A discussion about effective and appropriate contraception is important to sexually active women of all ages. In the United States approximately 60% of pregnancies are unplanned! Adolescents and women in their forties are most at risk for an unplanned pregnancy.

Contraceptives include barrier methods, hormonal preparations, the intrauterine device and sterilization. The "rhythm method" involves determining a woman’s fertile period and avoiding intercourse during this time. The rhythm method is difficult to use effectively and has a high failure rate.

Barrier methods include the diaphragm, spermicides and condoms. Male condoms offer the best protection against sexually transmitted diseases and should be used by all persons at risk regardless of other contraceptives used. Spermicides work by killing sperm before they have access to the egg. They are available in foam, sheets or inserts; many condoms also contain a spermicide. These are all available without a doctor’s visit but have a fairly high failure rate, ranging from 10-20%. A diaphragm is a plastic cup that is filled with a spermicide and placed against a woman’s cervix. A physician must fit the diaphragm. Of course all the barrier methods must be used every time sex occurs for maximal effectiveness!

Hormonal methods of contraception include oral contraceptive pills (OCPs), Depo-Provera injections and Norplant capsules. They are all very effective with a failure rate of less than 1%. OCPs contain low doses of estrogen and progestin; they both prevent ovulation and thicken cervical mucous thus preventing conception. Side effects are usually mild. Non-smoking, healthy women can usually continue taking OCPs until they reach menopause. Depo-Provera and Norplant both contain a progesterone like hormone. Depo-Provera is given as an injection every three months; Norplant capsules are placed into the upper arm and are effective for 5 years. One advantage of Norplant and Depo-Provera is that they do not require remembering to take a pill every day! Side effects include irregular bleeding and possibly weight gain.

The IUD (intrauterine device) is a copper containing T shaped device that is inserted into the uterus. It has a failure rate of less than 1% and is effective for 10 years. The IUD probably prevents pregnancy by acting as a spermicide and inhibiting fertilization. The IUD should only be used in women in a monogamous relationship and who is not at risk for acquiring a sexually transmitted disease. Some women may experience heavier periods with the IUD but overall side effects are mild.

Sterilization involves a tubal ligation in women or a vasectomy in the male. These are only recommended for couples who are absolutely sure they don’t want any more children. A tubal ligation is done in the hospital and requires an anesthetic. The fallopian tubes are burned or cut blocking the egg from reaching the sperm.

In deciding which contraceptive to use there are several questions you must answer: How effective do you want the contraceptive to be? Do you want more children? Are there non-contraceptive benefits to a particular method? Do you want to take a pill every day? Are you willing to use a barrier method every time you have sex? Are you at risk for a sexually transmitted disease? Discuss these issues with your physician before deciding on which method you choose. Remember you must use contraception to avoid an unplanned pregnancy!