Contraceptives, Types, Effectiveness, Implants, Side effects, Contraindications

What Are Contraceptives?

Contraceptives are methods or devices used to prevent pregnancy. They work by interfering with the normal process of ovulation, fertilization, or implantation of a fertilized egg.

Key Points:

Also called birth control.
Some methods are temporary (e.g., pills, condoms), while others are permanent (e.g., sterilization).
Some contraceptives also offer protection against sexually transmitted infections (STIs), like condoms.

What Are Different Types of Contraceptives?

Categorization is based on how contraceptives work.

1. Contraceptives Hormonal Methods

Use synthetic hormones to prevent ovulation, thicken cervical mucus, or thin the uterine lining.

Combined Oral Contraceptive Pills (COCs) – Estrogen + Progestin
Progestin-only Pills (Mini-pills)
Hormonal Patch – e.g., Xulane
Vaginal Ring – e.g., NuvaRing
Injection – e.g., Depo-Provera (every 3 months)
Implant – e.g., Nexplanon (lasts up to 3 years)

2. Barrier Methods

Physically block sperm from reaching the egg.

Male Condom
Female Condom
Diaphragm
Cervical Cap
Spermicide – often used with other barriers
Sponge – contains spermicide and acts as a barrier

3. Intrauterine Devices (IUDs)

Inserted into the uterus to prevent fertilization or implantation.Intrauterine Devices (IUDs)

Hormonal IUDs – e.g., Mirena, Kyleena, Skyla
Copper IUD – e.g., Paragard (non-hormonal, lasts up to 10 years)

4. Emergency Contraception

Used after unprotected sex.

Plan B (levonorgestrel) – best within 72 hours
Ella (ulipristal acetate) – effective up to 5 days
Copper IUD – most effective, within 5 days

5. Permanent Methods (Sterilization)

Irreversible or difficult to reverse.

Tubal Ligation (female sterilization)
Vasectomy (male sterilization)

6. Natural Methods

Involve tracking the menstrual cycle or behaviors.

Fertility Awareness Method (FAM)
Withdrawal Method (pull-out)
Lactational Amenorrhea Method (LAM) – breastfeeding-related

Contraceptives Effectiveness

Here is a breakdown of contraceptive effectiveness, ranked from most to least effective when used correctly and consistently

✅ Most Effective (Over 99%)

Implants (e.g., Nexplanon)
IUDs (both hormonal and copper)
Sterilization (tubal ligation, vasectomy)

🔸 Less than 1 pregnancy per 100 women per year

🟡 Very Effective (91–99%)

Birth Control Pills (combined or progestin-only)
Birth Control Patch
Vaginal Ring (e.g., NuvaRing)
Injectable (Depo-Provera)

🔸 Around 6–9 pregnancies per 100 women per year with typical use

🟠 Moderately Effective (80–90%)

Male Condoms
Female Condoms
Diaphragm
Sponge
Cervical Cap

🔸 Around 12–21 pregnancies per 100 women per year with typical use

🔴 Less Effective (Below 75%)

Withdrawal Method (pull-out)
Fertility Awareness Methods (tracking ovulation)
Spermicide Alone

🔸 High failure rate with typical use—around 20+ pregnancies per 100 women per year

🆘 Emergency Contraception

Plan B (levonorgestrel): ~89% effective if taken within 72 hours
Ella (ulipristal): more effective than Plan B, especially on day 4–5
Copper IUD: most effective EC if placed within 5 days (>99%)

How Contraceptives Work

1. Preventing Ovulation

Stops the release of an egg from the ovary.
No egg = no chance of fertilization.

Example: Birth control pills, hormonal IUDs, patches, implants.

2. Blocking Fertilization

Prevents sperm from meeting the egg.

Example: Condoms, diaphragms, cervical caps.

3. Altering Cervical Mucus

Makes the mucus in the cervix thick and sticky, blocking sperm.

Example: Hormonal pills, implants, hormonal IUDs.

4. Changing the Uterine Lining

Thins the lining of the uterus so a fertilized egg can’t implant.

Example: Hormonal methods like pills and IUDs.

5. Killing or Disabling Sperm

Sperm are destroyed or made inactive.

Example: Spermicide.

6. Emergency Contraception

Delays ovulation or prevents fertilization after unprotected sex.

Example: Plan B, Ella, Copper IUD.

7. Permanent Methods (Sterilization)

Blocks or cuts reproductive pathways (fallopian tubes or vas deferens).

Example: Tubal ligation, vasectomy.

Oral Contraceptives

Oral contraceptives (birth control pills) are hormone-based medications taken daily to prevent pregnancy. They are among the most popular reversible contraceptive methods.

Types of Oral Contraceptives

A. Combination Pills (Estrogen + Progestin)

How they work:

Suppress ovulation (prevent egg release).
Thicken cervical mucus (block sperm).
Thin the uterine lining (prevent implantation).

Common Brands:

Monophasic: Same hormone dose all month (e.g., Yaz, Lo Loestrin Fe).
Multiphasic: Varying hormone levels (e.g., Ortho Tri-Cyclen).
Extended-cycle: Fewer periods (e.g., Seasonique, Lybrel).

Effectiveness:

99% with perfect use
91% with typical use

B. Progestin-Only Pills (POPs / “Mini-Pills”)

How they work:

Thicken cervical mucus & sometimes suppress ovulation.
Must be taken at the same time daily (3-hour window).

Common Brands:

Norethindrone (Camila, Errin)
Drospirenone (Slynd)
Opill (New OTC option in the U.S., 2024)

Effectiveness:

99% with perfect use
91% with typical use

How to Take Birth Control Pills

Combination Pills (21/7 or 24/4 Schedule)

21 active pills + 7 placebo pills → Period during placebo week.
24 active pills + 4 placebos → Shorter, lighter periods.

Progestin-Only Pills (Daily, No Breaks)

Must be taken within the same 3-hour window daily.

If You Miss a Pill:

Combination pill:
- 1 pill missed? Take it ASAP + next dose on time.
- 2+ pills missed? Use backup contraception (condoms) for 7 days.
Progestin-only pill:
- >3 hours late? Use backup contraception for 2 days.

Pros & Cons of Birth Control Pills

Pros ✅	Cons ❌
✔ 99% effective when taken correctly	❌ Must take daily (easy to forget)
✔ Lighter, less painful periods	❌ No STI protection
✔ Can improve acne & PMS	❌ Side effects (nausea, headaches)
✔ Reversible (fertility returns fast)	❌ May increase blood clot risk (smokers >35)

Oral Contraceptives Side Effects

Common:

First 3 months: Nausea, breast tenderness, spotting.
Long-term: Possible mood changes, decreased libido.

Rare but serious:

Blood clots (higher risk if smoking, over 35, or with migraines).

5. Who Should NOT Take Birth Control Pill?
❌ Smokers over 35 (high clot risk).
❌ History of blood clots, stroke, or heart disease.
❌ Severe liver disease or breast cancer.
❌ Uncontrolled high blood pressure.

Contraceptives Hormonal vs Non Hormonal

Hormonal Contraceptives

These contain synthetic hormones (estrogen, progestin, or both) that prevent pregnancy by:

Stopping ovulation
Thickening cervical mucus
Thinning the uterine lining

🔹 Examples:

Birth control pills (combined or progestin-only)
Patch (e.g., Xulane)
Vaginal ring (e.g., NuvaRing)
Injection (e.g., Depo-Provera)
Implant (e.g., Nexplanon)
Hormonal IUDs (e.g., Mirena, Kyleena)

✅ Pros:

Highly effective
Regulates menstrual cycles
May reduce acne, cramps, and heavy bleeding

⚠️ Cons:

Requires prescription
May have side effects (e.g., nausea, mood changes, blood clots)
Not suitable for all (e.g., smokers over 35)

Non-Hormonal Contraceptives

These prevent pregnancy without using hormones. They work by:

Blocking sperm from reaching the egg
Killing sperm
Creating an environment where fertilization or implantation can’t occur

🔹 Examples:

Male condoms
Female condoms
Copper IUD (Paragard)
Diaphragm
Cervical cap
Sponge
Spermicide
Withdrawal method
Fertility awareness
Sterilization (vasectomy, tubal ligation)

✅ Pros:

Hormone-free (no hormonal side effects)
Some protect against STIs (e.g., condoms)
Available over the counter (some methods)

⚠️ Cons:

Generally less effective than hormonal options
Must be used correctly every time
Some methods can be messy or interrupt spontaneity

Contraceptive Monophasic vs Biphasic vs Triphasic

Here’s a simple breakdown of monophasic, biphasic, and triphasic oral contraceptives. All are types of combined oral contraceptive pills that contain estrogen and progestin, but the way the hormone levels are delivered throughout the cycle is what sets them apart.

Monophasic Pills

Same dose of estrogen and progestin in each active pill
Typically taken for 21 active days + 7 placebo days
Most common type

Pros:

Easy to use
Fewer side effects related to hormone fluctuations
Good for reducing acne, cramps, and regulating periods

Example: Alesse, Sprintec, Loestrin 21

Biphasic Pills

Two different hormone levels throughout the cycle
Usually:
- Lower dose of progestin for the first half
- Higher dose of progestin for the second half

Goal: Mimic more natural hormone changes and reduce side effects

Example: Necon 10/11, Mircette

Triphasic Pills

Three varying levels of hormones in a 21-day cycle
Estrogen and/or progestin levels change approximately every 7 days

Goal: Closely mimic the body’s natural menstrual cycle

✅ Pros:

May reduce breakthrough bleeding
Can be helpful for those sensitive to hormone changes

Example: Ortho Tri-Cyclen, Tri-Sprintec

Selection criteria for Monophasic, Biphasic and Triphasic Oral contraceptives

Choosing between monophasic, biphasic, and triphasic oral contraceptives depends on a few key clinical and personal factors. Here’s a simple guide to help understand the criteria for selecting the best option:

1. Simplicity and Consistency

Choose: Monophasic

Best for first-time users
Easy to manage (same hormone dose each day)
Fewer mood swings or hormonal fluctuations
Easier to skip periods if desired (for cycle control)

Ideal for:

Teenagers
Women with irregular periods
Women prone to mood changes

2. Hormonal Sensitivity or Side Effects

Choose: Biphasic or Triphasic

If patient experiences side effects like nausea, bloating, or breast tenderness with monophasic pills
These mimic natural hormone shifts better and may reduce some side effects

Ideal for:

Women sensitive to hormone levels
Women with mid-cycle breakthrough bleeding

3. Menstrual Regulation / Cycle Control

Choose: Triphasic

Designed to closely mimic the natural menstrual cycle
May reduce breakthrough bleeding and spotting

Ideal for:

Women with heavy or irregular periods
Women wanting a more “natural” cycle feel

4. Acne or PCOS Management

Choose: Monophasic

More stable hormone levels = better for managing acne, oily skin, or PCOS
Helps with cycle regulation and androgen control

5. Medical Conditions or Specific Needs

Migraines, cardiovascular risk, or clotting disorders? → Might require low-estrogen monophasic or progestin-only pill (POP)
Difficulty remembering to take pills consistently? → Consider long-acting methods like IUDs or injectables instead.

Contraceptives active ingredients and their functions

Contraceptives contain synthetic versions of estrogen and/or progestin, which help prevent pregnancy by stopping ovulation, thickening cervical mucus, or thinning the uterine lining. Some non-hormonal options also use active ingredients to create a hostile environment for sperm.

1. Estrogen-Based Ingredients

Function:

Prevents ovulation
Stabilizes the endometrium (reduces irregular bleeding)
Enhances the effects of progestin

2. Progestin-Based Ingredients

Function:

Thickens cervical mucus to block sperm
Prevents ovulation
Thins uterine lining to prevent implantation

Non-Hormonal Active Ingredients

Function:

Directly kill or disable sperm
Create a hostile environment for fertilization

Contraceptives Implant

Contraceptive implants are small, flexible rods inserted under the skin that release progestin to prevent pregnancy. They are a long-acting, reversible form of birth control that lasts for several years. These are one of the most effective long-acting reversible contraceptives (LARCs) available.

How Do Contraceptives Implants Work?

Contraceptive implants (like Nexplanon) release a steady dose of progestin (a synthetic form of the hormone progesterone), which prevents pregnancy in three main ways:

1. Prevents Ovulation (Primary Mechanism)

The progestin suppresses the release of eggs (ovulation) from the ovaries.

Without an egg, sperm cannot fertilize anything, preventing pregnancy.

2. Thickens Cervical Mucus

The hormones cause the mucus in the cervix to become thicker and stickier, making it difficult for sperm to swim through and reach an egg.

3. Thins the Uterine Lining (Endometrium)

Progestin makes the lining of the uterus thinner, so even if fertilization occurs, a fertilized egg cannot implant and grow.

Types of Contraceptive Implants

There are different types available globally, but Nexplanon (etonogestrel) is the most widely used today.

1. Nexplanon (Previously Implanon)

Active Ingredient: Etonogestrel (68 mg)
Duration: Up to 3 years
Insertion Site: Under the skin of the inner upper arm
Effectiveness: Over 99%

✅ Pros: ✔ One of the most common and widely used implants
✔ High effectiveness and long duration
✔ Safe for most women, including those who are breastfeeding

⚠ Cons:
❌ May cause irregular bleeding
❌ Requires a healthcare provider for insertion/removal

2. Jadelle

Active Ingredient: Levonorgestrel (75 mg per rod, total 150 mg)
Duration: Up to 5 years

✅ Pros:
✔ Longer-lasting than Nexplanon (up to 5 years)
✔ Commonly used in developing countries

⚠ Cons:
❌ Less commonly available in the U.S.
❌ More difficult to insert/remove than Nexplanon

3. Sino-Implant (II)

Active Ingredient: Levonorgestrel (75 mg per rod, total 150 mg)
Duration: Up to 4 years

✅ Pros:
✔ More affordable than other implants
✔ Used in many low-income countries

⚠ Cons:
❌ Not widely available in North America or Europe

How to Choose the Right Implant?

✅ For most people: Nexplanon (Etonogestrel, 3 years)
✅ For long-term use: Jadelle (Levonorgestrel, 5 years)
✅ For affordability: Sino-Implant (Levonorgestrel, 4 years)

Who can use Contraceptive Implants?

Suitable for most women, including those who:

Can’t use estrogen-based methods
Breastfeed
Want long-term contraception

Who shouldn’t use Contraceptive Implants?

Not recommended for women with:

Active liver disease
History of blood clots (in some cases)
Certain cancers (hormone-sensitive)
Unexplained vaginal bleeding

Contraceptive Injection

The contraceptive injection (also called the “birth control shot”) is a hormone-based method administered every few months (usually 3 months) to prevent pregnancy. It contains progestin (a synthetic progesterone) and works similarly to the implant but requires regular doses.

Types of Contraceptive Injections

Brand Name	Active Ingredient	Duration	How It’s Given
Depo-Provera	Medroxyprogesterone acetate (MPA) 150 mg	Every 3 months	Intramuscular (IM) shot
Sayana Press	Medroxyprogesterone acetate (MPA) 104 mg	Every 3 months	Subcutaneous (SC) shot
Noristerat	Norethisterone enanthate 200 mg	Every 2 months	Intramuscular (IM) shot

How Contraceptive Injection Works

Like the implant, the injection prevents pregnancy by:

Stopping ovulation (no egg is released)
Thickening cervical mucus (blocks sperm)
Thinning the uterine lining (prevents implantation)

Effectiveness:

>99% effective with perfect use
~94% effective with typical use (if doses are delayed)

Contraceptive Injection Side Effects

⚠ Common:

Irregular bleeding (especially in the first months)
Weight gain (average 2–5 lbs over a year)
Headaches, mood swings, or breast tenderness

⚠ Less Common but Serious Side effects:

Bone density loss (if used for >2 years without breaks)
Delayed return of fertility (may take 6–12 months after stopping)
Increased risk of blood clots (if other risk factors exist)

❌ Who Should Avoid Contraceptive Injection?

Women with:

History of blood clots/stroke
Severe liver disease
Unexplained vaginal bleeding
Osteoporosis or high risk of bone loss

Emergency Birth Control Pills (Morning-After Pill)

Emergency contraception (EC) pills are used to prevent pregnancy after unprotected sex or contraceptive failure (e.g., missed pills, condom break, sexual assault). They work best when taken as soon as possible after intercourse. It is not an abortion pill—it works before pregnancy occurs.

Types of Emergency Contraception Pills

1. Levonorgestrel Pills (Plan B, Take Action, MyWay, etc.)

How it works: Delays ovulation (no egg release).
Timeframe:
- Most effective within 72 hours (3 days).
- Can work up to 5 days, but effectiveness declines.
Availability:
- OTC (no prescription, no age restrictions in the U.S.)
- Sold at pharmacies, supermarkets, and online.
Effectiveness:
- 95% if taken within 24h
- 85% within 72h

Less effective for women over 165 lbs (75 kg)

2. Ulipristal Acetate (Ella)

How it works: Blocks progesterone, delaying ovulation longer.
Timeframe:
- Works up to 120 hours (5 days) after sex.
Availability:
- Prescription required in the U.S. (but available via telehealth).
Effectiveness:
- More effective than Plan B, especially for women over 165 lbs.

3. Copper IUD (Paragard –

Non-Hormonal Option)

How it works: Prevents fertilization/implantation.
Timeframe: Can be inserted up to 5 days after sex.
Effectiveness: >99% (most effective EC method).

Bonus: Also works as long-term contraception.

How Effective Are Emergency Birth Control Pills?

Most effective when taken as soon as possible after unprotected sex.
Plan B: Best within 24 hours (~95% effective), drops to ~58% if taken on day 3.
Ella: Maintains high effectiveness up to 5 days (~85% effective).
Not 100% effective, especially if taken late or near ovulation.

When Should You Use Emergency Contraceptive Pills?

Missed birth control pills or patch/ring delay.
Condom broke/slipped off.
Unprotected sex (forgot to use contraception).
Forced/unwanted intercourse.

🚫 Do NOT use ECPs as regular birth control, they are less effective than daily contraception methods.

Emergency Contraceptive Pills Side Effects

⚠ Temporary side effects may include:

Nausea/vomiting (if you vomit within 2 hours, you may need another dose).
Irregular bleeding or spotting before the next period.
Fatigue, headache, dizziness.
Breast tenderness.

Who Should NOT Use Emergency Contraceptive Pills (ECPs)?

Not recommended for:

❌ People with severe liver disease (for Ella).

❌ Those already pregnant (ECPs won’t work).

❌ People with certain medication interactions (check with a doctor).

Common Myths About Emergency Contraceptive Pills (ECPs)

Question: Emergency contraception is the same as an abortion pill.

Answer: Emergency contraceptive pills (ECPs) prevent pregnancy but do not terminate an existing pregnancy. They work by delaying ovulation, preventing sperm from meeting an egg. If implantation has already occurred, ECPs will not be effective. The abortion pill (mifepristone) is different and is used to terminate a pregnancy.

Question: Emergency contraception is 100% effective.

Answer: While ECPs are highly effective, they are not 100% guaranteed to prevent pregnancy. Plan B is about 95% effective if taken within 24 hours but drops to 58% by day 3. Ella is more effective than Plan B and works for up to 5 days. The sooner it’s taken, the better.

Question: Taking emergency contraceptive pills can make you infertile.

Answer: ECPs have no long-term effects on fertility. They only provide temporary hormone changes to prevent pregnancy for one cycle. A person can still conceive in the next cycle if no regular contraception is used.

Question: You can only take emergency contraception once in your lifetime.

Answer: There’s no limit to how many times a person can use ECPs. However, they should not be used as a primary birth control method because they are less effective than regular contraceptives and can cause irregular periods. If frequent emergency contraception is needed, a long-term method (e.g., IUD, implant, or birth control pills) is a better option.

Question: Emergency contraceptive pills work even if you’ve already ovulated.

Answer: ECPs work by delaying ovulation. If ovulation has already occurred, ECPs may not be effective. In that case, a copper IUD is the best emergency contraception option, as it prevents sperm from fertilizing the egg even after ovulation.

Birth Control Patch

The birth control patch (brand name Xulane, Twirla) is a hormonal contraceptive worn on the skin that releases estrogen + progestin to prevent pregnancy. It’s a weekly alternative to the pill.

How Birth Control Patch Works

✔ Prevents ovulation (stops egg release)
✔ Thickens cervical mucus (blocks sperm)
✔ Thins uterine lining (prevents implantation)

Effectiveness:

>99% with perfect use
~91% with typical use (if patches are delayed)

How to Use the Patch

Apply a new patch weekly for 3 weeks (21 days).
Locations: Buttocks, abdomen, upper arm, or back (not breasts).
Patch-free week (4th week) → Withdrawal bleeding occurs (like a period).
Restart after 7 days.

Who Should Avoid It?

❌ Smokers over 35
❌ History of blood clots, heart disease, or stroke
❌ Migraines with aura
❌ Liver tumors/cancer

Contraceptives Pills for Men

Unlike female contraceptive pills, which have been widely available for decades, male contraceptive pills are still in the research and development stage. However, scientists are actively working on creating effective and reversible oral contraceptives for men.

Why Don’t We Have Male Contraceptive Pills Yet?

Developing a male contraceptive pill has been challenging due to:

Sperm production is continuous, unlike female ovulation, which happens once a month.
Men produce millions of sperm daily, so reducing sperm count to an infertile level is more difficult.
Hormonal side effects – Testosterone suppression can cause mood swings, weight gain, and libido changes.

Common Male Contraceptive Methods

1. Condoms (Most Common & Accessible)

Type: Barrier method

How it works: Blocks sperm from entering the vagina.
Effectiveness: 98% (perfect use)

Pros:

Protects against STIs
No hormones or side effects
Cheap & available OTC

Cons:

Can break/slip off
Requires correct use every time

2. Vasectomy (Permanent Option)

Type: Surgical sterilization

How it works: Cuts/seals the vas deferens (sperm tubes).
Effectiveness: >99% (after 3 months & follow-up tests).

Pros:

Extremely reliable
No effect on testosterone or sex drive

Cons:

Not easily reversible (reversal is expensive & not guaranteed)
Requires minor surgery

3. Withdrawal (Pull-Out Method)

Type: Behavioral

How it works: Man ejaculates outside the vagina.
Effectiveness: 96% (perfect use), 78% (typical use) (pre-cum may contain sperm)

Pros:

Free & no devices

Cons:

High failure rate
Requires strong self-control

Herbal Contraceptives

Herbal contraceptives have been used in traditional medicine for centuries, but they are not as reliable or scientifically proven as modern birth control methods. If you’re considering herbal contraception, it’s important to understand that these methods may not be highly effective and should not be relied upon if you need highly reliable pregnancy prevention.

Common Herbal Remedies

Believed to Have Contraceptive Effects

Wild Carrot Seed (Queen Anne’s Lace)

How It’s Used: Seeds are chewed or taken as a tea after intercourse.
Possible Effect: May interfere with implantation by altering progesterone levels.
Effectiveness: Unreliable, not clinically tested.
Risks: Can cause digestive issues; not safe during pregnancy.

Neem (Azadirachta indica)

How It’s Used: Neem oil applied vaginally or neem extract taken orally.
Possible Effect: Thought to have spermicide-like properties and may prevent implantation.
Effectiveness: Not proven in humans, limited studies available.
Risks: Can be irritating to vaginal tissues.

Papaya (Papaya Seeds)

How It’s Used: Some cultures use raw papaya or papaya seeds to reduce fertility.
Possible Effect: May lower sperm count in men and affect implantation in women.
Effectiveness: Limited scientific evidence.
Risks: Can cause digestive upset; unproven for reliable contraception.

Pennyroyal (Mentha pulegium)

How It’s Used: Taken as a tea or infusion.
Possible Effect: Traditionally believed to cause menstrual stimulation and prevent implantation.
Effectiveness: Dangerous and toxic in high doses—can cause liver damage and even death.
Risks: Not recommended at all due to severe toxicity.

Cotton Root Bark

How It’s Used: Tea or tincture from the root bark.
Possible Effect: Thought to suppress progesterone, leading to potential early miscarriage.
Effectiveness: No reliable studies confirm this.
Risks: Can cause severe hormonal imbalances.

Why Herbal Contraceptives Are Risky

Lack of Scientific Proof – These methods have not been reliably tested in clinical trials.
Unpredictable Effectiveness – They may work for some, but failure rates are unknown.
Toxicity Risks – Some herbs, like pennyroyal, are dangerous even in small amounts.
Irregular Dosage & Potency – Herbs vary in strength, making it impossible to dose accurately.