of preventing pregnancy. If your religious and cultural beliefs do not allow the use of medications or devices for contraception, you could opt for these methods. Avoiding intercourse during your fertile period could also help prevent pregnancy.

However, the failure to determine the exact fertile period and mistakes in withdrawal methods could lead to pregnancy. Natural methods of contraception have a high rate of failure, and it is recommended to follow other techniques. None of these methods protect you from sexually transmitted diseases.

Natural Contraception Methods Include:

22. Coitus interruptus

Also known as withdrawal or pull out method, it involves the withdrawal of the penis from the vagina before ejaculation. Its efficacy depends on a man’s capability to withdraw prior to ejaculation. It has a 4% failure rate (23).

23. Lactational amenorrhea

It is the temporary absence of menstruation after childbirth. This occurs due to the increased levels of prolactin, which is a hormone that triggers milk secretion in mothers. These hormones suppress ovulation in breastfeeding women.

This type of contraception is best observed when you breastfeed your baby every four hours during the day and every six hours at night (24).

24. Calendar method

It is also known as the rhythm method. This method is based on the following facts:

  • An egg lives for only 24 hours after ovulation.
  • Sperm is viable only for 48 hours after intercourse.
  • Ovulation occurs between 12–16 days of a cycle.

The fertility period is determined based on the menstruation dates for six months. Subtracting the number of days in the shortest menstrual cycle by 18 will give you the earliest day of fertility period. Subtracting the number of days in the most extended cycle by 11 will provide you with the latest day of the fertile period (25).

25. Cervical mucus method

The fertility period can be predicted by quantifying the cervical mucus with fingers. Mucus usually becomes more elastic and copious during these days due to increased estrogen hormone in your body.

You may be able to understand the increased amount of cervical discharge during these days. Intercourse is safer four days after maximal cervical mucus until the onset of the next menstruation (26).

26. Basal body temperature method

The measurement of basal body temperature (BBT), that is, your body temperature while you are at rest, will help you to recognize the end of the fertility period in a cycle. The calendar method or cervical mucus method is used to determine the first day of the fertile period. There can be a slight increase in basal body temperature after ovulation, ranging from 0.5ºF/0.3ºC to 1.0°F/0.6ºC (27).

Basal body temperature may vary due to the following factors (28):

  • Fever
  • Diseases
  • Stress
  • Change in work schedules
  • Changes in sleeping time
  • Alcohol consumption
  • Travel
  • Gynecological disorders
  • Certain medication

27. Symptothermal method

This technique is based on self-assessment of the basal body temperature and thickness of cervical mucus. Biological changes of the cervix may not be evident in some women during the fertile period (27).

Advantages of natural methods: These are preferred as they involve no devices, no cost, and no chemicals.  These are viable options if a couple’s religious and cultural beliefs do not permit the use of medications or devices for contraception. Moreover, these methods have no adverse effects.

Disadvantages of natural methods: The chance of unintentional pregnancy is high, and they do not prevent sexually transmitted diseases. Natural ways of contraception are not suitable if you have irregular and unpredictable cycles.

A 2–23% failure rate is noted in the typical use of these methods (1).

Frequently Asked Questions

1. Can you get pregnant if you forget to take the pill one day?

If you miss one pill on your daily pill regime, it may not cause pregnancy. You should take the missed pill as soon as you remember, even if it means you should take two pills in a day. There is no requirement for additional contraception. You may continue your daily pill on time.

If you miss taking the pill for two days or more, it may result in pregnancy when you have unprotected sex. In such cases, you should use contraception, such as condoms, for the next seven days (29).

2. Can birth control pills cause infertility in the future?

Birth control pills may not cause infertility. Usually, irregular menstruation, ovulation problems, infections, and implantation failure may cause infertility in females. Infertility may also be caused by male factors such as sperm count and sperm motility.

Women return to fertility after the discontinuation of birth control methods. There is no scientific evidence from randomized control trials indicating infertility or birth defects in fetuses caused by birth control methods.

It is recommended to seek your doctor’s help to choose appropriate birth control methods, depending on your conveniences and requirements (30).

If other methods of contraception are not allowed or available for you, natural ways are the best options to prevent pregnancies. But these have a higher rate of failure. There are misconceptions that some foods and urination and douching (spraying with water) may help to avoid pregnancy. However, these are not recommended by experts. You should consider more effective methods of contraception to prevent pregnancy and sexually transmitted diseases.

References:

1. Birth Control Methods; Contraception; Centers for Disease Control and Prevention
2. Contraception: Hormonal contraceptives; Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
3. Contraception implant; Your contraceptive guide; National Health Service
4. Rosanna M Galzote, et al.; Transdermal delivery of combined hormonal contraception: a review of the current literature; International Journal of Women’s Health (2017).
5. Birth Control Shot; The U.S. Department of Health & Human Services (HHS)
6. Frans JME Roumen; Review of the combined contraceptive vaginal ring, NuvaRing®; Therapeutics and Clinical Risk Management (2008).
7. Birth Control Pill; HHS
8. Progestin-Only Oral Contraceptives; The United States National Library of Medicine
9. Estrogen and Progestin (Oral Contraceptives); The United States National Library of Medicine
10. Seasonale; Highlights Of Prescribing Information; The Food and Drug Administration; The United States Department of Health and Human Services
11. Classifications for Combined Hormonal Contraceptives; Reproductive Health; CDC
12. Emergency contraception; WHO
13. Emergency contraception; The American College of Obstetricians and Gynecologists
14. Emergency contraception (morning after pill, IUD); NHS
15. Intrauterine Device (IUD); The U.S. Department of Health & Human Services (HHS)
16. Male Condom; The U.S. Department of Health & Human Services (HHS)
17. Female condoms; The United States National Library of Medicine
18. Contraceptive diaphragm or cap; The National Health Service
19. Diaphragm and Cervical Cap; The U.S. Department of Health & Human Services (HHS)20. Vaginal sponge and spermicides; The United States National Library of Medicine
21. Sterilization for Women and Men; The American College of Obstetricians and Gynecologists
22. Fantasia HC.; Update on the Essure System for Permanent Birth Control; Nursing for Women’s Health (2017).
23. Coitus Interruptus (Withdrawal); CDC
24. Lactational Amenorrhea Method (LAM); The U.S. Department of Health & Human Services (HHS)
25. Iffy L.; [Risks associated with the rhythm method of contraception].; Contracept Fertil Sex (Paris) (1979).
26. Fehring RJ, et al.; Efficacy of cervical mucus observations plus electronic hormonal fertility monitoring as a method of natural family planning; JOGNN (2007)
27. Fertility Awareness-Based Methods of Family Planning; The American College of Obstetricians and Gynecologists
28. Frank E and  White R.; An updated basal body temperature method; TContraception (1996).
29. Your contraception guide; The National Health Service
30 Emergency contraception: dispelling the myths and misperceptions; WHO