The Food and Drug Administration has approved a number of birth control methods. The choice of birth control depends on factors such as a person's health, frequency of sexual activity, number of sexual partners, and desire to have children in the future. Failure rates, based on statistical estimates, are another key factor. The most effective way to avoid both pregnancy and sexually transmitted disease is to practice total abstinence (refrain from sexual contact).
Failure Rates in this chart are based on information from clinical trials submitted to the FDA during product reviews. This number represents the percentage of women who become pregnant during the first year of use of a birth control method. For methods that the FDA does not review, such as periodic abstinence, numbers are estimated from published literature. For comparison, about 85 out of 100 sexually active women who wish to become pregnant would be expected to become pregnant in a year.
Serious medical risks from contraceptives, such as stroke related to oral contraceptives, are relatively rare. This chart is a summary of important information, including risks, about drugs and devices approved by the FDA for contraception and sterilization. It is not intended to be used alone, and a health professional should be consulted regarding any contraceptive choice. Review product labeling carefully for more information on use of these products.
Male Condom, Latex/Polyurethane
FDA Approval Date: Latex: Use started before premarket approval was required. Polyurethane: cleared in 1989; available starting 1995.
Description: A sheath placed over the erect penis blocking the passage of sperm.
Failure Rate (number of pregnancies expected per 100 women per year): 11 (a, b)
Some Risks: Irritation and allergic reactions (less likely with polyurethane)
Protection from Sexually Transmitted Diseases (STDs): Except for abstinence, latex condoms are the best protection against STDs, including gonorrhea and AIDS.
Convenience: Applied immediately before intercourse; used only once and discarded. Polyurethane condoms are available for those with latex sensitivity.
Availability: Nonprescription
Female Condom
FDA Approval Date: 1993
Description: A lubricated polyurethane sheath shaped similarly to the male condom. The closed end has a flexible ring that is inserted into the vagina.
Failure Rate (number of pregnancies expected per 100 women per year): 21
Some Risks: Irritation and allergic reactions
Protection from Sexually Transmitted Diseases (STDs): May give some STD protection; not as effective as latex condom
Convenience: Applied immediately before intercourse; used only once and discarded.
Availability: Nonprescription
Diaphragm with Spermicide
FDA Approval Date: Use started before premarket approval was required.
Description: A dome-shaped rubber disk with a flexible rim that covers the cervix so that sperm cannot reach the uterus. A spermicide is applied to the diaphragm before insertion.
Failure Rate (number of pregnancies expected per 100 women per year): 17 (b, d, e)
Some Risks: Irritation and allergic reactions, urinary tract infection. (c) Risk of toxic shock syndrome, a rare but serious infection, when kept in place longer than recommended.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted before intercourse and left in place at least six hours after; can be left in place for 24 hours, with additional spermicide for repeated intercourse.
Availability: Prescription
Lea's Shield
FDA Approval Date: 2002
Description: A dome-shaped rubber disk with a valve and a loop that is held in place by the vaginal wall. Covers the upper vagina and cervix so that sperm cannot reach the uterus. Spermicide is applied before insertion.
Failure Rate (number of pregnancies expected per 100 women per year): 15
Some Risks: Skin irritation, spotting, discomfort (female and male partners), urinary tract infection. Theoretical risk of toxic shock syndrome.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted before intercourse and left in place at least 8 hours after; can be left in place for up to 48 hours, with additional spermicide for repeated intercourse.
Availability: Prescription
Cervical Cap with Spermicide
FDA Approval Date: Prentiff Cap--1988; FemCap--2003
Description: A soft rubber cup with a round rim, which fits snugly around the cervix.
Failure Rate (number of pregnancies expected per 100 women per year): Prentiff Cap--17; FemCap--23 (b, d, e)
Some Risks: Irritation and allergic reactions, abnormal Pap test. (c) Risk of toxic shock syndrome, a rare but serious infection, when kept in place longer than recommended.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: May be difficult to insert; can remain in place for 48 hours without reapplying spermicide for repeated intercourse.
Availability: Prescription
Sponge with Spermicide
FDA Approval Date: 1983 (Not currently marketed)
Description: A disk-shaped polyurethane device containing the spermicide nonoxynol-9.
Failure Rate (number of pregnancies expected per 100 women per year): 14-28 (d, e)
Some Risks: Irritation and allergic reactions, difficulty in removal. (c) Risk of toxic shock syndrome, a rare but serious infection, when kept in place longer than recommended.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted before intercourse and protects for repeated acts of intercourse for 24 hours without additional spermicide; must be left in place for at least six hours after intercourse; must be removed within 30 hours of insertion. Is discarded after use.
Availability: Nonprescription; not currently marketed
Spermicide Alone
FDA Approval Date: Use started before premarket approval was required. Since November 2002, only one active ingredient has been allowed.
Description: A foam, cream, jelly, film, suppository, or tablet that contains nonoxynol-9, a sperm-killing chemical
Failure Rate (number of pregnancies expected per 100 women per year): 20-50 (studies have shown varying effectiveness rates)
Some Risks: Irritation and allergic reactions, urinary tract infections (c)
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Instructions vary; check labeling. Inserted between 5 and 90 minutes before intercourse and usually left in place at least six to eight hours after.
Availability: Nonprescription
Oral Contraceptives--combined pill
FDA Approval Date: First in 1960; most recent in 2003
Description: A pill that suppresses ovulation by the combined actions of the hormones estrogen and progestin. A chewable form was approved in November 2003.
Failure Rate (number of pregnancies expected per 100 women per year): 1-2
Some Risks: Dizziness; nausea; changes in menstruation, mood, and weight; rarely, cardiovascular disease, including high blood pressure, blood clots, heart attack, and strokes
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken on daily schedule, regardless of frequency of intercourse. Women using the chewable tablet must drink 8 oz. of liquid immediately after taking.
Availability: Prescription
Oral Contraceptives--progestin-only minipill
FDA Approval Date: 1973
Description: A pill containing only the hormone progestin that reduces and thickens cervical mucus to prevent the sperm from reaching the egg.
Failure Rate (number of pregnancies expected per 100 women per year): 2
Some Risks: Irregular bleeding, weight gain, breast tenderness, less protection against ectopic pregnancy
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken on daily schedule, regardless of frequency of intercourse.
Availability: Prescription
Oral Contraceptives--91-day regimen (Seasonale)
FDA Approval Date: 2003
Description: A pill containing estrogen and progestin, taken in 3-month cycles of 12 weeks of active pills followed by one week of inactive pills. Menstrual periods occur during the 13th week of the cycle.
Failure Rate (number of pregnancies expected per 100 women per year): 1-2
Some Risks: Similar to oral contraceptives--combined pill
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken on daily schedule, regardless of frequency of intercourse. Since users will have fewer periods, they should consider the possibility that they might be pregnant if they miss scheduled periods. May have more unplanned bleeding and spotting between periods than with 28-day oral contraceptives.
Availability: Prescription
Patch (Ortho Evra)
FDA Approval Date: 2001
Description: Skin patch worn on the lower abdomen, buttocks, or upper body that releases the hormones progestin and estrogen into the bloodstream.
Failure Rate (number of pregnancies expected per 100 women per year): 1-2 (Appears to be less effective in women weighing more than 198 pounds.)
Some Risks: Similar to oral contraceptives--combined pill
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: New patch is applied once a week for three weeks. Patch is not worn during the fourth week, and woman has a menstrual period.
Availability: Prescription
Vaginal Contraceptive Ring (NuvaRing)
FDA Approval Date: 2001
Description: A flexible ring about 2 inches in diameter that is inserted into the vagina and releases the hormones progestin and estrogen.
Failure Rate (number of pregnancies expected per 100 women per year): 1-2
Some Risks: Vaginal discharge, vaginitis, irritation. Similar to oral contraceptives--combined pill
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Inserted by the woman; remains in the vagina for 3 weeks, then is removed for 1 week. If ring is expelled and remains out for more than 3 hours, another birth control method must be used until ring has been used continuously for 7 days.
Availability: Prescription
Post-Coital Contraceptives (Preven and Plan B)
FDA Approval Date: 1998-1999
Description: Pills containing either progestin alone or progestin plus estrogen
Failure Rate (number of pregnancies expected per 100 women per year): Almost 80 percent reduction in risk of pregnancy for a single act of unprotected sex
Some Risks: Nausea, vomiting, abdominal pain, fatigue, headache
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Must be taken within 72 hours of having unprotected intercourse.
Availability: Prescription
Injection (Depo-Provera)
FDA Approval Date: 1992
Description: An injectable progestin that inhibits ovulation, prevents sperm from reaching the egg, and prevents the fertilized egg from implanting in the uterus.
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks (serious medical risks from contraceptives are rare): Irregular bleeding, weight gain, breast tenderness, headaches
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: One injection every three months.
Availability: Prescription
Injection (Lunelle)
FDA Approval Date: 2000
Description: An injectable form of progestin and estrogen
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks: Changes in menstrual cycle, weight gain. Similar to oral contraceptives--combined.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Injection given once a month.
Availability: Prescription
Implant (Norplant)
FDA Approval Date: 1990
Description: Six matchstick-sized rubber rods that are surgically implanted under the skin of the upper arm, where they steadily release the contraceptive steroid levonorgestrel.
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks: Irregular bleeding, weight gain, breast tenderness, headaches, difficulty in removal
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Implanted and removed by health-care provider in minor outpatient surgical procedure; effective for up to five years.
Availability: Prescription. In July 2002, Norplant's manufacturer announced that it will no longer distribute the Norplant system. Women using the system should contact their doctors about what their contraceptive options will be after the five-year expiration date of their Norplant systems.
IUD (Intrauterine Device)
FDA Approval Date: 1976 (f)
Description: A T-shaped device inserted into the uterus by a health professional.
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks: Cramps, bleeding, pelvic inflammatory disease, infertility, perforation of uterus
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: After insertion by physician, can remain in place for up to one or 10 years, depending on type.
Availability: Prescription
Periodic Abstinence
FDA Approval Date: N/A
Description: To deliberately refrain from having sexual intercourse during times when pregnancy is more likely.
Failure Rate (number of pregnancies expected per 100 women per year): 20
Some Risks: None
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Requires frequent monitoring of body functions (for example, body temperature for one method).
Availability: Instructions from health-care provider
Trans-abdonimal Surgical Sterilization--female (Falope Ring, Hulka Clip, Filshie Clip)
FDA Approval Date: Before 1976 (g)
Description: The woman's fallopian tubes are blocked so the egg and sperm can't meet in the fallopian tube, preventing conception. (h)
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks: Pain, bleeding, infection, other post-surgical complications, ectopic (tubal) pregnancy.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: One-time surgical procedure that requires an abdominal incision.
Availability: Surgery
Sterilization Implant--female (Essure System)
FDA Approval Date: 2002
Description: Small metallic implant that is placed into the fallopian tubes. The device works by causing scar tissue to form, blocking the fallopian tubes and preventing conception. (h)
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks: Mild to moderate pain after insertion, ectopic (tubal) pregnancy.
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: Minor surgical procedure, permanent sterilization. Device is inserted through the vagina using a catheter. Women must rely on another birth control method during the first three months, until placement is confirmed with an X-ray procedure.
Availability: Prescription
Surgical Sterilization--male
FDA Approval Date: N/A
Description: Sealing, tying, or cutting a man's vas deferens so that the sperm can't travel from the testicles to the penis. (h)
Failure Rate (number of pregnancies expected per 100 women per year): less than 1
Some Risks (serious medical risks from contraceptives are rare): Pain, bleeding, infection, other minor postsurgical complications
Protection from Sexually Transmitted Diseases (STDs): None
Convenience: One-time surgical procedure.
Availability: Surgery
(a) Projected from six-month study and adjusted for use of emergency contraception.
(b) If spermicides are used with barrier methods, be sure that the spermicide is compatible with the condom or diaphragm (won't cause it to weaken or break). Oil-based lubricants (such as petroleum jelly or baby oil) will cause latex to weaken and should not be used with these methods.
(c) Spermicides used alone, with barrier devices, or with condoms can cause irritation to the skin lining the vagina, especially when the spermicide is used frequently. There is a possibility that spermicide might increase the risk of acquiring some sexually transmitted diseases because of disruption of the vaginal skin. Spermicide has not been proven to be effective against bacteria and viruses in people. Therefore, there is no reason to use spermicide during pregnancy.
(d) Medications for vaginal yeast infections may decrease effectiveness of spermicides.
(e) Less effective for women who have had a baby because the birth process stretches the vagina and cervix, making it more difficult to achieve a proper fit.
(f) First approval date of currently marketed IUDs. Some IUDs were sold before premarket approval was required. Those products are no longer on the market.
(g) Sold before premarket approval was required (1976).
(h) A contraceptive option for people who don't want children. Considered permanent because reversal is typically unsuccessful.
Method How it is Used Failure Rate Risks & Side Effects
Abstinence
No sexual intercourse and no type of contact between the male and female sexual organs where bodily fluids could be exchanged 0%
No Side Effects
Cervical Cap
A soft rubber barrier that covers the cervix in order to prevent sperm from entering into the uterus 20% (40% after childbirth)
No Side Effects (unless allergic)
Condom - Female
A sheath, often made of latex rubber, inserted into the vaginal to block the passage of sperm 21%
No Side Effects (unless allergic)
Condom - Male
A sheath, often made of latex rubber, covers the erect penis to block the passage of sperm 14%
No Side Effects (unless allergic)
Depo-Provera Injection
Injection of Progestin that is given every 3 months to prevent ovulation, change cervical mucus to block sperm, and change the lining or the uterus to prevent implantation of a fertilized egg 0.3%
Irregular or missed menstrual cycle,Weight gain, Breast tenderness
Diaphragm
A soft rubber dome that covers the cervix to block the passage of sperm. 20%
No Side Effects (unless allergic)
Fertility Awareness
Using the menstrual cycle and other tools to predict ovulation, and abstaining from intercourse during these expected fertile times 25%
No Side Effects
Intrauterine Device (IUD) - Copper
A device is inserted into a woman's uterus (by a doctor) to block sperm and change the uterus lining to prevent implantation of a fertilized egg 0.8%
Ectopic pregnancies, Increased bleeding during menstrual cycle, Severe menstruation cramps, Perforation of the uterus, Pelvic Inflammatory Disease (PID)
Intrauterine Device (IUD) - Progesterone 2%
Lunelle Injection
Injection os Progestin and Estrogen that is given every month to prevent ovulation, change cervical mucus to block sperm, and change the lining or the uterus to prevent implantation of a fertilized egg 0.1 - 1%
Similar to oral contraceptives
Nothing/Chance
No birth control method 85%
No Side Effects
Oral Contraceptive (estrogen/progestin)
Taken daily by women to suppress ovulation and change the lining of the uterus to prevent implantation of a fertilized egg 5%
Nausea, Headaches, Weight gain, Depression, Irregular Bleeding
*Women who smoke are advised not to take oral contraceptives
Oral Contraceptive (progestin only)
Taken daily by women to change cervical mucus to block sperm and also changes the uterus lining to prevent implantation of a fertilized egg 5%
Breast tenderness, Weight gain, Menstrual cycle changes
*Women who smoke are advised not to take oral contraceptives
Ortho-Evra Patch
A patch containing synthetic hormones placed on your skin works same as oral contraceptives 0.1 - 1%
Similar to oral contraceptives
Spermicide (only)
A jelly, foam, or cream containing chemicals that kill sperm 26%
No Side Effects (unless allergic)
Sponge
A soft saucer-shaped polyurethane sponge that blocks the cervix and absorbs semen 20% (40% after childbirth)
No Side Effects (unless allergic)
Sterilization - Female
Permanent surgical procedure to prevent pregnancy - fallopian tube is damaged to prevent passage of eggs and sperm 0.5%
If a woman conceives after a sterilization procedure there is a risk of an ectopic pregnancies.
Sterilization - Male
Permanent surgical procedure to prevent pregnancy - vas deferens tube is damaged to prevent passage of sperm into ejaculate 0.2%
No Side Effects
Withdrawal
Withdrawal of the penis before ejaculation 19%
No Side Effects
Implanon Description
Implanon™ (etonogestrel implant) is an off-white, non-biodegradable, etonogestrel-containing single sterile rod implant for subdermal use. The implant is 4 cm in length with a diameter of 2 mm (see
Figure 1). Each Implanon™ rod consists of an ethylene vinylacetate (EVA) copolymer core, containing 68 mg of the synthetic progestin etonogestrel (ENG), surrounded by an EVA copolymer
skin. The release rate is 60–70 µg/day in week 5–6 and decreases to approximately 35–45 µg/day at the end of the first year, to approximately 30–40 µg/day at the end of the second year, and then to approximately 25–30 µg/day at the end of the third year. Implanon™ is a progestin-only contraceptive and does not contain estrogen. Implanon™ does not contain latex and is not radio-opaque.
Overweight Women
The effectiveness of Implanon™ in overweight women has not been defined because women who weighed more than 130% of their ideal
body weight were not studied. However, serum concentrations of ENG are inversely related to body weight and decrease with time after insertion. It is therefore possible that with time Implanon™ may be less effective in overweight women, especially in the presence of other factors that decrease etonogestrel concentrations such as concomitant use of hepatic enzyme inducers.
Indications and Usage for Implanon
Implanon™ (etonogestrel implant) is indicated for women for the prevention of pregnancy. Implanon™ is a long-acting (up to 3 years), reversible, contraceptive method. Implanon™ must be removed by the end of the third year and may be replaced by a new Implanon™ at the time of removal, if continued contraceptive protection is desired.
In clinical trials involving 923 subjects and 1,854 women-years of Implanon™ use, the total exposure in 28-day cycles by year was
- Year 1: 10,867 cycles
- Year 2: 8,595 cycles
- Year 3: 3,492 cycles
The clinical trials excluded women who
- Weighed more than 130% of their ideal body weight
- Were chronically taking medications that induce liver enzymes
Among women aged 18–35 years of age at entry, six pregnancies during 20,648 cycles of use were reported. Two pregnancies occurred in each of Years 1, 2 and 3. Each conception was likely to have occurred shortly before or within two weeks after Implanon™ removal. With these six pregnancies, the cumulative Pearl Index was 0.38 pregnancies per 100 women-years of use.
http://www.drugs.com/pro/implanon.html
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