Birth Control

	Overview
	Health Tools
	Teens and Birth Control
	Birth Control Methods
	Choosing a Birth Control Method
	Emergency Contraception
	When to Call a Doctor
	Other Places To Get Help
	Related Information
	References
	Credits

Is this topic for you?

Sometimes a woman may not use birth control, or her method may fail. If this happens to you, you may still be able to prevent pregnancy if you act quickly. For more information, see the topic Emergency Contraception.

What is birth control?

Birth control is any method used to prevent pregnancy. Another word for birth control is contraception (say “kon-truh-SEP-shun”).

If you have sex without birth control, there is a chance that you could get pregnant. This is true even if you have not started having periods yet or you are getting close to menopause. Each year, about 85 out of 100 women who don't use birth control have an unplanned pregnancy.¹

The only sure way to prevent pregnancy is to not have sex. But finding a good method of birth control you can use every time can help you avoid an unplanned pregnancy.

What are the types of birth control?

There are many different kinds of birth control. Each has pros and cons. Learning about all the methods will help you find one that is right for you.

• Hormonal methods include birth control pills, shots (Depo-Provera), the skin patch, the implant, and the vaginal ring. Birth control that uses hormones is very good at preventing pregnancy.
• Intrauterine devices (IUDs) are inserted into your uterus. IUDs work very well for 5 to 10 years at a time and are very safe. And the Mirena IUD contains a hormone that can help with heavy periods and cramping.
• Barrier methods include condoms, diaphragms, and sponges. In general, these do not prevent pregnancy as well as IUDs or hormonal methods do. To help a barrier work better, use it with a spermicide, a chemical that kills sperm.
• Natural family planning (also called fertility awareness) can work if you and your partner are very careful. You will need to keep good records so you know when you are fertile. And during times when you are fertile, you will need to skip sex or use a barrier method.
• Permanent birth control (sterilization) gives you lasting protection against pregnancy. A man can have a vasectomy, or a woman can have her tubes tied (tubal ligation). But this is only a good choice if you are sure that you don't want any (or any more) children.

For hormonal or barrier methods to work best, you have to use them exactly the way your doctor or the package instructions say. Even then, accidents can happen. So it is a good idea to keep emergency birth control on hand as backup protection. You can buy “morning-after pills” called Plan B in most drugstores if you are over 18.

How do you choose the best method?

The best method of birth control is one that protects you every time you have sex. And with many types of birth control, that depends on how well you use it. To find a method that will work for you every time, some things to think about include:

• How well it works. Think about how important it is to you to avoid pregnancy. Then look at how well each method works. For example, if you plan to have a child soon anyway, you may not need a very reliable method. If you don't want children but feel it is wrong to end a pregnancy, choose a type of birth control that works very well.
• How much effort it takes. For example, birth control pills may not be a good choice if you often forget to take medicine. If you are not sure you will stop and use a barrier method each time you have sex, pick another method.
• When you want to have children. For example, if you want to have children in the next year or two, hormone shots may not be a good choice. They can make it hard to get pregnant for several months after you stop them. If you never want to have children, natural family planning is not a good choice because it often fails.
• How much the method costs. For example, condoms are cheap or free in some clinics. Some insurance companies cover the cost of prescription birth control. But cost can sometimes be misleading. An IUD costs a lot up front. But it works for years, making it low-cost over time.
• Whether it protects you from infection. Latex condoms can help protect you from sexually transmitted diseases (STDs), such as HIV. But they are not the best way to prevent pregnancy. To avoid both STDs and pregnancy, use condoms along with another type of birth control.

If you are using a method now that you are not happy with, talk to your doctor about other choices.

What health issues might limit your choices?

Some birth control methods may not be safe for you, depending on your health. To make sure a method is right for you, your doctor will need to know if you:

• Smoke.
• Are or could be pregnant.
• Are breast-feeding.
• Have any serious health problems, such as heart disease, high blood pressure, migraine headaches, or diabetes.
• Have a family history of bone thinning (osteoporosis) or blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism).
• Have ever had breast cancer.
• Have a sexually transmitted disease.

How can you get birth control?

You can buy:

• Condoms, sponges, and spermicides in drugstores without a prescription.
• Plan B emergency birth control in most drugstores without a prescription. But you do need proof that you are 18 or older.

You need to see a doctor or other health professional to:

• Get a prescription for birth control pills and other methods that use hormones.
• Have an IUD inserted.
• Be fitted for a diaphragm or cervical cap.

Some pharmacists will not sell Plan B or fill prescriptions for birth control pills. If this happens to you, ask for the location of a pharmacist who will, or go to:

• The Emergency Contraception Web site at http://ec.princeton.edu, or call 1-888-NOT-2-LATE (1-888-668-2523).
• The Planned Parenthood clinic nearest you, or call 1-800-230-PLAN (1-800-230-7526).

For information about birth control laws in your state, see the Guttmacher Institute’s State Center at www.guttmacher.org/statecenter/contraception.html.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Which birth control method should I use?

Whether you are male or female, your life can suddenly be changed forever by pregnancy or a sexually transmitted disease (STD). Think for a moment what this would be like for you.

The most dependable way to prevent pregnancy and STD infection is not to have sexual intercourse. This is called abstinence.

If you do not choose abstinence and are sexually active, always be prepared. To protect yourself and your future, think ahead about birth control methods and STD protection. Never have sex without protection. Using condoms will reduce your risk of getting an STD.

Even a single act of sexual intercourse can lead to pregnancy or an STD infection. A sexually active teen (boy or girl) who is not using any birth control has a 90% chance of conceiving a pregnancy within 1 year.²

Take charge of your health and your future

Even if you plan not to have sex until you're older, take a little time to learn and decide about:

• Which birth control methods are available.
• Which birth control methods you know you would be able to count on every time you'd need one.
• How to use a condom to avoid getting or spreading a sexually transmitted disease, including HIV. (Some STDs can be spread through oral sex as well as through intercourse.) If you are sexually active, male or female, always have a condom with you. Don't ever depend on someone else to have a condom when you need it.
• How to use a combination of methods for the best protection against pregnancy and sexually transmitted diseases.

It may not be easy to talk about sexual activity and birth control, but it is important that you know how to practice safe sex. Hopefully, you have a parent, school or church counselor, or health professional that you feel comfortable talking to. Organizations such as Planned Parenthood are private, confidential resources for learning how to be both sexual and responsible. See the Planned Parenthood Web site for teens at www.teenwire.com, or check your telephone listings for the Planned Parenthood office near you.

The best birth control methods for you are those that are easy for you to use (or are already in effect) each time you have intercourse. Follow up regularly with a health professional to make sure that your birth control method is working effectively for you. And if you have any side effects that are making it hard for you to use the method as directed, choose a different method.

If you have a long-term (chronic) illness or a disability, talk to a health professional about which birth control choices are best for you.

For teen boys and girls

Protect yourself and your partner from sexually transmitted diseases and pregnancy.

• Consider the benefits of abstinence.
• If you have sex, use a condom.
• If your partner is not comfortable with using a condom, don't have sex.
• If you are not using another form of birth control, use spermicide (which is put in the vagina before intercourse) with the condom. Spermicide or another form of birth control lowers your risk of getting pregnant if the condom fails.

For teen girls

Some teenage girls are worried about visiting a health professional for birth control.

• Don't be shy about protecting yourself from sexually transmitted diseases by having a condom on hand and asking your partner to use it.
• If you are concerned about having a pelvic exam or keeping your health information private, talk to your health professional or a family planning clinic counselor.
• If you have not been sexually active before now, a pelvic exam may not be necessary.
• If you have been sexually active, it's very important that you are screened for STDs every year. Some STDs can be screened for with a urine test. You may not need a Pap test and pelvic exam until 2 to 3 years after you become sexually active. (A Pap test checks for early signs of cervical cancer, which starts from a sexually transmitted virus, a type of human papillomavirus.)
• Have emergency contraception on hand or know how to get it if a condom breaks.

Before choosing and using a birth control method, be honest with yourself. If it failed and you started a pregnancy, what would you do? Are you ready to raise a child? Is an abortion an acceptable option for you? Answering these questions can help you know how committed you are to preventing a pregnancy. For most sexually active teens, it is worth it to use the most effective birth control methods possible.

When choosing a birth control method, also consider protecting yourself against sexually transmitted diseases. Condoms give the most effective STD protection for both partners, no matter what other birth control method you are using. Some studies suggest that female condoms are as effective as male condoms in preventing STDs.³ However, as birth control, condoms used alone are not highly dependable.

Emergency contraception

Emergency contraception is the use of either a copper intrauterine device (IUD) or a certain type of birth control pill on a specific dosing schedule. The pills can prevent a pregnancy when taken up to 5 days after unprotected sex, although they are most effective when used within 72 hours. Using a copper IUD can prevent pregnancy if it is inserted within 5 to 7 days after you have had unprotected sex.

Hopefully, you'll never need to use emergency contraception. However, if you have had unprotected sexual intercourse or you think your birth control method may have failed, emergency contraception is a last-resort way to prevent a pregnancy. It is not to be used as a substitute for ongoing birth control.

Experts recommend having a prescription for emergency contraception on hand (if not the actual pills) so that it is readily available should you ever need it.¹ Talk to your health professional or a family planning clinic about this.

If you do use emergency contraception, be sure to follow up with your health professional to find an effective, ongoing method of birth control.

For more information, see the Emergency Contraception Web site at http://ec.princeton.edu/.

There are many methods of birth control. Learn about the different kinds of birth control to help you choose the best one for you. When making your choice, also consider that only a condom will protect you from sexually transmitted diseases (STDs). To protect yourself and your partner against STDs, use a condom (along with your chosen birth control method) every time you have sex.

Hormonal methods

Hormonal methods are very reliable means of birth control. Hormonal methods use two basic formulas:

• Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills ("the Pill"), skin patches, and rings.
• Progestin-only hormonal methods include pills, also called "mini-pills," and injections (Depo-Provera). If you cannot take estrogen, a progestin-only method may be an option for you. See information about the progestin-only Mirena intrauterine device (IUD) below under IUDs.

Combination and progestin-only methods are prescribed for women for different reasons. Compare the recommendations for and against combination and progestin-only hormonal birth control pills, patches, and rings. Each type of method has its pros and cons.

• Combination pills may reduce acne, pain during ovulation, and premenstrual symptoms. Both types of pill reduce heavy bleeding and cramping. Unlike the combination pill, the progestin-only pill can be taken by almost all women, including those who are breast-feeding, although it must be taken at the same time each day to be effective. (Combination pills are also taken daily but without as much attention to the time of day.) When you first start taking either type of birth control pill, it is necessary to use a backup birth control method for the first week.
• Patches or vaginal rings are similar to combination pills, but they don't require taking a daily pill. The patch is changed weekly, and the ring is changed monthly (with 1 week off after 3 weeks of use).
• One type of birth control pill called YAZ or Yasmin reduces severe mood and physical symptoms that some women get before they start their monthly periods.⁴ These symptoms are called premenstrual dysphoric disorder (PMDD). YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms.
• The progestin-only (Depo-Provera) shot does not require taking a daily pill. Instead, you see your health professional once every 3 months for the injection.

Intrauterine device (IUD)

An intrauterine device (IUD) is a small device that is placed in the uterus to prevent pregnancy. IUDs are wrapped with copper (Copper T 380-A) or contain a hormone (the Mirena IUD releases a progestin called levonorgestrel). Once an IUD is in place, it can provide birth control for 5 to 10 years, depending on the type. Unlike IUDs that were used in the 1970s, present-day IUDs are small, safe, and highly effective.

If a sexually transmitted disease is present at the time the IUD is inserted, the infection can be carried into the uterus. This can lead to pelvic inflammatory disease (PID), which can lead to infertility.⁵

The progestin IUD (Mirena) typically reduces menstrual flow and cramping over time. On the other hand, the copper IUD can cause longer and heavier periods. However, the progestin IUD can have other side effects, including spotting, mood swings, and breast tenderness. These side effects occur less frequently than with other progestin-only methods.

Barrier methods

Barrier methods (including the diaphragm; cervical cap; Lea's Shield; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) prevent sperm from entering the uterus and reaching the egg. Typically, barrier methods are not highly effective, but they generally have fewer side effects than hormonal methods or IUDs. Spermicides and condoms should be used together or along with another method to increase their effectiveness. Barrier methods can interrupt lovemaking because they must be used every time you have sex.

Condoms (male or female) should always be used if you are at risk of getting or spreading a sexually transmitted disease, such as genital herpes, chlamydia, or HIV.

Fertility awareness (periodic abstinence or natural family planning)

Fertility awareness requires that a couple chart the time during a woman's menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a good choice if you need a highly effective form of birth control.

Breast-feeding may work as a form of birth control in the first 6 months after giving birth if you follow specific guidelines. For this method to work, you must breast-feed your baby every time. You can't use formula or other supplements. This is called the lactational amenorrhea method (LAM). Although LAM has been shown to be 98.5% effective when these conditions are met, many doctors recommend that you use another birth control method.⁶

Permanent birth control (sterilization)

Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is one of the most effective forms of birth control. Sterilization is intended to be permanent, and although you can try to reverse it with another surgery, reversal is not always successful.

• Tubal ligation or implants. Tubal ligation is a surgical procedure where the fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked. A new nonsurgical sterilization technique uses a small metal coil, or tubal implant, inserted up into each fallopian tube. Over time, scar tissue grows around each tubal implant, permanently blocking the tubes. Most women are able to return home within a couple of hours after either procedure. You must use another form of birth control for 3 months after receiving tubal implants. Sometimes tubal implants can require a repeat procedure.
• Vasectomy. In this minor surgery, the vas deferens, the tubes that carry sperm from the testicles to the seminal fluid (semen), are cut and blocked so that the semen no longer contains sperm. This does not interfere with a man's ability to have an erection or enjoy sex.

Female sterilization is more complicated, has higher risks of problems after surgery, and is more expensive than male sterilization.

Contraception following pregnancy

Birth control is an important consideration after you have had a child. Your ability to become pregnant again may return within 3 to 6 weeks after childbirth. Think about what type of birth control you will be using, and make a plan during your pregnancy. Start using birth control as soon as possible after childbirth. Most methods of birth control can be started soon after childbirth, although some may not be recommended if you are breast-feeding.

Understanding conception

You can best evaluate the advantages and disadvantages of the different methods of birth control when you understand:

• How pregnancy occurs.
• How each method prevents pregnancy.

With so many methods available and so many factors to consider, choosing birth control can be difficult. You may be able to decide on a method by asking yourself the following questions.

Might I want to have a biological child in the future?

One of your first considerations might be to determine whether you want permanent or temporary birth control. In other words, you should consider whether you want to conceive any (or more) children. This is a decision that will affect the rest of your life and can be made only after thinking it through carefully.

If you know that you will not ever want to conceive a pregnancy, tubal ligation or tubal implants for you or a vasectomy for your partner is a reasonable option to consider.

If you are not sure about the future even though you know how you feel now, a temporary method is a better choice. If you are young, have few or no children, are choosing sterilization because your partner wants it, or think it will solve money or relationship problems, you may regret your decision later.

How would an unplanned pregnancy affect my life?

If an unplanned pregnancy would seriously impact your plans for the future, choose a birth control method that is highly effective. Or, if you have a stable relationship and income and plan to have children in the future anyway, you may feel comfortable using a less reliable method.

How effective are different types of birth control?

See a table showing the birth control failure rates of each method.

Hormonal injections (Depo-Provera) and the hormonal and copper IUDs are highly effective methods of birth control (97% and 99.9% effective). That means fewer than 1 to 3 out of 100 women using these methods will become pregnant in a year.⁷

Birth control pills (both combination and progestin-only) have a high success rate of 92%. That means that 8 out of every 100 women taking pills become pregnant in a year. If taken carefully every day or at the same time every day, birth control pills are over 99% effective.⁷ The hormonal skin patch and vaginal ring are thought to be about as effective as birth control pills.

Barrier methods, including the diaphragm, cervical cap, Lea's Shield, male condom, female condom, and spermicide, are moderately successful at preventing pregnancy. The diaphragm and cervical cap are 84% effective for women who have not had a vaginal childbirth. This means that of all such women using a diaphragm or cap, 16 out of every 100 get pregnant in a year.⁷ Women who have delivered a baby vaginally have lower rates of success with diaphragms and cervical caps.⁷ These methods are more effective when they are used every time you have sex and when they are fitted correctly. Some women find it hard to plan ahead or to interrupt an intimate moment before having sex to use a barrier method.

Condoms alone or spermicides alone are also moderately successful at preventing pregnancy.

• The male condom is 85% effective.⁷ This means that out of 100 couples who use only male condoms for birth control each time they have sex, 15 will become pregnant in a year.
• The female condom is 79% effective.⁷ This means that of all couples who use only female condoms, 21 out of 100 will become pregnant in a year.
• Spermicide is 71% effective.⁷ This means that of all couples who use only spermicide, 29 out of 100 will become pregnant in a year.

Consider carefully whether these higher risks of pregnancy are acceptable to you. Experts recommend that you use condoms along with another method or spermicide and condoms together to increase their effectiveness.

To be effective, a barrier method must be in place every time you have sex. When possible, put a diaphragm, cervical cap, sponge, or shield in place ahead of time. If not, it's necessary to interrupt the moment and put the barrier in place. Some people successfully use a condom or other barrier method as part of their lovemaking.

Consider how comfortable you feel about using a particular method of birth control. If you are not comfortable with or might not consistently use a birth control method for any reason, that method is not likely to be reliable for you in the long run. A reality check for birth control methods can help you determine which method is right for you.

How can I prevent sexually transmitted diseases?

Unless you know that your partner has no other sex partners and is free of sexually transmitted diseases (STDs), you are at risk for STD infection. If you are at risk, protect yourself from infection every time you have sex. Use a condom in addition to any other birth control method you choose.

You can choose between a male or female condom to reduce your risk for HIV (the virus that causes AIDS), gonorrhea, syphilis, chlamydia, genital warts, herpes, pelvic inflammatory disease (PID), and other infections.

What health factors could limit my choice of birth control?

If you have health problems or other risk factors, some birth control methods may not be right for you.

• Smoking. If you smoke more than 15 cigarettes a day and are 35 or older or have high blood pressure, a history of stroke, a history of blood clots, liver disease, or heart disease, you may not be able to use combined hormonal methods.
• Migraines. If you have migraine headaches, talk to your health professional about whether you can try combined hormonal contraception.
• Diabetes. If you have advanced or long-standing diabetes, discuss the risks of taking hormonal birth control methods with your health professional.
• Breast-feeding. If you are breast-feeding, the estrogen in combined hormonal birth control can lower your milk supply. Progestin-only pills or Depo-Provera injections do not affect your milk supply and are a good option for breast-feeding women.

Other health problems that might keep you from using a particular birth control method are relatively rare, especially in young women. However, before using any method, you should talk with your health professional to see if it is safe for you.

If you are at risk of sexually transmitted disease (STD) infection, consider the following:

• IUD. All women at risk for an STD should be screened before getting an intrauterine device (IUD).⁸ If a sexually transmitted disease is present at the time the IUD is inserted, the infection can be carried into the uterus. This can lead to pelvic inflammatory disease, which can cause infertility.⁵ If you are getting an IUD and have any risk of getting an STD, use condoms before and after the IUD is inserted.
• Depo-Provera. Use of Depo-Provera may increase the risk of chlamydia or gonorrhea infection among women who are exposed to these diseases.⁹ If you have any risk of getting an STD, use condoms.

Using Depo-Provera for 2 or more years can also cause bone loss, which may not be fully reversible after stopping the medication.¹⁰ Bone loss can lead to osteoporosis later in life, a condition that causes bones to become thin and brittle, making them more likely to break.

A small study among teens showed that bone loss from Depo-Provera was reversed after they stopped getting the shots.¹¹ Talk to your doctor about your risks if you have used Depo-Provera longer than 2 years.

What other factors might influence my decision?

Each method has benefits.

• Combination pills, which contain both estrogen and progestin, may reduce acne, pain during ovulation, premenstrual symptoms, and heavy menstrual bleeding and cramping.
• One type of birth control pill called YAZ or Yasmin reduces severe mood and physical symptoms that some women get before they start their monthly periods.⁴ These symptoms are called premenstrual dysphoric disorder (PMDD). YAZ has been approved by the U.S. Food and Drug Administration for treating PMDD symptoms.
• Seasonale or Seasonique is a combination pill you take for 84 days rather than the normal 21 days; then you take no pills for 7 days in order to have a period (menstruate). This decreases your menstrual periods to only 4 a year.
• Lybrel is a low-dose combination pill. You take a hormone pill every day of the month, and have no monthly periods. (But it is common to have unexpected spotting or bleeding, especially during the first year.)
• The progestin IUD (Mirena) and the progestin-only injection (Depo-Provera) can relieve cramping and menstrual bleeding, make periods less frequent, or even stop periods altogether.
• Unlike the combination pill, most women can take the progestin-only pill, including those who are breast-feeding (because estrogen lowers milk supply). However, you must take the progestin-only pill at the same time each day to prevent pregnancy.

The most common reasons women give for quitting hormonal contraception (combination pills, patches, or rings; progestin-only pills or injections; or the progestin IUD [Mirena]) include:¹²

• Irregular bleeding (12%).
• Nausea (7%).
• Mood changes (5%).
• Weight gain (5%, except for Mirena IUD).
• Breast tenderness (4%).
• Headache (4%).

Condoms and spermicides are available without a prescription. You can buy condoms and spermicides at most drugstores.

What are some other considerations in choosing a birth control method?

Other factors to consider when choosing a method of birth control include:

• Health benefits, such as decreased risk for sexually transmitted diseases with condoms and reduced risk of ovarian cancer and uterine cancer with long-term use of birth control pills.
• Convenience and ease of use. Birth control forms such as patches, shots, IUDs, and vaginal rings are convenient for women who have trouble remembering to take a daily pill or couples who know they won't use a barrier method every time they have sex.
• Cost. Over time, the higher one-time cost of IUD insertion or sterilization surgery may be less than the continued costs of buying pills or condoms and spermicide.

Birth control methods work the same for people of any age, although some methods are not recommended for sexually active teenagers or women over 35 who smoke. This can be because of health reasons or poor pregnancy prevention if the method is not used every time. It's important to understand:

• How pregnancy occurs.
• The myths about sex and pregnancy.

Once you have looked at the facts about the different methods and considered your own values and needs, you can choose the method that will work best for you. Using condoms with any method may increase its reliability and protect you from sexually transmitted diseases (STDs). For more information, see:

Which birth control method should I use?

You can use emergency contraception if a condom breaks, you've forgotten a pill, you are taking other medications that may affect contraception medications, or you have had unprotected sex. Emergency contraception does not protect against sexually transmitted diseases.

There are two kinds of emergency contraception:

• Hormonal emergency contraception. Even though it is called the "morning-after pill," hormonal emergency contraception is effective when taken up to 5 days after unprotected sex, although it is most effective when it is used within 72 hours.
• Copper T intrauterine device. The copper IUD is inserted within 7 days after unprotected sex.

The Emergency Contraception Web site at http://ec.princeton.edu/ can help you find an emergency contraception provider close to you.

You can buy Plan B in most drugstores.

• If you are 18 or older, you can get Plan B from a pharmacist, without a prescription. Bring proof of your age.
• If you are younger than 18, you can get Plan B with a prescription.

Some pharmacists refuse to fill emergency contraception prescriptions based on their personal beliefs. If this happens to you, ask for the location of a pharmacist who will fill the prescription, use the Web address above, or call the Planned Parenthood clinic closest to you.

Different birth control methods have different side effects and possible complications. It is important to understand the risks of the birth control method you use. Talk to your health professional if you have concerns about side effects.

Call your health professional if you have symptoms of pregnancy, such as having missed one or more periods or having your period but with a lot less bleeding than usual. Take a home pregnancy test. If the test is negative but you still suspect that you are pregnant, schedule an appointment with your health professional.

If you are an adult, the law protects the privacy of your health information. Your gynecological exam and test results are your private information. Your health professional will not share your private information with anyone but you unless you give him or her permission to do so.

If you are a teen, your privacy depends on the laws in your state. Most state laws protect a teen's privacy and freedom to see a health professional for birth control services. Some states, however, require most teens to have a parent's consent for prescription birth control. For information about your state's laws, see Minors' Access to Contraceptive Services at www.guttmacher.org/statecenter/contraception.html.

Call your health professional immediately if you have any of the following symptoms:

Hormonal methods

• Sudden or severe abdominal pain
• Sudden or severe chest pain
• Sudden shortness of breath or difficulty breathing
• Severe headache
• Sudden eye problems or changes in your vision
• Severe leg pain (anywhere, most likely in your calf)

Intrauterine device (IUD)

• Symptoms of pregnancy, such as missing a period or tender breasts
• Fever of 100°F (37.8°C) or higher
• Pain in the lower abdomen
• Bad-smelling, heavy discharge from the vagina
• Vomiting not caused by stomach flu

Pregnancy after sterilization is rare. However, when it does happen, the risk of tubal (ectopic) pregnancy is higher than normal. If you have had a tubal ligation or tubal implants and now have possible pregnancy symptoms, have a pregnancy test right away. An ectopic pregnancy can become life-threatening.

If you have an IUD or have had a sterilization procedure, your health professional will give you instructions to follow.

Who to See

Most methods of birth control require at least one visit to your health professional for an exam and to get a prescription. Some methods may require a visit to a specialist. Women who are seeking birth control can see:

• A family medicine doctor.
• A gynecologist.
• A nurse practitioner.
• An internist.
• A certified nurse-midwife.
• A physician assistant.

Family planning clinics, local health departments, and university health clinics can provide counseling, exams, and prescriptions or referrals. These types of clinics might be easiest for teens to use.

Tubal ligation or implants are usually done by a gynecologist or family medicine doctor. Vasectomy is usually done by a family medicine doctor or a urologist. Either procedure may also be done by a general surgeon.

What to Think About

You can buy condoms and spermicides at a drugstore or grocery store without a prescription. Be sure to read the directions on the package insert and always use condoms correctly.

When you go to your health professional for birth control, you will probably have a physical exam to make sure that your reproductive organs are healthy and normal. Usually, a pelvic exam and Pap test are done at this time. (A Pap test is a check for early signs of cervical cancer.) However, it is not always necessary to have an exam before starting prescription birth control.

Your health professional will also look at your medical history to see if you have any conditions that could be made worse or could cause problems with a specific birth control method.

For teen girls: Some teenage girls are worried about visiting a health professional for birth control.

• If you are concerned about having a pelvic exam or keeping your health information private, talk to your health professional or a family planning clinic counselor.
• If you have not been sexually active before now, a pelvic exam may not be necessary.
• If you have been sexually active, it's very important that you are screened for sexually transmitted diseases (STDs) every year. This can be done with a urine test. You may not need a Pap test and pelvic exam until 2 to 3 years after you become sexually active.

Natural family planning does not require a visit to a health professional; it requires careful attention and dedication. This is one reason why many couples become pregnant when using it for birth control. In fact, this method is best used for conceiving a planned pregnancy. To learn about natural family planning, look for a natural family planning or fertility awareness class at local women's clinics, hospitals, and churches.

Online Resources

Organizations

• Exposure to Sexually Transmitted Diseases

Citations

1. Hatcher RA, et al. (2005). Pocket Guide to Managing Contraception 2005–2007. Tiger, GA: Bridging the Gap Foundation.

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3. Minnis AM, Padian NS (2005). Effectiveness of female controlled barrier methods in preventing sexually transmitted infections and HIV: Current evidence and future research directions. Sexually Transmitted Infections, 81(3): 193–200.

4. Yonkers KA, et al. (2005). Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstetrics and Gynecology, 106(3): 492–501.

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6. Grimes DA (2003). Contraception during breastfeeding. Contraception Report, 13(4): 7–13.

7. Trussell J (2004). The essentials of contraception: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 221–252. New York: Ardent Media.

8. American College of Obstetricians and Gynecologists (2005). Intrauterine device. ACOG Practice Bulletin No. 59. Obstetrics and Gynecology, 105(1): 223–232.

9. Morrison CS, et al. (2004). Hormonal contraceptive use, cervical ectopy, and the acquisition of cervical infections. Sexually Transmitted Diseases, 31(9): 561–567.

10. U.S. Food and Drug Administration (2004). Black box warning added concerning long-term use of Depo-Provera contraceptive injection. FDA Talk Paper No. T04-50. Available online: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01325.html.

11. Scholes D, et al. (2005). Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Archives of Pediatrics and Adolescent Medicine, 159(2): 139–144.

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Other Works Consulted

• Grimes DA (2002). Switching emergency contraception to over-the-counter status. New England Journal of Medicine, 347(11): 846–849.

• Raymond E (2005). Emergency contraception. ACOG Practice Bulletin No. 69. Obstetrics and Gynecology, 106(6): 1443–1452.