Contraception

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. Many women are not adequately protected from an unwanted pregnancy by their choice of birth control method. In fact, about half of all pregnancies (49 percent) are unplanned. Of these unplanned pregnancies, more than half (53 percent) of the women were using some form of birth control, reports the Alan Guttmacher Institute (AGI), a non-profit organization that focuses on reproductive health research. According to AGI, there are two main reasons for contraceptive failure. One is inconsistency—for example, forgetting to take your birth control pills or not using a condom every time you have sex. The other is incorrect use of contraception—for example, not inserting a diaphragm the right way or not using enough spermicide. 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, the AGI notes that as many as half of all pregnancies that occur in women over age 40 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. 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: Find out how much the contraceptive costs. Do you have to pay for it all at once or can the cost be spread out over a year? Will your health insurance cover it? Ask yourself if you can realistically use this method. Are you sure you understand how to use it properly? Will this method embarrass you or your partner? Does it fit with your lifestyle? Find out how to use the method correctly and what to do if you forget to use it occasionally. Ask your health care professional about side effects. What should you expect? What should you do about them if they occur and when should you expect them to stop? Will this method cause any unacceptable weight gain? You can probably think of many more questions about the birth control method you're currently using or one you're considering. 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. Contraceptive Options The contraceptive options women may choose are: Birth control pills (BCPs), also called oral contraceptives (OCs) Long-acting hormonal methods, such as shots and implants Intrauterine devices (IUDs) Barrier methods such as condoms, diaphragms, the contraceptive sponge and cervical caps Spermicides Hormonal contraceptive patch Hormonal contraceptive vaginal ring Natural family planning Sterilization Emergency contraception Birth Control Pills (BCPs) There are three different 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 and 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 BCPs contain 20 to 50 mcg of estrogen, a lower dose (one-fourth or less) than the BCPs marketed 20 to 30 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, or add five additional days (tablets) of estrogen at the end of the 21-day cycle. In May 2007, the FDA approved Lybrel, the first continuous use birth control pill. It is a multiphasic pill (containing varying levels of estrogen and progestin designed to be taken at specific times 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. It was approved in 2003. 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: Regulate, shorten or eliminate a woman's menstrual cycle Decrease severe cramping and heavy bleeding Reduce anemia Reduce ovarian cancer risk. The risk of ovarian cancer is believed to decrease by as much as 80 percent for women who take BCPs for 10 years or more, and approximately 40 percent for those who take them on a short-term basis. Reduce colorectal cancer risk. The largest study conducted so far on this subject found that women who had ever used BCPs had a 40 percent lower risk of colorectal cancer, and women who used BCPs for at least two years had half the risk of colorectal cancer as non-BCP users. Reduce the development of ovarian cysts Decrease benign breast disease Protect future ability to become pregnant Reduce the severity and incidence of pelvic inflammatory disease (PID)-infection primarily of the fallopian tubes and/or the female reproductive tract Protect against ectopic pregnancy (pregnancy outside the uterus, in the fallopian tubes) Reduce the risk of uterine (endometrial) cancer. Studies find that oral contraceptives protect against this disease by providing the progestins needed to oppose the stimulation of the uterine lining caused by estrogen. Although the amount of reduction in risk varies depending on the type of progestin used in the pill, the overall risk drops about 50 percent. Minimize perimenopausal symptoms, such as irregular menstrual bleeding Reduce acne Treat the emotional and physical symptoms of premenstrual dysphoric disorder (PMDD), a severe form of PMS. Only one combination OC has been shown to be clinically effective for this use. It contains the progestin drospirenone and ethinyl estradiol, a form of estrogen. Risks Women with certain health conditions may not be able to use birth control pills. These include: Heart disease or stroke Liver disease Blood clots in the deep veins or lung Breast cancer Severe or uncontrolled diabetes. Women with diabetes who have experienced blood vessel damage or had the disease for more than 20 years should not use BCPs. Smokers 35 or older. Smoking cigarettes while taking BCPs triples a woman's risk of having an ischemic stroke—the type of stroke caused by a blood clot in the brain—or a hemorrhagic stroke—the type of stroke caused when a blood vessel ruptures in the brain, according to a large World Health Organization (WHO) study. Certain types of migraine headaches. Women who take birth control pills and have a history of migraines have an increased risk of stroke compared to nonusers with a history of migraine. Your risk is greatest if you have migraines with "aura"—blurred vision, temporary loss of vision or seeing flashing lights or zigzag lines. As a result, both the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) have concluded that for women of any age who have migraines with aura and women over age 35 who get migraines (with or without aura), the risks of BCPs usually outweigh the benefits. Severe hypertension. BCP users with a history of high blood pressure faced a substantially higher relative risk of ischemic (blood clot in the brain) and hemorrhagic (blood vessel rupture in the brain) strokes than nonusers with no such history. Oral contraceptives have been associated with a small, but significant increase in ischemic stroke risk in many, but not all studies. This was a particular concern with early birth control pills that contained higher doses of estrogen, but newer BCPs containing less estrogen are associated with a lower risk of stroke than high-dose pills. In otherwise healthy young women (non-smokers without persistent high blood pressure), the risk is low. Smoking cigarettes while taking BCPs dramatically increases risks of heart attack for women over age 35. Even teenage girls are at greater risk of heart attack and stroke if they smoke while taking BCPs, according to the American Heart Association. 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 BCPs may increase their risk for cancer, particularly breast cancer. However, the evidence remains unclear, notes the American Cancer Society. Studies have found a slightly higher risk of breast cancer in women who take birth control pills. However, women who stopped using the pill 10 or more years ago do not show an increased risk. Discuss the risks and benefits of birth control pills with your health care professional. There is some evidence that long-term use of BCPs may increase the risk of cancer of the cervix (the narrow, lower portion of the uterus). There is also some evidence that BCPs may increase the risk of certain benign (noncancerous) liver tumors. However, the actual risk and role of birth control pills in both these cancers is unclear. Possible side effects Nausea, breast tenderness and bleeding are the most common side effects of all BCPs. Most side effects decrease or disappear after three months of continuous use. Switching to another BCP 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 BCPs. Medications known to interact with BCPs are rifampin (an antibiotic) and anticonvulsants. If you take these drugs regularly but are still interested in using BCPs as your birth control method, talk with your health care professional. The "Mini Pill" A second BCP option is referred to as the "mini-pill." One pill, which contains only progestin, is taken every day. These pills work by 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. They are not as effective as combined BCPs. Progestin-only pills must be taken exactly on time, everyday. However, the progestin-only pill is often an option if you want to use oral contraception, but can't take estrogen. If you are breast-feeding 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 BCPs. 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 BCPs, the mini-pill does not protect you from sexually transmitted diseases, so condoms are necessary if you or your partner are at risk. Emergency Contraception This type of contraception is used after unprotected intercourse. Emergency contraceptive pills (ECPs) contain the same hormones as BCPs, but are taken differently. In fact, some BCPs can be used as ECPs with a health care professional's guidance. To be the most effective, the pills should be started as soon as possible after unprotected intercourse and no more than 72 hours after, although some data suggests it may be effective up to 120 hours after unprotected intercourse. Commonly called "the morning after pill," Plan B, the only FDA-approved emergency contraceptive pill, has just been approved for over the counter sales as well. Plan B is expected to be available over the counter for women ages 18 and over by the end of 2006. To be the most effective, emergency contraceptive pills should be started as soon as possible after unprotected intercourse and no more than 72 hours after, although some data suggests it may be effective up to 120 hours after unprotected intercourse. Following the first dose of medication, a second dose must be taken within 12 hours. Many health care professionals are willing to provide women with a prescription for ECPs to keep on hand and now that they will be available over the counter, you may want to stock up on your own. Discuss these options with your health care professional, or call the hotline 1-888-NOT-2LATE to locate a health care professional who can help you. Side Effects and Risks 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 ECPs to minimize nausea and vomiting. Emergency contraceptive pills that contain only progestin cause fewer side effects. Because ECPs 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 BCPs on a regular basis may be able to use ECPs. Discuss your options with a health care professional. If you waited longer than 72 hours after unprotected sex, you still have an 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 98 percent of women who have been pregnant in the past and 92 percent of women who have never been pregnant. 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. 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: Progestin shots (Depo-Provera (DMPA), 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 all together. 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, ectopic pregnancy 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 loss 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. Intrauterine Devices (IUD). The IUD is a plastic, T-shaped device that is inserted by a health care professional into the uterus. One type of IUD, the ParaGard IUD, also known as a "copper-T" IUD, is coiled with copper and can be kept in place for up to 10 years. However, you shouldn't use the ParaGard IUD if you have any risk factors for pelvic inflammatory disease (PID) or have a recent history of pelvic inflammatory disease or experience heavy menstrual bleeding because a copper-IUD can increase heavy bleeding. A levonorgestrel-releasing IUD (Mirena) can be kept in place for up to five years. During that time, it slowly releases a low dose of the same progestin, levonorgestrel, found in many birth control pills. The levonorgestrel thickens cervical mucous, preventing sperm from reaching an egg. It also helps reduce cramping and bleeding. Once it's removed, pregnancy becomes possible almost immediately. You shouldn't use the Mirena IUD if you have a history of pelvic inflammatory disease (PID) unless you have had a subsequent intrauterine or ectopic pregnancy pregnancy. Although experts do not completely understand how the IUD prevents pregnancy, they believe the device works this way: It causes just enough tissue disturbances in the uterus to create an unfriendly environment for sperm. Few, if any, sperm can make it through the uterus to the fallopian tubes, so fertilization can't occur. The progestin in the progestin-releasing IUD thickens the cervical mucus and blocks sperm. The copper released by the copper-coil IUD also helps repel sperm. Some women are reluctant to use IUDs because of the damaging effects caused by the Dalkon Shield, an IUD popular in the 1970s. That IUD was withdrawn from the market in 1975. Newer IUDs are constructed differently and are considered safe and effective for women with low risk of sexually transmitted diseases. Benefits. IUDs are highly effective in preventing pregnancy; they also provide some protection against ectopic pregnancies. Once the IUD is inserted, it requires no care other than checking the strings attached to the IUD to ensure that it remains in place. The strings are fine threads that hang into the cervix and can be felt from the vagina. Side effects. The most common side effects associated with ParaGard IUD use are cramping and heavy bleeding in some women. Women using the Mirena IUD may initially have irregular periods/bleeding. After a few months, you may experience lighter periods or no periods at all. Use of all IUDs has been associated with an increased incidence of pelvic inflammatory disease (PID), so women who have a recent history of PID or who are at high risk for contracting STDs should not use the IUD. Cramping, pain and heavy bleeding associated with IUD use in some women is most common at the time of insertion. Menstrual-related symptoms and discomfort may subside after several months. 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 spermacide. The male condom The condom is a sheath made of latex or polyurethane that is placed on the penis just prior to intercourse to prevent sperm from entering the uterus. Latex condoms, when used consistently and correctly, provide the best available means of reducing the risk of transmission of many sexually transmitted diseases (STDs), including gonorrhea, chlamydia, HIV and trichomoniasis. Condoms also can reduce the risk of genital herpes, syphilis, chancroid, and human papillomavirus infection, but only when the infected areas are covered or protected by the condom, according to the Centers for Disease Control and Prevention. Condoms made of lambskin, however, do not offer such protection because they have microscopic holes that may stop sperm, but are large enough to allow viruses to pass through. The FDA approved the female condom in 1993. It is a soft, thin, polyurethane sheath with two flexible rings, one that contains the closed end of the sheath and is inserted into the vagina. The other ring stays outside the vagina. Spermicides Spermicides are nonprescription, non-hormonal chemical products containing the active ingredient nonoxynol-9 (N-9) or octoxynol-9 (0-9). They can be used alone or in combination with other barrier contraceptives. Spermicides are available as foam, cream, gel, suppository and film, and, when used with other barrier contraceptives, are more effective than either method used alone. The U.S. Food and Drug Administration (FDA) recommended changes to condom labels in late 2005. The proposed labels will state that using latex condoms can reduce—but not eliminate—the risk of pregnancy and the transmission of HIV and other STDs. The proposals also address latex condoms containing the spermicide nonoxynol-9, which, according to the FDA, may irritate the vagina or rectum and increase the chances of contracting HIV from an infected partner. The proposals also note that condoms leave some male genital skin exposed, which could permit transmission of herpes or other STDs. These proposed changes have not yet been approved. A draft of the proposals is posted on the FDA's Web site. Diaphragms and cervical caps These barrier contraceptives require a prescription and initial fitting by a health care professional. The diaphragm is a soft rubber dome with a flexible rim that covers the cervix. The cervical cap fits snugly on the surface of the cervix. Both devices block sperm from entering the uterus, but should be used along with a spermicide. The diaphragm can be inserted up to six hours before intercourse and should remain in place for six to eight hours after intercourse, but it should never be kept in place any longer than 24 hours. The cervical cap can be left in place for up to 48 hours. These devices are easy to insert and remove for most women, although about 10 percent of women can't use the cervical cap because they have an irregularly shaped cervix. Proper fit of either device is important. If you choose one of these options, have your health care professional check once a year to see if your diaphragm or cervical cap fits correctly. Pregnancy and childbirth can change how these devices fit. You should also carefully examine your diaphragm or cervical cap before each use to be sure it is not punctured or torn. Benefits One benefit of the barrier method is availability: Condoms and spermicides can be purchased over the counter (without a prescription). Side effects Some women and men experience allergic reactions to certain spermicides, rubber or latex used in condoms, diaphragms or cervical caps. Consult with a health care professional if you develop any symptoms after using contraception. Symptoms might include: Rash Respiratory distress Swelling Hay fever-type reactions such as itchy, swollen eyes, runny nose and sneezing Asthma-type symptoms such as chest tightness, wheezing, coughing and shortness of breath Diaphragm and spermicide use has been associated with an increased risk of urinary tract infections (UTI) and yeast infections. Emptying your bladder immediately after intercourse and removing the diaphragm after six hours may decrease your chances of developing a UTI. The Contraceptive Sponge The vaginal sponge (Today), which had been withdrawn from the market, won FDA re-approval in April 2005. The one-gram sponge is available over the counter, is 84 percent to 91 percent effective in preventing pregnancy in women who have never given birth and in 68 to 80 percent of women who have given birth, and contains the spermicide nonoxynol-9. When moistened with water and placed in the vagina, it releases the spermicide and begins working right away and for the next 24 hours. The sponge should be left in place for at least six hours after intercourse. Don't leave it in place for more than 30 hours. Vaginal Contraceptive Ring One of the newest contraceptives on the market, NuvaRing, available by prescription only, consists of a soft, flexible, transparent, ring that measures approximately two-and-one-tenth 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 or two will become pregnant. Side effects: 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 (skin) patch approved by the FDA in 2001. The one-and-three-quarter inch square patch consists of three layers, with hormones embedded in the adhesive layer. The patch is applied to the skin (lower abdomen, buttocks or upper body, 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, upper respiratory infection, menstrual cramps and abdominal pain. 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, stating 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. Women taking or considering the birth control patch should talk to their health care professional about these risks. Natural Family Planning (Fertility Awareness) 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, called "Essure," and the traditional tubal ligation procedure, often called "getting your tubes tied." The Essure procedure. The Essure procedure can be performed in your doctor's office with local anesthesia. Your doctor uses a special instrument called a hysteroscope to place specially designed spring-like coils called micro-inserts through your vagina and cervix into the opening of your fallopian tube in your uterus. There is no incision. Within three months, the micro-inserts cause your body to form a tissue barrier that prevents sperm from reaching the egg. During this three-month period, you need to use another form of birth control. After three months, you have to return to your doctor's office for a special x-ray to make sure your tubes are completely blocked. In clinical studies, most women reported little to no pain, and were able to return to their normal activities in a day or two. Essure may reduce the risk of tubal (ectopic) pregnancy. Tubal ligation: With this type of sterilization procedure, your fallopian tubes are blocked with a ring or burned or clipped shut. This procedure is typically performed under general anesthesia in a hospital. The surgeon makes a small incision through the abdomen and inserts a special instrument called a laparoscope to view the pelvic region and tubes and to perform the procedure. Recovery typically takes four to six days. Risks include pain, bleeding, infection and other postsurgical complications, as well as an ectopic, or tubal, pregnancy. 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 women 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. After a sterilization procedure, women may experience pain and discomfort for several days or longer. Men often experience painful swelling that may last a half a day. 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; figures are divided into "perfect use" and "typical use" categories.