Method	Action/Effectiveness	Advantages	Disadvantages and Side Effects
Hormonal contraceptives Combination of estrogen and progesterone	Suppresses ovulation by suppressing production of FSH and LH. Most efficient form of contraception (99.7%) if used consistently.	Convenient; easy to take Withdrawal bleeding cycles are predictable. Not related to sex act. Safe for older nonsmoking women until menopause. Many noncontraceptive health benefits.	Absolute contraindications, e.g., thromboembolic or coronary artery disease, some cancers or liver disease. Relative contraindications, e.g., migraines, hypertension, immobility 4 wk or more, abnormal genital bleeding. Some decrease in glucose tolerance. Effectiveness decreased if taken during use of barbiturates No protection against STDs
Progestin only Minipill (0) qd Depo-Provera (IM) q3mo	Impairs fertility Thickens cervical mucus; decreases sperm penetration. Alters endometrial maturation Effectiveness: Undetermined; can reach 100% reliability if used exactly as precribed	(Oral) convenient, easy to take. (IM) 4 times a yr;lactation OK during this	Ovulation may occur. rregular bleeding, mood changes, weight gain. May change glucose and insulin values. No protection against STDs.
Emergency Postcoital Contraception Estradiol ( 100 pg) and orgestrol (1.0 mg)	Antifertility; taken within 72 h of unprotected coitus Take 2 pills as soon as possible; take 2 pills 12h later Effectiveness: 75-85%	Available, prn	Nausea, headache, dizziness
Intrauterine Devices (IUDs) Small T-shaped deviceinserted into uterine cavity Medicated: Copper Progesterone	Prevents fertility Recommended for women who have had at least one child Damages sperm in transit to fallopian tube Alters cervical mucus and endometrial maturation Effectiveness rate: 90-99%	Can be used by women who cannot use hormonal contraception; no disruption of ovulation pattern Can be used effectively for 10 yr (Copper) Change every yr (Progesterone) Less blood loss during menses and decreases primary dsymenorrhea	Contraindications: history of PID, pregnancy, undiagnosed genital bleeding, genital malignancy, abnormal uterine cavity Risks: uterine perforation, infection (may be followed by PID) in the first 3 mo of insertion; unnoticed expulsion Side effects (especially with copper-T): heavy flow, spotting between periods, and months of insertion Must check for string after each menses and before intercourse No protection against STDs
Mechanical Barriers Diaphragm: shallow rubber device that fits over cervix	Barrier preventing sperm from entering cervix (if it is correct size, undamaged, correctly placed, and is used with spermicide) Effectiveness: 83-90%; 99% in highly motivated women	Does not interrupt sex act, except to add spermicide just before act* Insert up to 6 hr before intercourse and leav in place for 6hr after last intercourse, but not longer than 24 hr. Safe: no side effects from well-fitted device if woman is not allergic to diaphragm or spermicide Decreased incidence of vaginitis, cervicitis, PID	Requires careful cleansing with warm water and mild soap; powder with cornstarch, and store away from heat. Size/fit must be checked after trimester abortion, weight gain or loss of 15-20 lb or more, or every 2 yr Spermicide must be reinserted for additional acts that may follow after initial intercourse
Mechanical Barriers (continued) Cervical cap: l¼" to l½“ soft natural rubber dome with a firm but pliable rim	Physical barrier to sperm. Spermicide inside cap adds a chemical barrier. Effectiveness similar to that of diaphragm.	Worn for 8 hr but not longer than 48 hr. No need to add spermicide for repeated acts of intercourse.	Need a Pap smear every yr: higher rate of conversion from class I to class III. If in place over 48 h, it produces an odor and might be associated with TSS. Cannot be worn during menstrual flow (menses) or up to at least 6 wk postpartum. Contraindications: abnormal Pap smear, hard to fit, history of TSS or genital infection, allergy. Change after genital surgery or birth, major change in weight. Must be checked each yr. Does not protect against STDs.
Female condom: vaginal sheath of natural latex rubber with flexible rings at both the closed and the open ends.	Barrier preventing sperm from entering vagina. Effectiveness similar to other mechanical methods used with spermicide. Note: Male and female condoms should not be used at the same time.	Apply well in advance of intercourse; spermicide added just before intercourse. Heightens sesnsation for man. About as satisfying for both woman and man as intercourse without it. Provides protection from STDs.	Cost A new one must be used every act of intercourse.
Condom: thin, stretchable latex sheath to cover penis	Barrier preventing sperm from entering vagina, applied over erect penis before loss of preejaculatory drops and is held in place as penis is withdrawn. Spermicidal foam, jelly, or cream is also used* Effectiveness rate: 64-98% when used with spermicide.	Safety—no side effects. Provides protection from spread of STDs. With spermicide (0.5 g of nonoxynol-9) added to interior or exterior surface, provides protection from STDs, including HIV.	Check expiration date. Requires high motivation to use correctly/constantly. Must be properly applied and removed. Sheath may tear during intercourse.
Chemical Barriers Spernlicide: aerosol foams, foaming tablets, suppositories, creams, and films (V-Film)	Physical barrier to sperm penetration. Chemical action on sperm (kills sperm). Nonoxynol-9 has a bacteriostatic action. Effectiveness rate: 70-98% when used with diaphrahm or condoms.	Increases effectiveness of mechanical barriers. Ease of application. Aids lubrication of vagina* Requires no medical examination or prescription. May be used during lactation. Backup for missed oral contraceptive pills.	Messy. Some people are allergic to preparations. Tabs or suppositories take 10-15 min to dissolve. If it is only method being used, each intercourse should be preceded (by 30 min) by a fresh application; may be allergenic.
Other Methods Natural family planning: BBT each morning before any physical activity. Symptothermal variation: BBT plus cervical mucus changes. Calendar method. Predictor test for ovulation.	Requires sexual abstinence during woman's fertile period (4 d before ovulation), abd for 3 or 4 days after ovulation Effectiveness: about 80%	Physically safe to use—no drugs or appliances are of most religions.	Effectiveness depends on high level of motivation and diligence. Requires fairly predictable menstrual cycle.