Overview
What Is It?
Contraception refers to a woman's chosen form of birth control, including hormonal, barrier, chemical and natural methods.
Choosing a birth control method is one of the most personal health care decisions a woman makes. In nearly four decades of childbearing years, your need for birth control will most likely change many times. But at each life stage, you can make informed decisions by learning about all your contraceptive options and selecting one or more that best fits your reproductive health needs.
Why Do Unplanned Pregnancies Occur with Contraception?
Many women are not adequately protected from an unwanted pregnancy by their choice of birth control method. In fact, studies indicate that one-third to one-half of all pregnancies in the United States are unplanned. Of these unplanned pregnancies, almost half of the women were using some form of birth control.
Failure of the Contraceptive
There are several reasons for failure of contraception, including inappropriate use (for example, not inserting a diaphragm the right way or not using enough spermicide); failure to continue use of the method (for example, forgetting to take your birth control pills or not using a condom every time you have sex); and failure of the contraceptive method itself.
Myths or personal concerns about the risks and safety of certain birth control options also contribute to incorrect use of birth control. Women may use a particular method only occasionally, for example, thinking that less frequent use is safer than continuous use. Or they may stop using a particular method because of bothersome side effects.
Age-related changes can lead women to believe they no longer need to use contraception. For example, women nearing menopause may mistakenly think they are no longer fertile because their menstrual cycles are no longer regular. However, about 38 percent of pregnancies that occur in perimenopausal women are unintended. Although menopause does mark the end of a woman's childbearing years, you have not gone through menopause until 12 consecutive months without a period. You can get pregnant even if your periods are irregular.
How to Choose the Right Birth Control Method
Today, American women have more contraceptive options to choose from than ever before. So you should be able to find one that works well for you and fits your lifestyle.
Other things to consider before making a contraception choice:
You can probably think of many more questions about birth control. Learn as much as you can about your options and make an informed decision about which method is the best and safest for you. Consider your needs and discuss them with your health care professional during your next medical appointment.
To get you started, here is some basic information about contraceptive options approved by the U.S. Food and Drug Administration (FDA), and resources you can use for more in-depth research.
For a comparison of how effective each type of contraception is for preventing pregnancy, please see the chart, "Contraceptive Failure Rates" at the end of this entry.
Types of Contraceptive Options
The contraceptive options women may choose are:
Birth Control Pills
There are three types of BCPs on the market today: the combination pill, the mini-pill and the emergency contraceptive pill. The combination pill is the most widely prescribed. It contains two hormones: estrogen and progestin. It works by suppressing ovulation each month.
Learn more: Birth Control Pills
Long-Acting Hormonal Methods
Several options are available to women who want long-term, but not permanent, protection against pregnancy, including intrauterine devices, hormonal patches and vaginal rings. These options rely on estrogen-progestin or progestin alone to prevent ovulation.
Learn more: Long-Acting Hormonal Methods
Barrier Methods
Barrier methods are less effective than hormonal methods but cause fewer side effects and are associated with less risk. They include condoms, diaphragms, the contraceptive sponge and cervical caps
Learn more: Barrier Methods
Spermicides
Spermicides are nonprescription, nonhormonal chemical products (foam, cream, gel, suppository and film) containing the active ingredient nonoxynol-9 (N-9) or octoxynol-9 (O-9).
Learn more: Spermacides
Natural Family Planning
A calendar, body temperature and physical symptoms, such as the consistency of cervical mucus, are used to determine when ovulation is likely, and you avoid intercourse during this time.
Learn More: Natural Family Planning
Permanent Contraception
Female sterilization closes a woman's fallopian tubes by blocking, tying or cutting them so an egg cannot travel to the uterus.
Learn more: Permanent Contraception
The Effectiveness of Contraceptives
The statistics below represent the percentage of women who experienced unintended pregnancy during one year of using the contraceptive method indicated.
| Method | Failure Rate |
| Permanent Contraception:(Sterilization) Male Sterilization Female Sterilization | 0.15% 0.5% |
| Hormonal Methods: Hormone Shot (Depo-Provera) Combined Pill (Estrogen/Progestin) Minipill (Progestin only) Three-month pill (Seasonale, Seasonique) Patch (Ortho Evra) Ring (Nuva Ring) Implanon | Less than 1% 2-3% 3% Less than 2% Less than 1% 1% Less than 1% |
| Intrauterine Devices (IUDs): Copper T Levonorgestrel-Releasing IUD | 0.5% 0.1% |
| Barrier Methods: Male Latex Condom(*) Diaphragm(**) Cervical Cap (no previous births)(**) Cervical Cap (previous births)(**) Female Condom Sponge | 14% 5-20% 15% 30% 21% 18-28% (higher failure rate after childbirth) |
| Spermicide: (gel, foam, suppository, film) | 26% |
Natural Methods: Withdrawal Natural Family Planning (calendar, temperature, cervical mucus) | 18-20% 15-20% |
| No Method | 85% |
*used without spermicide
**used with spermicide
Birth Control Pills (BCPs)
There are three types of birth control pills on the market today: the combination pill, the mini-pill and the emergency contraceptive pill. The combination pill is the most widely prescribed. It contains two hormones: estrogen and progestin. It works by suppressing ovulation each month, thinning the uterine lining and changing the consistency of the mucus in a woman's cervix, making it harder for sperm to move into contact with an egg.
All combination birth control pills contain 10 to 50 mcg of estrogen, a lower dose (one-fourth or less) than the birth control pills marketed 30 to 50 years ago. They come in different formulations. Some require taking a constant dose of both medications for 21 days followed by one week of placebo tablets. Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle (multiphasic) or add additional days (tablets) of estrogen at the end of the 21- or 24-day cycle.
Lybrel is the first continuous-use birth control pill. It is a monophasic pill (containing the same levels of estrogen and progestin throughout the entire pill-taking schedule) and comes in a 28-day pack. This product is designed to be taken continuously with no break in between pill packets, which means you won't have a period. However, you may have some spotting or breakthrough bleeding, particularly when you first start using Lybrel.
Seasonale is a 91-day oral contraceptive regimen also designed to reduce the number of months you have a menstrual cycle. Tablets containing progestin and estrogen are taken for 12 weeks (84 days), followed by one week of placebo tablets. Therefore, the number of expected menstrual periods is reduced from once a month to about once every three months, or four times a year. Seasonique is the same as Seasonale except with Seasonale, women take inactive pills during their four yearly periods and with Seasonique, they take a low dose of estrogen during their periods. Recently, Lo-Seasonique was approved by the FDA as well. It is similar to Seasonique but with lower doses of hormones.
If and when you decide to get pregnant and stop taking birth control pills, you may get pregnant immediately—there are no long-term effects on your fertility from birth control pills.
Benefits
Birth control pills are now prescribed by health care professionals because of their long- and short-term health benefits for women. Birth control pills can:
Risks
Women with certain health conditions may not be able to use birth control pills. These include:
Smoking cigarettes while taking birth control pills dramatically increases risks of heart attack for women over age 35. Smoking is far more dangerous to a woman's health than taking birth control pills, but the combination of oral contraceptive pill use and smoking has a greater effect on heart attack risk than the simple addition of the two factors.
Some women worry that birth control pills may increase their risk for cancer, particularly breast cancer. Research has shown that women using birth control pills have a slightly higher risk of breast cancer than women who have never used them. This risk appears to go back to normal over time once pill use is stopped. Women who stopped taking the pill more than 10 years ago do not appear to have an increased risk for breast cancer. Discuss the risks and benefits of birth control pills with your health care professional.
There is some evidence that long-term use of birth control pills may increase the risk of cancer of the cervix (the narrow, lower portion of the uterus). There is also some evidence that birth control pills may increase the risk of certain benign (noncancerous) liver tumors.
Side effects and warnings. Nausea, breast tenderness and bleeding are the most common side effects of all birth control pills. Most side effects decrease or disappear after three months of continuous use. Switching to another pill formulation can also relieve side effects.
A serious issue often overlooked by both health care professionals and women is that interactions with other medications can reduce the effectiveness of birth control pills. Medications known to interact with birth control pills are rifampin (an antibiotic) and some anticonvulsants. If you take these drugs regularly but are still interested in using the pill as your birth control method, talk with your health care professional.
Vaginal Contraceptive Ring
One of the newest contraceptives on the market, NuvaRing, is available by prescription only and consists of a soft, flexible, transparent ring that measures about 2 inches in diameter. It contains a combination of estrogen and progestin hormones (ethinyl estradiol and levonorgestrel). It is inserted into the vagina like a tampon, where the hormones are slowly released on a continual basis. You need to insert a new ring each month for continuous contraception. You can insert the ring yourself into your vagina, where it should remain for three weeks. Then you remove the ring for one week, during which time you have your period.
Benefits. NuvaRing only needs to be inserted once a month, making it a convenient form of birth control. And, like oral contraceptives, NuvaRing is highly effective when used according to the labeling. For every 100 women using NuvaRing for an entire year, only one will become pregnant.
Side effects and warnings. Side effects of the NuvaRing may include vaginal discharge, vaginitis and irritation. Like oral contraceptives, NuvaRing may increase the risk of blood clots, heart attack and stroke. Women who use NuvaRing are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
Skin Patch
The contraceptive Ortho Evra is a transdermal (through the skin) patch approved by the FDA in 2001 that contains ethinyl estradiol and the progesterone norelgestromin. The one-and-three-quarter-inch patch is applied to the skin (abdomen, buttocks or upper torso, but not breasts) where it slowly releases hormones for a week. It must be replaced every week. After three weeks (and three new patches) you have one week that is patch-free, during which you get your period.
Benefits. The Ortho Evra patch is 99 percent effective in preventing pregnancy when used correctly. It also removes the problem of having to remember to take a pill every day or insert a device before intercourse.
Side effects and warnings. In clinical trials, the patch was less effective in women weighing more than 198 pounds. Also, some women experienced breast symptoms, headache, a reaction at the application site, nausea and emotional changes. Other risks are similar to those from using birth control pills, including an increased risk of blood clots, heart attack and stroke. Women who use Ortho Evra are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
In 2005, the FDA updated the labels on Ortho Evra, warning that the birth control patch delivers a higher dose of estrogen than the birth control pill and therefore may increase the risk of blood clots and other serious side effects. Women taking or considering the birth control patch should talk to their health care professional about these risks.
The "Mini Pill"
A second birth control pill option is referred to as the "mini-pill." One pill, which contains only progestin, is taken every day. These pills work by preventing ovulation and reducing and thickening cervical mucus to prevent sperm from reaching the egg. They also keep the uterine lining from thickening, which prevents a fertilized egg from implanting in the uterus. However, with progestin-only birth control pills, ovulation isn't consistently suppressed, so the actions on cervical mucus and the endometrium are the critical factors. They may not be as effective as combined birth control pills. Progestin-only pills must be taken at exactly the same time, every day.
However, the progestin-only pill is often an option if you want to use oral contraception but can't take estrogen. If you are breastfeeding or experience uncomfortable side effects from estrogen, such as headaches, this could be the best option for you.
Protection against ectopic pregnancy is not as strong with the mini-pill as it is with combination pills. The main side effect from mini-pills is menstrual irregularity; you may not have any bleeding for months or you may have some spotting between periods. As with combined birth control pills, the mini-pill does not protect you from sexually transmitted diseases, so condoms are necessary if you or your partner is at risk.
Emergency Contraception
This type of contraception is used after unprotected intercourse. Emergency contraceptive pills contain the same hormones as birth control pills but are taken differently. In fact, some birth control pills can be used as emergency contraception with a health care professional's guidance.
Commonly called "the morning after pill," there are several FDA-approved emergency contraception pills in the United States: Plan B One-Step, Next Choice and generic levonorgestrel tablets, all of which contain the progestin levonorgestrel, and ulipristal acetate tablets, sold under the brand name "ella."
ella can prevent pregnancy when taken orally within five days (120 hours) after unprotected sex. It is a progesterone agonist/antagonist whose likely main effect is to inhibit or delay ovulation. ella cuts the chances of becoming pregnant by about two-thirds for at least 120 hours after unprotected sex, studies have shown.
Plan B One-Step should be taken within 72 hours of unprotected sex. Recent research shows that the levonorgestrel pills may be effective up to 120 hours after unprotected sex but are more effective the sooner they are taken. Next Choice and generic levonorgestrel tablets works similarly to Plan B One-Step, but consists of a two-dose regimen, with the first dose taken within 72 hours of unprotected sex and the second 12 hours later. Newer studies indicate that both pills may be taken together as soon as possible after unprotected sex.
Women 17 and over can buy the levonorgestrel emergency contraceptive pills without a prescription. They must ask for them at the pharmacy counter and show proof of age. Younger girls are required to have a prescription. In states that allow pharmacists to write prescriptions, they may prescribe emergency contraceptive pills directly to women of any age, even those who are too young to buy emergency contraception over the counter. Those states are: Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont and Washington.
ella is available only by prescription, but women could keep a supply at home. Discuss these options with your health care professional.
If you are under 17 in a state requiring a prescription for emergency contraception, visit www.not-2-late.com or call 1-888-NOT-2-LATE or 1-800-230-PLAN to locate a health care professional who can help you. The website and hotlines also provide information on which pharmacies sell emergency contraception pills because not all pharmacies carry them.
Side effects and warnings. Emergency contraceptive pills should not be used regularly as birth control because they can disrupt your menstrual cycle. They are also not 100 percent effective and can cause side effects such as nausea and vomiting, headaches, breast tenderness, dizziness and bloating. Medication may be prescribed with emergency contraceptive pills to minimize nausea and vomiting. Emergency contraceptive pills that contain only progestin cause fewer side effects.
Because emergency contraceptive pills are intended for use only as their name implies—during an emergency when other contraceptives failed or were not used—women who might otherwise not be able to take birth control pills on a regular basis may be able to use emergency contraceptive pills. Discuss your options with a health care professional.
And if you waited longer than 72 hours after unprotected sex, you have another option. An IUD can be inserted by a health care professional up to 120 hours (five days) after unprotected sex and should prevent a fertilized egg from implanting in most cases. The same precautions apply for using an IUD as an emergency contraceptive as for choosing it as a birth control method: If you are at risk for sexually transmitted diseases (if you have multiple sexual partners) or if you have a recent history of pelvic inflammatory disease, you aren't a good candidate for this type of emergency contraception.
, or the low-dose form, Depo-Subq-Provera): This method provides pregnancy protection for up to three months. A health care professional injects the medication into your buttocks or upper arm muscle. You will need to return to your health care professional's office every three months for another injection to continue protection. This option may bring some changes in menstrual bleeding. Early on, you may experience spotting. Later, many women stop having periods altogether. It is OK not to have a period when using progestin shots. With this birth control method, the uterine lining doesn't grow thick enough to shed and cause menstruation. Progestin shots have been shown to reduce the risk of uterine (endometrial) cancer and prevent anemia and pelvic inflammatory disease.
Side effects may include bloating/weight gain, headaches, depression, loss of interest in sex and hair loss, and it usually takes 12 weeks before the effects of the shot disappear. Recent studies show a link between Depo-Provera and a loss of bone density, which can lead to an increased risk of osteoporosis. The bone density may not return completely after discontinuing Depo-Provera. Because this bone density loss is greater with long-term use, talk to your health care professional about another method of birth control after two years on Depo-Provera.
Barrier Methods
Barrier methods are less effective than hormonal methods but cause fewer side effects and are associated with less risk. The effectiveness of barrier forms of contraception can be increased when used with spermicide.
Natural Family Planning
Couples using this method identify a woman's most fertile period by tracking her menstrual cycle. A calendar, body temperature and physical symptoms, such as the consistency of cervical mucus, are used to determine when ovulation is likely, and you avoid intercourse during this time.
Benefits and risks. The most obvious benefit to natural family planning is that no artificial devices or hormones are used to prevent pregnancy. Little to no cost is involved. But, experts say, while these methods can work, a couple needs to be extremely motivated to use them effectively and accurately to prevent pregnancy.
Permanent Contraception (sterilization)
Permanent contraception is the most common type of contraception overall, and it is a particularly common choice for women age 35 and older. Female sterilization closes a woman's fallopian tubes by blocking, tying or cutting them so an egg cannot travel to the uterus. There are two primary forms of female sterilization: a fairly new nonsurgical implant system (sold under the brand names Essure and Adiana), and the traditional tubal ligation procedure (done via laparoscopy or minilaparotomy), often called "getting your tubes tied."
Vasectomy. Male sterilization is called a vasectomy. This procedure is performed in the doctor's office. The scrotum is numbed with an anesthetic, so the doctor can make a small incision to access the vas deferens, the tubes through which sperm travels from the testicle to the penis. The doctor then seals, ties or cuts the vas deferens. Following a vasectomy, a man continues to ejaculate, but the fluid does not contain sperm. Temporary swelling and pain are common side effects of surgery. A newer approach to this procedure can reduce swelling and bleeding.
Benefits and risks. Sterilization is a highly effective way to permanently prevent pregnancy—it's considered more than 99 percent effective, meaning less than one woman in 100 will get pregnant after having a sterilization procedure. Surgery for female sterilization is more complex and carries greater risk than surgery to sterilize men, and recovery takes longer. Reversing sterilization in men and women is extremely difficult, however, and often unsuccessful. There is a small possibility of getting pregnant after sterilization; some evidence suggests that women who are younger when they are sterilized have a higher risk of getting pregnant.
Couples who are not sure about sterilization but want to postpone having children for at least five to 10 years should first consider using long-acting contraceptive methods such as IUDs or hormonal shots or implants before choosing sterilization.
Facts to Know
Many women do not get the protection they expect from their birth control methods because they do not use the methods correctly.
Of women using birth control, nearly half experience unplanned pregnancies.
Birth control pills, also called oral contraceptives, are now available in a variety of low-dose options that are safe and effective for most healthy women. Birth control pills include combination pills, which contain estrogen and progestin, and a "mini-pill" option that does not contain estrogen.
Oral contraceptives may reduce the risk of ovarian and uterine cancers and provide other health benefits such as regulating menstrual cycles; one brand of oral contraceptives has been shown to be effective for treating symptoms associated with premenstrual syndrome.
When used consistently and correctly, condoms offer the best available means of reducing the risk of infection from the following STDs: gonorrhea, chlamydia and trichomoniasis. Condoms can also reduce the risk of genital herpes, syphilis, chancroid and HPV infection, but only when the infected areas are covered or protected by the condom.
Women who have medical or religious concerns about artificial birth control methods can use fertility awareness methods, sometimes called natural family planning. These methods require that couples be motivated and adhere to a schedule that avoids sex when a woman is ovulating and most likely to be fertile.
According to the Guttmacher Institute, seven in 10 teens have had intercourse by their 19th birthday. A sexually active teenager who doesn't use contraception has a 90 percent chance of becoming pregnant within one year. Studies show that teens who talk to their parents about sex, pregnancy, birth control and sexually transmitted diseases are less likely to become sexually active at an early age and more likely to use protection when they do have sex.
Sterilization is the most popular form of birth control in the United States. It is considered a permanent form of birth control.
It can be helpful to review your contraceptive options as you age to make sure your current birth control method continues to fit your lifestyle and reproductive health needs.
Questions to Ask
Review the following Questions to Ask about contraception so you're prepared to discuss this important health issue with your health care professional.
How effective is this contraceptive option, and how do I use it correctly? What are its risks and benefits for me?
(For implantable contraceptives): Do you have experience in inserting the implant? Will it hurt me? After it's inserted, will it be visible?
What is the difference between the old and new IUDs? Are the new IUDs really safer to use?
Should I consider the pill? What are its advantages and disadvantages?
What is the difference between barrier devices like the diaphragm and cervical cap and the vaginal ring? What is the ring and how does it work?
Does this contraception option protect me from AIDS or other sexually transmitted diseases?
If I want to consider permanent contraception, what are my options?
Questions To Ask Yourself
How important is it to you and your partner that you do not become pregnant at this time?
What is the likelihood that you and your partner will be able to follow the requirements of the contraceptive method you choose?
Do you take medication or have a medical condition that might make some contraceptives a poor choice for you?
Do you smoke?
How often do you have intercourse?
How old are you? Do you have children, or do you want to have children some day?
Will your health insurance pay for your contraceptive choice? If not, can you afford it long term?
What do I do if I miss a day of taking my birth control pills?
The pills you have to worry most about missing are the ones right before and right after the seven placebo pills in your pack. Known as the pill-free interval, the placebos are designed to be taken the week you have your period to help you stay in the rhythm of taking a pill every day. If you start a new pack late or take longer than seven days "pill free," you might ovulate and could become pregnant. Read the package insert that came with your pills; it will explain what to do about missed pills. Or call your health care professional. In the meantime, use backup contraception just to be safe. In general, if you miss a pill, take it as soon as you remember and then continue taking one pill each day as prescribed (depending on when you missed your pill, you may take two pills on the same day). If you miss two or more pills in the first week of your pill cycle and you have unprotected intercourse during this week, consider using emergency contraception. If you miss pills in the fourth week of a 28-day pack, those pills are likely placebo if you're using a 21/7 regimen. However, some of the newer formulations may contain active pills, so read the package insert for instructions.
I've heard that I can't get pregnant while I'm breastfeeding. Does that mean I don't need a contraceptive?
The lactational amenorrhea method (LAM) refers to the natural cessation of a woman's menstrual period while she is breastfeeding. Ovulation doesn't occur at this time, so birth control is automatic. LAM is only effective in preventing pregnancy if the mother is breastfeeding exclusively; her baby is less than six months old; and the mother's periods have not yet returned. If a woman starts to get her period again, it's a pretty good indication that she's ovulating and able to get pregnant. But, in general, even though breastfeeding does provide some contraceptive protection, it is not a completely reliable form of contraception. There are several birth control options that are safe for breastfeeding women and their babies, so why take chances? Here are your options:
The mini-pill is a progestin-only pill that usually has no negative impact on milk production (combination pills can dry up milk) and may even provide a little boost in milk volume. You can start this pill right after delivery under the guidance of your health care professional.
Nonhormonal contraception methods such as barrier devices and copper IUDs are preferred in women who are nursing because they don't contain hormones that could affect milk supply or pass through the milk. If hormonal methods are the only option, progestin-only birth control is preferred in women who are breast-feeding.
Barrier methods such as condoms and spermicides have no impact on breastfeeding and may be helpful in overcoming vaginal dryness caused by breastfeeding (use lubricated condoms). They can be used immediately postpartum. If you want to use a diaphragm or cervical cap, wait until after your sixth postpartum week; diaphragms and cervical caps need to be fitted after you completely heal, and it's not advisable to use them until you've stopped bleeding.
You can have an IUD inserted between six and eight weeks postpartum.
I've been taking birth control pills for several years. Do I need to give my body a rest and stop taking them for a while?
There is no scientific evidence that taking oral contraceptives does any long-term harm to your endocrine system, which regulates hormones.
My partner hates to use condoms because he says they make sex less pleasurable. Is there anything else I can do to protect myself from STDs?
You could try the female condom, which has a looser fit. There are also male condoms designed to enhance pleasure, which are sold over the counter.
You might try a few things to make condom use more fun. How about unrolling it onto your partner's penis yourself?
Condoms sometimes help men maintain an erection; tell your partner you want to use a condom so sex will last longer. If all else fails, refuse to have sex with him if he doesn't use a condom or find other ways to enjoy each other sexually. (Keep in mind that avoiding penis-vagina contact is the only way to stay safe from pregnancy, but other sexual acts, such as oral sex, still put you at risk for some STDs.)
How do I keep a condom from slipping?
First, check during sex that the condom is still where it should be. Second, make sure your partner knows to withdraw soon after ejaculation, before the penis gets smaller. And third, while he is withdrawing, he should hold the rim of the condom.
I've heard that birth control pills cause cancer, but I've also heard they can protect against cancer. Which is true?
Studies find a slightly higher risk of breast cancer in women who take birth control pills. There is also evidence, however, that use of birth control pills decreases the incidence of uterine, ovarian and possibly colorectal cancer. The longer a woman uses the pill, the more her risk of developing these cancers is reduced. Birth control pills may also protect against developing breast and ovarian cysts. Discuss the risks and benefits of birth control pills with your health care professional.
I've had all the children I want, but I'm not ready for sterilization. I've been considering the IUD. Is it safe?
Yes. The fears surrounding intrauterine devices (IUDs) stem mainly from problems with the Dalkon Shield, an IUD introduced in the 1970s. The construction of the Dalkon Shield increased the risk of bacterial infections, which resulted in pelvic inflammatory disease for many women. Today's IUDs are constructed differently and are safe and highly effective. IUDs are not good options for women at risk for contracting sexually transmitted infections, however.
I am 16 years old and would like to use birth control pills. The problem is that I smoke cigarettes. My mom used to smoke and was told she couldn't use them. Can I?
In women younger than 35, the benefits of birth control pills appear to outweigh the risks, even in heavy smokers, unless there is a family history of blood clots. However, smoking puts you at risk for numerous serious health problems, including cancer and heart disease, so you should talk to your health care professional about ways to help you kick the habit.
Organizations and Support
For information and support on Contraception, please see the recommended organizations, books and Spanish-language resources listed below.
American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org
American Social Health Association (ASHA)
Website: http://www.ashastd.org
Address: P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
Email: info@ashastd.org
American Society for Reproductive Medicine (ASRM)
Website: http://www.asrm.org
Address: 1209 Montgomery Highway
Birmingham, AL 35216
Phone: 205-978-5000
Email: asrm@asrm.org
ASHA's STI Resource Center Hotline
Website: http://www.ashastd.org/herpes/herpes_hotline.cfm
Address: American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
AWARE Foundation
Website: http://www.awarefoundation.org
Address: 834 Chestnut Street, Suite 400
Philadelphia, PA 19107
Phone: 215-955-9847
CDC National Prevention Information Network
Website: http://www.cdcnpin.org
Address: P.O. Box 6003
Rockville, MD 20849
Hotline: 1-800-458-5231
Phone: 404-679-3860
Email: info@cdcnpin.org
Emergency Contraception Hotline
Website: http://ec.princeton.edu
Address: Office of Population Research
Princeton University, Wallace Hall
Princeton, NJ 08544
Hotline: 1-888-NOT-2-LATE (1-888-668-2528)
Guttmacher Institute
Website: http://www.guttmacher.org
Address: 1301 Connecticut Avenue NW, Suite 700
Washington, DC 20036
Hotline: 1-877-823-0262
Phone: 202-296-4012
Email: info@guttmacher.org
International Women's Health Coalition (IWHC)
Website: http://www.iwhc.org
Address: 333 Seventh Avenue, 6th floor
New York, NY 10001
Phone: 212-979-8500
Email: info@iwhc.org
National Abortion and Reproductive Rights Action League (NARAL)
Website: http://www.naral.org
Address: 1156 15th Street, NW, Suite 700
Washington, DC 20005
Phone: 202-973-3000
National Abortion Federation
Website: http://www.prochoice.org
Address: 1660 L Street, NW, Suite 450
Washington, DC 20036
Hotline: 1-800-772-9100
Phone: 202-667-5881
Email: naf@prochoice.org
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Website: http://www.cdc.gov/nchhstp
Address: Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov
National Women's Health Network (NWHN)
Website: http://www.nwhn.org
Address: 1413 K Street, NW, 4th floor
Washington, DC 20005
Hotline: 202-682-2646
Phone: 202-682-2640
Email: nwhn@nwhn.org
Planned Parenthood Federation of America
Website: http://www.plannedparenthood.org
Address: 434 West 33rd Street
New York, NY 10001
Hotline: 1-800-230-PLAN (1-800-230-7526)
Phone: 212-541-7800
Sexuality Information and Education Council of the United States (SIECUS)
Website: http://www.siecus.org
Address: 90 John Street, Suite 704
New York, NY 10038
Phone: 212-819-9770
A Gynecologist's Second Opinion: The Questions & Answers You Need to Take Charge of Your Health
by William H. Parker, Rachel L. Parker
All About Birth Control: A Complete Guide
by Jon Knowles
Sex Ed
by Miriam Stoppard
Sexual Health Questions You Have...Answers You Need
by Michael V. Reitano, Charles Ebel
The Whole Truth About Contraception: A Guide to Safe and Effective Choices
by MD, MPH Beverly Winikoff, Suzanne Wymelenberg
The Yale Guide to Women's Reproductive Health: From Menarche to Menopause
by Mary Jane Minkin, Carol V. Wright
Association of Reproductive Health Professionals
Website: http://www.arhp.org/Publications-and-Resources/Patient-Resources/printed-materials/Facts-About-EC-SP
Address: ARHP-East
1901 L Street, NW, Suite 300
Washington, DC 20036
Phone: 202-466-3825
Email: arhp@arhp.org
Center for Young Women's Health
Website: http://www.youngwomenshealth.org/spcontra.html
Address: Center for Young Women's Health
333 Longwood Avenue, 5th Floor
Boston, MA 02115
Phone: 617-355-2994
[Section: Birth Control Pills]
Birth Control Pills (BCPs)
There are three types of birth control pills on the market today: the combination pill, the mini-pill and the emergency contraceptive pill. The combination pill is the most widely prescribed. It contains two hormones: estrogen and progestin. It works by suppressing ovulation each month, thinning the uterine lining and changing the consistency of the mucus in a woman's cervix, making it harder for sperm to move into contact with an egg.
All combination birth control pills contain 10 to 50 mcg of estrogen, a lower dose (one-fourth or less) than the birth control pills marketed 30 to 50 years ago. They come in different formulations. Some require taking a constant dose of both medications for 21 days followed by one week of placebo tablets. Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle (multiphasic) or add additional days (tablets) of estrogen at the end of the 21- or 24-day cycle.
Lybrel is the first continuous-use birth control pill. It is a monophasic pill (containing the same levels of estrogen and progestin throughout the entire pill-taking schedule) and comes in a 28-day pack. This product is designed to be taken continuously with no break in between pill packets, which means you won't have a period. However, you may have some spotting or breakthrough bleeding, particularly when you first start using Lybrel.
Seasonale is a 91-day oral contraceptive regimen also designed to reduce the number of months you have a menstrual cycle. Tablets containing progestin and estrogen are taken for 12 weeks (84 days), followed by one week of placebo tablets. Therefore, the number of expected menstrual periods is reduced from once a month to about once every three months, or four times a year. Seasonique is the same as Seasonale except with Seasonale, women take inactive pills during their four yearly periods and with Seasonique, they take a low dose of estrogen during their periods. Recently, Lo-Seasonique was approved by the FDA as well. It is similar to Seasonique but with lower doses of hormones.
If and when you decide to get pregnant and stop taking birth control pills, you may get pregnant immediately—there are no long-term effects on your fertility from birth control pills.
Benefits
Birth control pills are now prescribed by health care professionals because of their long- and short-term health benefits for women. Birth control pills can:
Risks
Women with certain health conditions may not be able to use birth control pills. These include:
Smoking cigarettes while taking birth control pills dramatically increases risks of heart attack for women over age 35. Smoking is far more dangerous to a woman's health than taking birth control pills, but the combination of oral contraceptive pill use and smoking has a greater effect on heart attack risk than the simple addition of the two factors.
Some women worry that birth control pills may increase their risk for cancer, particularly breast cancer. Research has shown that women using birth control pills have a slightly higher risk of breast cancer than women who have never used them. This risk appears to go back to normal over time once pill use is stopped. Women who stopped taking the pill more than 10 years ago do not appear to have an increased risk for breast cancer. Discuss the risks and benefits of birth control pills with your health care professional.
There is some evidence that long-term use of birth control pills may increase the risk of cancer of the cervix (the narrow, lower portion of the uterus). There is also some evidence that birth control pills may increase the risk of certain benign (noncancerous) liver tumors.
Side effects and warnings. Nausea, breast tenderness and bleeding are the most common side effects of all birth control pills. Most side effects decrease or disappear after three months of continuous use. Switching to another pill formulation can also relieve side effects.
A serious issue often overlooked by both health care professionals and women is that interactions with other medications can reduce the effectiveness of birth control pills. Medications known to interact with birth control pills are rifampin (an antibiotic) and some anticonvulsants. If you take these drugs regularly but are still interested in using the pill as your birth control method, talk with your health care professional.
Vaginal Contraceptive Ring
One of the newest contraceptives on the market, NuvaRing, is available by prescription only and consists of a soft, flexible, transparent ring that measures about 2 inches in diameter. It contains a combination of estrogen and progestin hormones (ethinyl estradiol and levonorgestrel). It is inserted into the vagina like a tampon, where the hormones are slowly released on a continual basis. You need to insert a new ring each month for continuous contraception. You can insert the ring yourself into your vagina, where it should remain for three weeks. Then you remove the ring for one week, during which time you have your period.
Benefits. NuvaRing only needs to be inserted once a month, making it a convenient form of birth control. And, like oral contraceptives, NuvaRing is highly effective when used according to the labeling. For every 100 women using NuvaRing for an entire year, only one will become pregnant.
Side effects and warnings. Side effects of the NuvaRing may include vaginal discharge, vaginitis and irritation. Like oral contraceptives, NuvaRing may increase the risk of blood clots, heart attack and stroke. Women who use NuvaRing are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
Skin Patch
The contraceptive Ortho Evra is a transdermal (through the skin) patch approved by the FDA in 2001 that contains ethinyl estradiol and the progesterone norelgestromin. The one-and-three-quarter-inch patch is applied to the skin (abdomen, buttocks or upper torso, but not breasts) where it slowly releases hormones for a week. It must be replaced every week. After three weeks (and three new patches) you have one week that is patch-free, during which you get your period.
Benefits. The Ortho Evra patch is 99 percent effective in preventing pregnancy when used correctly. It also removes the problem of having to remember to take a pill every day or insert a device before intercourse.
Side effects and warnings. In clinical trials, the patch was less effective in women weighing more than 198 pounds. Also, some women experienced breast symptoms, headache, a reaction at the application site, nausea and emotional changes. Other risks are similar to those from using birth control pills, including an increased risk of blood clots, heart attack and stroke. Women who use Ortho Evra are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
In 2005, the FDA updated the labels on Ortho Evra, warning that the birth control patch delivers a higher dose of estrogen than the birth control pill and therefore may increase the risk of blood clots and other serious side effects. Women taking or considering the birth control patch should talk to their health care professional about these risks.
The "Mini Pill"
A second birth control pill option is referred to as the "mini-pill." One pill, which contains only progestin, is taken every day. These pills work by preventing ovulation and reducing and thickening cervical mucus to prevent sperm from reaching the egg. They also keep the uterine lining from thickening, which prevents a fertilized egg from implanting in the uterus. However, with progestin-only birth control pills, ovulation isn't consistently suppressed, so the actions on cervical mucus and the endometrium are the critical factors. They may not be as effective as combined birth control pills. Progestin-only pills must be taken at exactly the same time, every day.
However, the progestin-only pill is often an option if you want to use oral contraception but can't take estrogen. If you are breastfeeding or experience uncomfortable side effects from estrogen, such as headaches, this could be the best option for you.
Protection against ectopic pregnancy is not as strong with the mini-pill as it is with combination pills. The main side effect from mini-pills is menstrual irregularity; you may not have any bleeding for months or you may have some spotting between periods. As with combined birth control pills, the mini-pill does not protect you from sexually transmitted diseases, so condoms are necessary if you or your partner is at risk.
Emergency Contraception
This type of contraception is used after unprotected intercourse. Emergency contraceptive pills contain the same hormones as birth control pills but are taken differently. In fact, some birth control pills can be used as emergency contraception with a health care professional's guidance.
Commonly called "the morning after pill," there are several FDA-approved emergency contraception pills in the United States: Plan B One-Step, Next Choice and generic levonorgestrel tablets, all of which contain the progestin levonorgestrel, and ulipristal acetate tablets, sold under the brand name "ella."
ella can prevent pregnancy when taken orally within five days (120 hours) after unprotected sex. It is a progesterone agonist/antagonist whose likely main effect is to inhibit or delay ovulation. ella cuts the chances of becoming pregnant by about two-thirds for at least 120 hours after unprotected sex, studies have shown.
Plan B One-Step should be taken within 72 hours of unprotected sex. Recent research shows that the levonorgestrel pills may be effective up to 120 hours after unprotected sex but are more effective the sooner they are taken. Next Choice and generic levonorgestrel tablets works similarly to Plan B One-Step, but consists of a two-dose regimen, with the first dose taken within 72 hours of unprotected sex and the second 12 hours later. Newer studies indicate that both pills may be taken together as soon as possible after unprotected sex.
Women 17 and over can buy the levonorgestrel emergency contraceptive pills without a prescription. They must ask for them at the pharmacy counter and show proof of age. Younger girls are required to have a prescription. In states that allow pharmacists to write prescriptions, they may prescribe emergency contraceptive pills directly to women of any age, even those who are too young to buy emergency contraception over the counter. Those states are: Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont and Washington.
ella is available only by prescription, but women could keep a supply at home. Discuss these options with your health care professional.
If you are under 17 in a state requiring a prescription for emergency contraception, visit www.not-2-late.com or call 1-888-NOT-2-LATE or 1-800-230-PLAN to locate a health care professional who can help you. The website and hotlines also provide information on which pharmacies sell emergency contraception pills because not all pharmacies carry them.
Side effects and warnings. Emergency contraceptive pills should not be used regularly as birth control because they can disrupt your menstrual cycle. They are also not 100 percent effective and can cause side effects such as nausea and vomiting, headaches, breast tenderness, dizziness and bloating. Medication may be prescribed with emergency contraceptive pills to minimize nausea and vomiting. Emergency contraceptive pills that contain only progestin cause fewer side effects.
Because emergency contraceptive pills are intended for use only as their name implies—during an emergency when other contraceptives failed or were not used—women who might otherwise not be able to take birth control pills on a regular basis may be able to use emergency contraceptive pills. Discuss your options with a health care professional.
And if you waited longer than 72 hours after unprotected sex, you have another option. An IUD can be inserted by a health care professional up to 120 hours (five days) after unprotected sex and should prevent a fertilized egg from implanting in most cases. The same precautions apply for using an IUD as an emergency contraceptive as for choosing it as a birth control method: If you are at risk for sexually transmitted diseases (if you have multiple sexual partners) or if you have a recent history of pelvic inflammatory disease, you aren't a good candidate for this type of emergency contraception.
[Section: Long-Acting Hormonal Methods]
Long-Acting Hormonal Methods
Several options are available to women who want long-term, but not permanent, protection against pregnancy. These options rely on estrogen-progestin or progestin alone to prevent ovulation. They include:
[Section: Barrier Methods]
Barrier Methods
Barrier methods are less effective than hormonal methods but cause fewer side effects and are associated with less risk. The effectiveness of barrier forms of contraception can be increased when used with spermicide.
[Section: Natural Family Planning]
Natural Family Planning
Couples using this method identify a woman's most fertile period by tracking her menstrual cycle. A calendar, body temperature and physical symptoms, such as the consistency of cervical mucus, are used to determine when ovulation is likely, and you avoid intercourse during this time.
Benefits and risks. The most obvious benefit to natural family planning is that no artificial devices or hormones are used to prevent pregnancy. Little to no cost is involved. But, experts say, while these methods can work, a couple needs to be extremely motivated to use them effectively and accurately to prevent pregnancy.
[Section: Permanent Contraception]
Permanent Contraception (sterilization)
Permanent contraception is the most common type of contraception overall, and it is a particularly common choice for women age 35 and older. Female sterilization closes a woman's fallopian tubes by blocking, tying or cutting them so an egg cannot travel to the uterus. There are two primary forms of female sterilization: a fairly new nonsurgical implant system (sold under the brand names Essure and Adiana), and the traditional tubal ligation procedure (done via laparoscopy or minilaparotomy), often called "getting your tubes tied."
Vasectomy. Male sterilization is called a vasectomy. This procedure is performed in the doctor's office. The scrotum is numbed with an anesthetic, so the doctor can make a small incision to access the vas deferens, the tubes through which sperm travels from the testicle to the penis. The doctor then seals, ties or cuts the vas deferens. Following a vasectomy, a man continues to ejaculate, but the fluid does not contain sperm. Temporary swelling and pain are common side effects of surgery. A newer approach to this procedure can reduce swelling and bleeding.
Benefits and risks. Sterilization is a highly effective way to permanently prevent pregnancy—it's considered more than 99 percent effective, meaning less than one woman in 100 will get pregnant after having a sterilization procedure. Surgery for female sterilization is more complex and carries greater risk than surgery to sterilize men, and recovery takes longer. Reversing sterilization in men and women is extremely difficult, however, and often unsuccessful. There is a small possibility of getting pregnant after sterilization; some evidence suggests that women who are younger when they are sterilized have a higher risk of getting pregnant.
Couples who are not sure about sterilization but want to postpone having children for at least five to 10 years should first consider using long-acting contraceptive methods such as IUDs or hormonal shots or implants before choosing sterilization.
[Section: Facts to Know]
Facts to Know
Many women do not get the protection they expect from their birth control methods because they do not use the methods correctly.
Of women using birth control, nearly half experience unplanned pregnancies.
Birth control pills, also called oral contraceptives, are now available in a variety of low-dose options that are safe and effective for most healthy women. Birth control pills include combination pills, which contain estrogen and progestin, and a "mini-pill" option that does not contain estrogen.
Oral contraceptives may reduce the risk of ovarian and uterine cancers and provide other health benefits such as regulating menstrual cycles; one brand of oral contraceptives has been shown to be effective for treating symptoms associated with premenstrual syndrome.
When used consistently and correctly, condoms offer the best available means of reducing the risk of infection from the following STDs: gonorrhea, chlamydia and trichomoniasis. Condoms can also reduce the risk of genital herpes, syphilis, chancroid and HPV infection, but only when the infected areas are covered or protected by the condom.
Women who have medical or religious concerns about artificial birth control methods can use fertility awareness methods, sometimes called natural family planning. These methods require that couples be motivated and adhere to a schedule that avoids sex when a woman is ovulating and most likely to be fertile.
According to the Guttmacher Institute, seven in 10 teens have had intercourse by their 19th birthday. A sexually active teenager who doesn't use contraception has a 90 percent chance of becoming pregnant within one year. Studies show that teens who talk to their parents about sex, pregnancy, birth control and sexually transmitted diseases are less likely to become sexually active at an early age and more likely to use protection when they do have sex.
Sterilization is the most popular form of birth control in the United States. It is considered a permanent form of birth control.
It can be helpful to review your contraceptive options as you age to make sure your current birth control method continues to fit your lifestyle and reproductive health needs.
[Section: Questions to Ask]
Questions to Ask
Review the following Questions to Ask about contraception so you're prepared to discuss this important health issue with your health care professional.
How effective is this contraceptive option, and how do I use it correctly? What are its risks and benefits for me?
(For implantable contraceptives): Do you have experience in inserting the implant? Will it hurt me? After it's inserted, will it be visible?
What is the difference between the old and new IUDs? Are the new IUDs really safer to use?
Should I consider the pill? What are its advantages and disadvantages?
What is the difference between barrier devices like the diaphragm and cervical cap and the vaginal ring? What is the ring and how does it work?
Does this contraception option protect me from AIDS or other sexually transmitted diseases?
If I want to consider permanent contraception, what are my options?
Questions To Ask Yourself
How important is it to you and your partner that you do not become pregnant at this time?
What is the likelihood that you and your partner will be able to follow the requirements of the contraceptive method you choose?
Do you take medication or have a medical condition that might make some contraceptives a poor choice for you?
Do you smoke?
How often do you have intercourse?
How old are you? Do you have children, or do you want to have children some day?
Will your health insurance pay for your contraceptive choice? If not, can you afford it long term?
[Section: Key Q&A]
What do I do if I miss a day of taking my birth control pills?
The pills you have to worry most about missing are the ones right before and right after the seven placebo pills in your pack. Known as the pill-free interval, the placebos are designed to be taken the week you have your period to help you stay in the rhythm of taking a pill every day. If you start a new pack late or take longer than seven days "pill free," you might ovulate and could become pregnant. Read the package insert that came with your pills; it will explain what to do about missed pills. Or call your health care professional. In the meantime, use backup contraception just to be safe. In general, if you miss a pill, take it as soon as you remember and then continue taking one pill each day as prescribed (depending on when you missed your pill, you may take two pills on the same day). If you miss two or more pills in the first week of your pill cycle and you have unprotected intercourse during this week, consider using emergency contraception. If you miss pills in the fourth week of a 28-day pack, those pills are likely placebo if you're using a 21/7 regimen. However, some of the newer formulations may contain active pills, so read the package insert for instructions.
I've heard that I can't get pregnant while I'm breastfeeding. Does that mean I don't need a contraceptive?
The lactational amenorrhea method (LAM) refers to the natural cessation of a woman's menstrual period while she is breastfeeding. Ovulation doesn't occur at this time, so birth control is automatic. LAM is only effective in preventing pregnancy if the mother is breastfeeding exclusively; her baby is less than six months old; and the mother's periods have not yet returned. If a woman starts to get her period again, it's a pretty good indication that she's ovulating and able to get pregnant. But, in general, even though breastfeeding does provide some contraceptive protection, it is not a completely reliable form of contraception. There are several birth control options that are safe for breastfeeding women and their babies, so why take chances? Here are your options:
The mini-pill is a progestin-only pill that usually has no negative impact on milk production (combination pills can dry up milk) and may even provide a little boost in milk volume. You can start this pill right after delivery under the guidance of your health care professional.
Nonhormonal contraception methods such as barrier devices and copper IUDs are preferred in women who are nursing because they don't contain hormones that could affect milk supply or pass through the milk. If hormonal methods are the only option, progestin-only birth control is preferred in women who are breast-feeding.
Barrier methods such as condoms and spermicides have no impact on breastfeeding and may be helpful in overcoming vaginal dryness caused by breastfeeding (use lubricated condoms). They can be used immediately postpartum. If you want to use a diaphragm or cervical cap, wait until after your sixth postpartum week; diaphragms and cervical caps need to be fitted after you completely heal, and it's not advisable to use them until you've stopped bleeding.
You can have an IUD inserted between six and eight weeks postpartum.
I've been taking birth control pills for several years. Do I need to give my body a rest and stop taking them for a while?
There is no scientific evidence that taking oral contraceptives does any long-term harm to your endocrine system, which regulates hormones.
My partner hates to use condoms because he says they make sex less pleasurable. Is there anything else I can do to protect myself from STDs?
You could try the female condom, which has a looser fit. There are also male condoms designed to enhance pleasure, which are sold over the counter.
You might try a few things to make condom use more fun. How about unrolling it onto your partner's penis yourself?
Condoms sometimes help men maintain an erection; tell your partner you want to use a condom so sex will last longer. If all else fails, refuse to have sex with him if he doesn't use a condom or find other ways to enjoy each other sexually. (Keep in mind that avoiding penis-vagina contact is the only way to stay safe from pregnancy, but other sexual acts, such as oral sex, still put you at risk for some STDs.)
How do I keep a condom from slipping?
First, check during sex that the condom is still where it should be. Second, make sure your partner knows to withdraw soon after ejaculation, before the penis gets smaller. And third, while he is withdrawing, he should hold the rim of the condom.
I've heard that birth control pills cause cancer, but I've also heard they can protect against cancer. Which is true?
Studies find a slightly higher risk of breast cancer in women who take birth control pills. There is also evidence, however, that use of birth control pills decreases the incidence of uterine, ovarian and possibly colorectal cancer. The longer a woman uses the pill, the more her risk of developing these cancers is reduced. Birth control pills may also protect against developing breast and ovarian cysts. Discuss the risks and benefits of birth control pills with your health care professional.
I've had all the children I want, but I'm not ready for sterilization. I've been considering the IUD. Is it safe?
Yes. The fears surrounding intrauterine devices (IUDs) stem mainly from problems with the Dalkon Shield, an IUD introduced in the 1970s. The construction of the Dalkon Shield increased the risk of bacterial infections, which resulted in pelvic inflammatory disease for many women. Today's IUDs are constructed differently and are safe and highly effective. IUDs are not good options for women at risk for contracting sexually transmitted infections, however.
I am 16 years old and would like to use birth control pills. The problem is that I smoke cigarettes. My mom used to smoke and was told she couldn't use them. Can I?
In women younger than 35, the benefits of birth control pills appear to outweigh the risks, even in heavy smokers, unless there is a family history of blood clots. However, smoking puts you at risk for numerous serious health problems, including cancer and heart disease, so you should talk to your health care professional about ways to help you kick the habit.
[Section: Organizations and Support]
Organizations and Support
For information and support on Contraception, please see the recommended organizations, books and Spanish-language resources listed below.
American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org
American Social Health Association (ASHA)
Website: http://www.ashastd.org
Address: P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
Email: info@ashastd.org
American Society for Reproductive Medicine (ASRM)
Website: http://www.asrm.org
Address: 1209 Montgomery Highway
Birmingham, AL 35216
Phone: 205-978-5000
Email: asrm@asrm.org
ASHA's STI Resource Center Hotline
Website: http://www.ashastd.org/herpes/herpes_hotline.cfm
Address: American Social Health Association
P.O. Box 13827
Research Triangle Park, NC 27709
Hotline: 1-800-227-8922
Phone: 919-361-8400
AWARE Foundation
Website: http://www.awarefoundation.org
Address: 834 Chestnut Street, Suite 400
Philadelphia, PA 19107
Phone: 215-955-9847
CDC National Prevention Information Network
Website: http://www.cdcnpin.org
Address: P.O. Box 6003
Rockville, MD 20849
Hotline: 1-800-458-5231
Phone: 404-679-3860
Email: info@cdcnpin.org
Emergency Contraception Hotline
Website: http://ec.princeton.edu
Address: Office of Population Research
Princeton University, Wallace Hall
Princeton, NJ 08544
Hotline: 1-888-NOT-2-LATE (1-888-668-2528)
Guttmacher Institute
Website: http://www.guttmacher.org
Address: 1301 Connecticut Avenue NW, Suite 700
Washington, DC 20036
Hotline: 1-877-823-0262
Phone: 202-296-4012
Email: info@guttmacher.org
International Women's Health Coalition (IWHC)
Website: http://www.iwhc.org
Address: 333 Seventh Avenue, 6th floor
New York, NY 10001
Phone: 212-979-8500
Email: info@iwhc.org
National Abortion and Reproductive Rights Action League (NARAL)
Website: http://www.naral.org
Address: 1156 15th Street, NW, Suite 700
Washington, DC 20005
Phone: 202-973-3000
National Abortion Federation
Website: http://www.prochoice.org
Address: 1660 L Street, NW, Suite 450
Washington, DC 20036
Hotline: 1-800-772-9100
Phone: 202-667-5881
Email: naf@prochoice.org
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Website: http://www.cdc.gov/nchhstp
Address: Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-CDC-INFO (1-800-232-4636)
Email: cdcinfo@cdc.gov
National Women's Health Network (NWHN)
Website: http://www.nwhn.org
Address: 1413 K Street, NW, 4th floor
Washington, DC 20005
Hotline: 202-682-2646
Phone: 202-682-2640
Email: nwhn@nwhn.org
Planned Parenthood Federation of America
Website: http://www.plannedparenthood.org
Address: 434 West 33rd Street
New York, NY 10001
Hotline: 1-800-230-PLAN (1-800-230-7526)
Phone: 212-541-7800
Sexuality Information and Education Council of the United States (SIECUS)
Website: http://www.siecus.org
Address: 90 John Street, Suite 704
New York, NY 10038
Phone: 212-819-9770
A Gynecologist's Second Opinion: The Questions & Answers You Need to Take Charge of Your Health
by William H. Parker, Rachel L. Parker
All About Birth Control: A Complete Guide
by Jon Knowles
Sex Ed
by Miriam Stoppard
Sexual Health Questions You Have...Answers You Need
by Michael V. Reitano, Charles Ebel
The Whole Truth About Contraception: A Guide to Safe and Effective Choices
by MD, MPH Beverly Winikoff, Suzanne Wymelenberg
The Yale Guide to Women's Reproductive Health: From Menarche to Menopause
by Mary Jane Minkin, Carol V. Wright
Association of Reproductive Health Professionals
Website: http://www.arhp.org/Publications-and-Resources/Patient-Resources/printed-materials/Facts-About-EC-SP
Address: ARHP-East
1901 L Street, NW, Suite 300
Washington, DC 20036
Phone: 202-466-3825
Email: arhp@arhp.org
Center for Young Women's Health
Website: http://www.youngwomenshealth.org/spcontra.html
Address: Center for Young Women's Health
333 Longwood Avenue, 5th Floor
Boston, MA 02115
Phone: 617-355-2994
The Emergency Contraception Website. Office of Population Research at Princeton University and the Association of Reproductive Health Professionals. http://ec.princeton.edu/index.html. Accessed January 9, 2012.
Implanon website. http://www.spfiles.com/piimplanon.pd.pdf. Accessed December 5, 2011.
Today Sponge website: http://www.todaysponge.com/answers2.html. Accessed October 2011.
Plan B One Step website: http://planbonestep.com/?utm_source=Google&utm_medium=cpc&utm_term=plan%20b&utm_campaign=Branded&gclid=CMHy7ZP-4KsCFYeo4AodsjI1Qg. Accessed October 2011.
"Facts on American Teens' Sexual and Reproductive Health." The Guttmacher Institute. August 2011. http://www.guttmacher.org/pubs/FB-ATSRH.html. Accessed October 2011.
"Ovarian Cancer Overview." The American Cancer Society. June 2011.
http://www.cancer.org/Cancer/OvarianCancer/OverviewGuide/ovarian-cancer-overview-prevention. Accessed October 2011.
"Breast Cancer Risk Factors." The American Cancer Society. September 2011. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-risk-factors. Accessed October 2011.
Adiana website. http://www.adiana.com. Accessed March 16, 2011.
"Get Emergency Contraception Now." Office of Population Research at Princeton University and the Association of Reproductive Health Professionals. August 12, 2009. http://ec.princeton.edu. Accessed August 2009.
"Overview of contraception." Uptodate.com. Updated February 2009. Subscription necessary to view text. Accessed March 2009.
"Risks and side effects associated with estrogen-progestin contraceptives." Uptodate.com. Updated February 2009. Subscription necessary to view text. Accessed March 2009.
"Mirena patient information." http://berlex.bayerhealthcare.com. Accessed March 2009.
"Birth control and family planning." Medline, the National Institutes of Health. December 2008. http://www.nlm.nih.gov. Accessed March 2009.
"Ortho Evra." www.orthoevra.com. Accessed March 2009.
"Seasonale and Seasonique." www.seasonale.com. Accessed March 2009.
"Birth Control Pill Use Cuts Ovarian Cancer Risk." The American Cancer Society. January 2008. http://www.cancer.org. Accessed March 2009.
"Barrier methods of contraception." The American College of Obstetricians and Gynecologists. July 2008. http://www.acog.org/publications/patient_education/bp022.cfm. Accessed March 2009.
"Lactational amenorrhea." The Mayo Clinic. July 2008. http://www.mayoclinic.com. Accessed March 2009.
"Facts on American Teens' Sexual and Reproductive Health." The Guttmacher Institute. September 2006. http://www.guttmacher.org. Accessed March 2006.
"Birth control pills may lower colon cancer risk." Reuters. February 2008. http://www.reuters.com. Accessed March 2009.
"What causes endometrial cancer?" The American Cancer Society. August 2008. http://www.cancer.org. Accessed March 2009.
"Birth control options for women—female sterilization." The University of Maryland Medical Center. November 2008. http://www.umm.edu. Accessed March 2009.
McSwain H, Brodie MF. Fallopian tube occlusion, an alternative to tubal ligation. Tech Vasc Interv Radiol. 2006 Mar;9(1):24-9.
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