Birth Control: Options, How They Work, and Conflict
Introduction of Terms
Typically most patients, when asked about birth control options, are aware of both male condoms and oral birth control – but do they understand how they work? The truth is that there are many more birth control options to consider. Why are physicians not presenting these options to patients? Unfortunately time constraints can often limit patient education. However, at least a brief explanation can be given with a comprehensive hand out detailing birth control options and their mechanisms of action (how they work).
The term contraceptive may be familiar to many patients. A contraceptive in a mainstream medical dictionary is defined as any process, device or method used to prevent conception from occurring. Conception is also defined here as when the fertilized ovum has finished implanting into the mother’s uterine lining. Conception, or when implantation is complete, marks the onset of pregnancy in the mainstream medical realm. Fertilization is also defined in this source to occur when the nuclei of the sperm and egg fuse. Often, lay people define conception as the moment of fertilization. Neither definition of conception is unscientific, but one does need to know which definition is being used in order to understand how a birth control is working. I will use the term contraception and birth control interchangeably in this discussion. In addition, a contraceptive can be of a permanent nature (such as a vasectomy or a tubal ligation). Those of a temporary nature will be detailed in this discussion.
Types of Birth Control
1. Hormonal Birth Control:
Hormonal birth control introduces hormones into the female’s body via various routes. The following bulleted examples of hormonal birth control are explained below by: Route - Product Name® (which hormones they contain)
- Oral Birth Control (“the pill”)– Yasmin® (progestin and estrogen), Ortho Micronor® (progestin)
- Intravaginal – NuvaRing® (estrogen and progesterone)
- Subdermal – Norplant® (progestin) implants
- Intrauterine device – Mirena® (progestin) IUD
- Transdermally – Ortho Evra® (estrogen and progesterone)
- Intramuscular injection – Depo-Provera® (progesterone only)
Hormones (either progesterone or progesterone and estrogen) are added to the female’s body to bring these hormones to higher-than-normal physiologic levels. The above bulleted examples all work by two main mechanisms of action: to prevent ovulation as well as to prevent implantation of the fertilized ovum into the uterine lining. If ovulation is not successfully inhibited, then hormonal birth control has the potential to prevent implantation of the fertilized ovum. If one believes that life starts at fertilization, then birth control that has the potential to prevent implantation would not be an option for use. This is due to the fertilized ovum not being able to continue its life because it was unable to attach. All of the above examples except Depo-Provera have a third main mechanism of action: they alter the female’s secretions to impede sperm travel to help prevent fertilization.
2. Copper IUD:
The copper IUD is an intrauterine device that, instead of emitting hormones, emits copper. The copper works in the female’s body to alter the female’s secretions to impede sperm travel as well as to alter the lining of the uterus to prevent implantation of a fertilized ovum into the uterus. Spontaneous abortions can later occur if one becomes pregnant with either the copper IUD or the progestin IUD in place. This can occur even if the intrauterine devices are removed early in pregnancy.
3. Emergency Forms:
These forms are used when one has intercourse without using protection (or if protection fails) and they want to stop the implantation of a fertilized ovum or possibly prevent fertilization from occurring. The copper IUD can be inserted after unprotected intercourse as a form of emergency birth control. Hormonal forms may also be taken after unprotected intercourse as an emergency form of birth control. The hormonal forms can work to prevent ovulation and impede sperm movement, as well as prevent implantation. How it works will depend on when it is taken in relation to the female menstrual cycle. For example, if ovulation has already occurred, then introduction of an emergency form of birth control will only be able to prevent implantation of the fertilized ovum. The following are examples of emergency hormonal forms:
- Preven ™ – (estrogen and progesterone)
- Progestin-only minipill (Example: Plan B® One Step)
The copper IUD’s effects are mainly to prevent implantation, though it may also work to prevent fertilization by impeding sperm movement. Again, how it works will also depend on when it is inserted in relation to the female menstrual cycle. The hormonal forms and the copper IUD must be used within a certain time frame after intercourse to ensure their effectiveness. Once implantation of the fertilized ovum is complete, the hormonal emergency forms cannot terminate an established pregnancy. Again, to reiterate, pregnancy is defined here as when the fertilized ovum has finished implanting into the uterine lining.
4. Barrier Methods:
There are also a number of barrier methods that work to solely prevent fertilization by preventing the travel of sperm into the cervix. They each form a barrier either over the penis or the cervix. The following bulleted items are examples of barrier methods. They are often used with a spermicide and have to be in place before intercourse begins (some even need to stay in place for hours after the completion of intercourse).
- Male/Female Condom – covers penis/lines vagina.
- FemCap ® – covers cervix
- Lea’s Shield ® -covers cervix
- Diaphragm -covers cervix
5. Other Options:
There are other birth control options such as the introduction of spermicide alone into the vagina in an attempt to kill sperm and prevent fertilization. In addition, one can abstain from intercourse, termed as abstinence, as an effective form of birth control. It is important to note that the presence of sperm near the vaginal opening can result in pregnancy, as the sperm can travel via the vaginal secretions into the vagina. Males can withdraw the penis prior to ejaculation, but it needs to be noted that pre-ejaculate fluid can contain some sperm. Furthermore, after a woman has a child she can continually breast feed (Lactational Amenorrhea Method) to inhibit her body from ovulation and menstruation. If done correctly, this can be an effective form of birth control for 6 months. Also, women can monitor their menstrual cycles to find out when they are ovulating and then either abstain from intercourse or wear a barrier method during that time frame every month. By using such Fertility Awareness Methods, a woman can find out when she is ovulating by marking her monthly menstrual cycles, checking her basil metabolic temperatures every morning, checking for changes in vaginal secretions or by purchasing over-the-counter ovulation kits. This method can also be used to assist when one desires to become pregnant. Additionally, an abortion is also a form of birth control. This is performed on an embryo or a fetus after implantation is complete to end the life of the embryo or the fetus.
The forms of birth control one is willing to use should be dictated by when one believes life begins. It is ideal to be fully educated on all forms of birth control so that one can make an informed decision on his/her own. It is the patient’s right to ask questions regarding all options. Condoms and abstinence are the only forms of birth control that can protect against sexually transmitted diseases. Consult your primary care physician or gynecologist about finding a form of birth control.
* The guardian. Accessed: March 15, 2012. Available: http://www.guardian.co.uk/science/2008/nov/10/ivf-embryos-stem-cells-pregnancy
Note: Dr. Corrie Thompson, NMD does not endorse any publishers or products. The references used and cited and the products named are for educational purposes only and is not meant to diagnose or treat. Discuss the content of this site with a health care professional (your primary care physician) and then continue under their care as it pertains to this content. Dr. Corrie Thompson, NMD under Aletes Medical Center, LLC has published her original work to this website unless otherwise noted.