Types
 

1. Hormonal Pills, Patches, Rings, and Injections
 

These methods rely on synthetic hormones (estrogen and progestin, or progestin alone) to prevent pregnancy. Progestins work by thickening cervical mucus which blocks sperm, thinning the endometrium which prevents implantation of a fertilized egg, and sometimes can prevent ovulation. Estrogens work by preventing ovulation. 
 

• Combined Oral Contraceptive Pills (COCs): Daily pills containing an estrogen and progestin. 

• Progestin-Only Pills (POPs / "Mini-Pill"): Daily pills containing only progestin. Ideal for patients who cannot take estrogen (e.g., history of blood clots, high blood pressure, or breastfeeding). Most require strict adherence to taking the pill at the same time each day.

• Contraceptive Injection (Depo-Provera): An intramuscular injection of medroxyprogesterone acetate administered every 12 weeks (4 times per year).

• Transdermal Contraceptive Patch (e.g., Xulane, Twirla): A small adhesive patch worn on the skin (abdomen, buttocks, or upper torso) that releases estrogen and progestin. Replaced weekly for 3 weeks, followed by 1 patch-free week.

• Vaginal Contraceptive Ring (e.g., NuvaRing, Annovera): A flexible, clear ring inserted into the vagina that continuously releases estrogen and progestin. Left in place for 3 weeks, then removed for 1 week.

• Etonogestrel Implant (Nexplanon): A small, flexible plastic rod inserted just under the skin of the inner upper arm. It continuously releases a low dose of progestin. Highly effective for up to 5 years.
   

2. Intrauterine Devices (IUDs)
 

These devices require a minor procedure in which a small, flexible t-shaped device is inserted through the cervix and into the uterus.
​

• Hormonal Intrauterine Device (IUD) (e.g., Mirena, Kyleena, Liletta, Jaydess): locally releases progestin (levonorgestrel). Effective for 3 to 8 years depending on the brand.

• Non-Hormonal Copper IUD (ParaGard): the copper creates a localized inflammatory reaction that is toxic to sperm. Effective for up to 10–12 years. Requires a provider REMS certification. 

***Please note that while IUDs and the Nexplanon implant are excellent, highly effective options, I currently do not have the training to provide these options.

3. Barrier Methods = less effective
 

Barrier options physically block sperm from entering the uterus to meet an egg. They are used exclusively during sexual intercourse.
 

• Male Condoms: Help reduce the transmission of STIs and prevent pregnancy

• Female Condoms: Pouches inserted into the vagina or rectum prior to intercourse. Also provides some STI protection.

• Diaphragm: A shallow, dome-shaped silicone cup inserted into the vagina over the cervix prior to intercourse. Must be used with spermicide and left in place for at least 6 hours after sex.

• Cervical Cap (e.g., FemCap): A smaller silicone cup that fits tightly directly over the cervix via suction. Used with spermicide and left in place for at least 6 hours post-intercourse.

• Contraceptive Sponge: A soft, round foam device saturated with spermicide inserted over the cervix.

4. Chemical & Barrier Gels = less effective
 

• Contraceptive Gels & Spermicides (e.g., Phexxi, Nonoxynol-9):

  • Nonoxynol-9: A chemical surfactant that immobilizes and destroys sperm cells (available as gels, foams, or suppositories).

  • Phexxi (Lactic acid, citric acid, and potassium bitartrate): A non-hormonal, prescription vaginal gel used immediately before sex that maintains the vagina's naturally acidic pH (3.5–4.5), rendering sperm immobile.

5. Emergency Contraception
 

Used after unprotected intercourse, condom failure, or missed contraceptive doses to prevent pregnancy before it occurs.
 

• Levonorgestrel Oral Pills (Plan B One-Step / OTC): Most effective when taken within 72 hours of unprotected sex. Less effective in individuals with higher BMIs.

• Ulipristal Acetate (Ella / Rx): A selective progesterone receptor modulator effective up to 120 hours (5 days) after unprotected sex. Maintains efficacy at higher BMIs than Plan B.

• Copper IUD Insertion within 5 days of unprotected sex

6. Permanent / Surgical Methods (Sterilization)
 

• Tubal Ligation / Salpingectomy ("Tubes Tied"): Surgical occlusion or complete removal of the fallopian tubes to prevent eggs from reaching sperm.

• Vasectomy: A minor surgical procedure cutting or sealing the vas deferens tubes in men to prevent sperm from entering the ejaculate.

Contraindications and Risk

*The U.S. Medical Eligibility Criteria (US MEC) outlines medical conditions that make certain contraceptive methods unsafe or contraindicated.

Estrogen-Containing Methods (COCs, Patch, Ring)
 

Estrogen increases the production of hepatic clotting factors and can elevate blood pressure.

Major Contraindications (US MEC Category 4 = Unacceptable Health Risk):
 

• History of or active Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), unless on stable treatment.

• Known thrombogenic mutations (e.g., Factor V Leiden, Prothrombin mutation).

• Migraine with aura (at any age) due to a significantly elevated risk of ischemic stroke.

• Hypertension (severe ≥160/100 mmHg, or with vascular disease).

• Age 35 or older who smoke 15 or more cigarettes per day.

• Current or history of breast cancer.

• Ischemic heart disease, stroke, or complicated valvular heart disease.

• Less than 21 days postpartum (due to naturally high postpartum venous thromboembolism risk).

Progestin-Only Methods (POPs, Depo-Provera, Nexplanon, Hormonal IUDs)
 

Progestin-only options avoid estrogen-related vascular risks and are safe for most patients with blood clot risks or high blood pressure.

Major Contraindications:
 

• Current Breast Cancer: Progestin can stimulate breast cancer tissue (Category 4 for all progestin methods).

• Severe Liver Disease / Hepatoma: Impaired metabolism of hormones (Category 3/4).

• Unexplained Vaginal Bleeding: Must be evaluated to rule out underlying endometrial pathology before inserting an IUD or implant.

• For Depo-Provera specifically: Current or history of ischemic heart disease or stroke (Category 3). Long-term use requires caution in patients with significant risk factors for decreased bone mineral density (osteopenia/osteoporosis).

• For Hormonal IUDs specifically: Current pelvic inflammatory disease (PID), purulent cervicitis, or distortion of the uterine cavity (e.g., large fibroids).

Non-Hormonal Methods (Copper IUD, Barriers)
 

• Copper IUD: Contraindicated in acute PID, purulent cervicitis, uterine cavity distortion, Wilson's disease, or copper allergy.

• Barrier Methods / Spermicides: Nonoxynol-9 spermicide causes micro-abrasions with frequent use, increasing HIV/STI acquisition risk; contraindicated in individuals at high risk for HIV. Latex allergy contraindicates latex condoms/diaphragms (polyurethane or silicone alternatives are used).

Common Side Effects
 

Estrogen-Containing Methods (Pills, Patch, Ring)
 

• Common: Nausea, breast tenderness, breakthrough spotting/bleeding (especially in the first 3 months), mild headaches, mood fluctuations, fluid retention.

• Method-Specific: Patch can cause localized skin irritation; Ring can increase clear vaginal discharge or minor local sensation.

Progestin-Only Methods (Implants, POPs, Depo-Provera, Hormonal IUDs)
 

• Irregular Bleeding: Unscheduled spotting, prolonged light bleeding, or complete amenorrhea (absence of periods). Nexplanon frequently causes unpredictable spotting patterns.

• Depo-Provera (Injection): Weight gain (average 5–10 lbs over 1–2 years), possible loss of bone mineral density with prolonged use, mood changes, delayed return of menses. Usually can take up to a year or sometimes more after the last injection for regular ovulation to resume. Hence, it is not recommended for individuals planning to conceive within the next year. 

• Hormonal IUDs: Initial unscheduled spotting for 3 to 6 months, followed by significantly lighter periods or amenorrhea (often considered a desirable benefit). Minor pelvic cramping post-insertion.

• Systemic Progestin Effects: Mild acne, breast tenderness, or oily skin (variable by progestin type).

Non-Hormonal Methods (Copper IUD, Gels, Barriers)
 

• Copper IUD: Heavier, longer, or more painful menstrual periods (dysmenorrhea), particularly during the first 3 to 6 months after placement.

• Phexxi & Spermicides: Vaginal burning, itching, or irritation; increased risk of urinary tract infections (UTIs) or yeast infections.

• Diaphragm / Cervical Cap: Increased risk of recurrent UTIs or vaginal irritation if left in place beyond recommended timeframes.

Which One is Right for Me?
 

Choosing a method requires a personalized approach. Many options, especially the hormonal options, have contraindications, risks, and side effects. During our appointment, I will prepare you with more detailed information regarding these medications, so we can select the best one for you.

 

                                                       References & Guidelines
 

• Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2024.

• Centers for Disease Control and Prevention (CDC). U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), 2024.

• Centers for Disease Control and Prevention (CDC). Appendix A: Summary of U.S. MEC Classifications for Hormonal Contraceptive Methods and Intrauterine Devices.

• Centers for Disease Control and Prevention (CDC). Emergency Contraception: U.S. Selected Practice Recommendations.