Method	Action/Effectiveness	Advantages	Disadvantages and Side Effects
Hormonal Contraceptives
Pill—combination of estrogen and progesterone	Suppresses ovulation by suppressing production of FSH and LH	Convenient; easy to take Withdrawal bleeding cycles are predictable	Absolute contraindications (e.g., thromboembolic or coronary artery disease; some cancers or liver disease)
Oral contraceptives (daily)	Most efficient form of contraception (99.7%) if used consistently	Not related to sex act Safe for older nonsmoking women until menopause Many noncontraceptive health benefits (oral)	Relative contraindications (e.g., migraines, hypertension, immobility 4 weeks or more, abnormal genital bleeding) Some decrease in glucose tolerance Effectiveness decreased if taken during use of barbiturates, phenytoin, antibiotics No protection against STIs
Contraceptive patch—combination of estrogen and progesterone (change q wk)	Suppresses ovulation Thickens cervical mucus Decreases sperm penetration 99% effective in women <198 lb; 92% effective in women >198 lb	Convenient Patch applies to abdomen, buttocks, upper arm, or upper torso Changed once/week	Absolute contraindications (e.g., thromboembolic or coronary artery disease, some cancers or liver disease) Relative contraindications (e.g., migraines, hypertension, immobility 4 weeks or more, allergic reaction to patch) No protection against STIs
Mini-pill—progestin only (PO daily)	Impairs fertility Thickens cervical mucus Decreases sperm penetration Alters endometrial maturation Effectiveness: undetermined; can reach 100% reliability if used exactly as prescribed	Convenient, easy to take	Ovulation may occur Irregular bleeding, mood changes, weight gain May change glucose and insulin values No protection against STIs
Depo-Provera—synthetic progesterone (IM q 3 mo)	Suppresses ovulation Thickens cervical mucus Changes the uterine lining, making it harder for sperm to enter or survive in the uterus Effectiveness: 99.7%	Private Effective after 24 hours Does not require regular attention Does not interrupt sex play Has no estrogen May decrease risk for ovarian and uterine cancers	Requires injections every 3 months Delay of return to fertility Possible weight gain and irregular bleeding No protection against STIs
Emergency Postcoital Contraception
Estradiol (100 mcg) and levonorgestrel (0.5 mg)	Antifertility; taken within 72 hours of unprotected sex Take as soon as possible; repeat 12 hours later Effectiveness: 75%–85%	Available prn	Nausea, headache, dizziness
Intrauterine Devices (IUDs)
Small, T-shaped, medicated device inserted into uterine cavity	Prevents fertility	Can be used by women who cannot use hormonal contraception; no disruption of ovulation pattern	Contraindications: history of PID, pregnancy, undiagnosed genital bleeding, genital malignancy, abnormal uterine cavity, severe cervicitis, HIV/AIDS, history of ectopic pregnancy, history of toxic shock
Copper (Paragard)	Recommended for women who have had at least one child Damages sperm in transit to fallopian tube	Can be used effectively for 10 years	Risks: uterine perforation, infection (may be followed by PID) in the first 3 months of insertion; unnoticed expulsion Side effects (especially with Paragard): heavy flow, spotting between periods, and cramping within first few months of insertion Must check for string after each menses and before intercourse
Progesterone (Mirena)	Alters cervical mucus and endometrial maturation Effectiveness: 90%–99%	Not necessary to change every year. Can be used up to 5 years. Less blood loss during menses and decreases primary dysmenorrhea	No protection against STIs
Mechanical Barriers
Diaphragm: shallow rubber device that fits over cervix	Barrier preventing sperm from entering cervix (if it is correct size, undamaged, correctly placed, and used with spermicide) Effectiveness: 83%–90%; 99% in highly motivated women	Does not interrupt sex act, except to add spermicide just before act* Insert up to 6 hours before intercourse and leave in place for 6 hours after last intercourse, but not longer than 24 hours Safe: no side effects from well-fitted device if woman is not allergic to diaphragm or spermicide Decreased incidence of vaginitis, cervicitis, PID	Requires careful cleansing with warm water and mild soap; powder with cornstarch, and store away from heat. Use might be associated with TSS† Size/fit must be checked after birth, second/third-trimester abortion, weight gain or loss of 15–20 lb or more, or every 2 years Spermicide must be reinserted for additional acts that may follow after initial intercourse
Cervical cap: 1¼–1½-inch soft natural rubber dome with a firm but pliable rim	Physical barrier to sperm Spermicide inside cap adds a chemical barrier Effectiveness depends on its fit. 80%–91% effective for nulliparas 60%–74% effective in multiparas	Worn for 8 hours but not longer than 48 hours No need to add spermicide for repeated acts of intercourse	Need a Pap smear every year: higher rate of conversion from class I to class III‡ If in place over 48 hours, it produces an odor and might be associated with TSS† Cannot be worn during menstrual flow (menses) or up to at least 6 weeks postpartum Contraindications: abnormal Pap smear, hard to fit, history of TSS or genital infection, allergy Change after genital surgery, abortion or birth, major change in weight Must be checked each year Does not protect against STIs
Female condom: vaginal sheath of natural latex rubber with flexible rings at both the closed and the open ends	Barrier preventing sperm from entering vagina Effectiveness similar to other mechanical methods used with spermicide (79%–95%) Note: Male and female condoms should not be used at the same time	Apply up to 8 hours in advance of intercourse; spermicide added just before intercourse Heightens sensation for man About as satisfying for both woman and man as intercourse without it Provides protection from STIs	Cost A new one must be used for every act of intercourse
Condom: thin, stretchable latex sheath to cover penis	Barrier preventing sperm from entering vagina, applied over erect penis before loss of pre-ejaculatory drops and is held in place as penis is withdrawn Spermicidal foam, jelly, or cream is also used* Effectiveness rate: 64%–98% when used with spermicide	Safety—no side effects Provides protection from spread of STIs With spermicide (0.5 gm of nonoxynol-9) added to interior or exterior surface, provides protection from STIs, including HIV	Check expiration date Requires high motivation to use correctly/consistently Must be properly applied and removed Sheath may tear during intercourse Can have small undetectable holes
Chemical Barriers
Spermicide: aerosol foams, foaming tablets, suppositories, creams, and films (VCF)	Physical barrier to sperm penetration Chemical action on sperm (kills sperm) Nonoxynol-9 has a bacteriostatic action Effectiveness rate: 70%–98% when used with diaphragm or condoms	Increases effectiveness of mechanical barriers Ease of application. Aids lubrication of vagina* Requires no medical examination or prescription May be used during lactation Backup for missed oral contraceptive pills	Messy Some people are allergic to preparations Tabs or suppositories take 10–15 minutes to dissolve If it is only method being used, each intercourse should be preceded (by 30 minutes) by a fresh application; may be allergenic
Other Methods
Natural family planning: basal body temperature (BBT) each morning before any physical activity Symptothermal variation: BBT plus cervical mucus changes Calendar method Predictor test for ovulation	Requires sexual abstinence during woman’s fertile period (4 days before ovulation), and for 3 or 4 days after ovulation Effectiveness: about 80%	Physically safe to use—no drugs or appliances are used; meets requirements of most religions	Effectiveness depends on high level of motivation and diligence Requires fairly predictable menstrual cycle

^* Spermicide provides lubrication, but if additional lubrication is needed, use water-based products only (e.g., K-Y Jelly).

^† TSS: toxic shock syndrome. Although there is no direct link between TSS and use of the diaphragm or cervical cap, a possible association remains (see Sterilization).

^‡ Class I Pap smear: no abnormal cells; class III Pap smear: suspicious abnormal cells present.