Birth Control

Methods
Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Effectiveness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Hormonal Methods of Birth Control . . . . . . . . . . . . . 10
Birth Control Pill. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Transdermal Patch. . . . . . . . . . . . . . . . . . . . . . . . . 12
Contraceptive Ring . . . . . . . . . . . . . . . . . . . . . . . . 14
Injection Method. . . . . . . . . . . . . . . . . . . . . . . . . . 16
Intrauterine Device (IUD)
Intrauterine System (IUS). . . . . . . . . . . . . . . . . . . . 18
Emergency Contraceptive Pill (ECP) . . . . . . . . . . . . . 20
Barrier Methods of Birth Control. . . . . . . . . . . . . . . . 22
Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Female (Internal) Condom . . . . . . . . . . . . . . . . . . 24
Sponge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Spermicides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Other Methods of Birth Control. . . . . . . . . . . . . . . . . 30
Abstinence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Fertility Awareness. . . . . . . . . . . . . . . . . . . . . . . . . 31
Withdrawal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Sterilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Cost and Availability . . . . . . . . . . . . . . . . . . . . . . . . . . 34
More Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

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Introduction
Deciding when to start using birth control and
choosing a method that will work for you is an
important decision. This booklet outlines different
birth control methods and issues to consider when
deciding to become sexually active. More resources
are listed at the end of this booklet if you want more
information or need to speak with someone directly.

Deciding to have sex is a very personal choice.

Sex also involves how you feel about yourself and
others, how you relate to people and the choices
you make. Sex is healthy and should be enjoyable;
however, it can also be risky. Protection needs to be
used whenever you are sexually active to prevent
pregnancy and the spread of sexually transmitted
infections (STIs) such as chlamydia, gonorrhea,
syphilis, and HIV (human immunodeficiency virus).
STIs are usually passed through oral, vaginal or anal
intercourse, and in some cases through contact with
blood from an infected person.

Are you ready?

There are many issues to consider before you choose
to be sexually active, such as being ok to share your
body with someone, your comfort about talking about
your feelings and how sex will affect the relationship.
A healthy relationship is not abusive, hurtful
or controlling.

Birth Control Methods 3

 Ask yourself these questions to help you
decide if you are ready:
• Am I able to talk openly and honestly about my
feelings and about sex?
• Do I think that having sex with my partner may
change our relationship?
• If the relationship breaks up, will I still feel good
about my decision to have sex?
• Do I feel pressured from my partner or my friends
to have sex?
• Do I feel comfortable enough with my partner to
say no to sexual activity?
• Will I feel guilty because of my moral, religious or
family beliefs?
• Do I feel comfortable talking with my partner
about preventing STIs and pregnancy?
• As a couple, are we ready to deal with an
unplanned pregnancy?
• Do I know enough about STIs and HIV, and am I
willing to go for testing?
• Do I know the sexual history of my partner? How
many sexual partners has my partner had before
me? Has my partner always used protection when
having sex?
• Is my partner willing to be tested?
• Am I willing to use condoms every time I
have sex?
• Do I find it easier to have sex when I use drugs
and alcohol?

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 It can be diffcult to talk about sex. If you have had sex
and felt it was not the right choice for you, you do
not need to continue having sex. Your body belongs
to you and you have the right to take care of it as
you choose.

What is the best birth control

method?
There are many methods of birth control. It is best to
choose one that is right for you. Most methods do
not protect against STIs, so condoms should be used
for sex all of the time. When considering which birth
control method is best for you, think about:
• Where do I need to go to get the method?
• How convenient is the method to use?
• Is my partner involved with this method?
• What is the cost of this method?

Being sexually active also means taking responsibility

for your body’s health by getting regular check-ups
including Pap testing (screening for changes in the
cells of the cervix) and testing for STIs.

Birth Control Methods 5

Anatomy
Female Anatomy

fallopian tubes
ovaries
uterus
cervix
vagina
clitoris
vulva

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Male Anatomy

bladder
seminal vesicles
prostate
vas deferns
penis
urethra
scrotum
testicles

Birth Control Methods 7

Effectiveness
Before choosing a birth control method, think about
how well each method works. Birth control methods
are measured for effectiveness by typical users (per
cent of couples who use the method and have an
accidental pregnancy during the first year) and by
perfect use (per cent of couples who use it all the
time and use it perfectly and still have an accidental
pregnancy during the first year). The following chart
shows the effectiveness or how well each method
works. For example, if 100 women use the birth
control pill, it prevents pregnancy for 92 to 99.7 per
cent of the women.

No Method Birth Control Pill

Typical Perfect Typical Perfect

Use Use Use Use
15 %
15 %
91 %
99.7 %

Transdermal Patch Contraceptive Ring

Typical Perfect Typical Perfect

Use Use Use Use
91 %
99.7 %
91 %
99.7 %

Injection
Note: Method
The emergency IUD
contraceptive pill (ECP) is not recommended as a
regular method of birth control.
Typical Perfect Typical Perfect
8 Use Use Use Region
Use of Peel
% % % %
 Typical Perfect Typical Perfect
Use Use Use Use
91 %
99.7 %
91 %
99.7 %

Injection Method IUD

Typical Perfect Typical Perfect

Use Use Use Use
94 %
99.8 %
99.2 %
99.8 %

Male Condom Female Condom

Typical Perfect Typical Perfect

Use Use Use Use
82 %
98 %
79 %
95 %

Sponge Spermicides

Typical Perfect Typical Perfect

Use Use Use Use
76 %
91 %
72 %
82 %

Abstinence Sterilization

Typical Perfect Typical Perfect

Use Use Use Use
100 %
100 %
99.5 %
99.9 %

Fertility Awareness Withdrawal

Typical Perfect Typical Perfect

Use Use Use Use
76 %
95 %
78 %
96 %

Adapted from Contraceptive Technology, 20th ed. R Hatcher et al, 2011

Birth Control Methods 9

Hormonal Methods of Birth Control

Birth Control Pill

Prescription needed

How does it work?

• A pill is taken once a day
• Most common
are 28 day packs
(21 days of
hormones
and seven
days of reminders) or 21 day packs
(21 days of hormones), but continuous pills are
also available
• Contains the female hormones progesterone and
estrogen or just progesterone (for women not
able to take estrogen)
• Stops the ovaries from releasing eggs (ovulation)
• Changes the lining of the uterus and makes
it difficult for the egg to attach to the wall of
the uterus
• Thickens the cervical mucus and makes it more
difficult for the sperm to travel into the uterus

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 Advantages
• 91 to 99.7 per cent effective
• Menstrual periods may be shorter in length and
lighter in flow with less cramping
• Regulates periods
• May reduce the risk of some cancers of the
reproductive system
• May improve acne
• Allows for spontaneous sex
• Easily reversible

Disadvantages
• No protection against STIs
• Should be taken about the same time every day
to keep a steady level of hormones in the body
• May be some side effects (stomach upset,
breast tenderness, bleeding between periods,
headaches)
• Women with certain conditions may not be able
to take the pill due to increased risk of a blood
clot (e.g., smokers over the age of 35 years, high
blood pressure)

Birth Control Methods 11

Hormonal Methods of Birth Control

Transdermal Patch
Prescription needed

How does it work?

• Patch is a 4 cm square of
polyester containing the
female hormones estrogen and
progesterone
• Placed on upper arm, buttock,
abdomen – not breast
• Hormones are absorbed
through the skin
• Stops the ovary from releasing
an egg (ovulation)
• Thickens the cervical mucus and makes it more
difficult for the sperm to travel into the uterus
• Changes the lining of the uterus and makes
it difficult for the egg to attach to the wall of
the uterus
• The patch is changed every week for three weeks
• On week four you do not wear a patch and you
will have your regular period

Advantages
• 91 to 99.7 per cent effective
• Menstrual periods may be shorter in length and
lighter in flow with less cramping

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 • Regulates periods
• May reduce the risk of some cancers of the
reproductive system
• Less chance of stomach upset
• May improve acne
• Allows for spontaneous sex
• Easily reversible
• Do not have to remember to take a pill everyday

Disadvantages
• No protection against STIs
• Maybe less effective for women who weigh more
than 198lbs (90kg)
• Possible skin irritation where the patch is placed
• Must remember to change the patch as directed
for it to work properly
• May be some side effects (breast tenderness,
stomach upset, bleeding between periods, headaches)
• Small chance of the patch becoming loose or
falling off
• May be seen by others, depending where it is worn
• Women with certain conditions may not be able
to use the patch due to increased risk of a blood
clot (for example, smokers over the age of 35
years, high blood pressure).

Birth Control Methods 13

Hormonal Methods of Birth Control

Contraceptive Ring
Prescription needed

How does it work?

• Flexible ring is
inserted into the
vagina and releases
female hormones
estrogen and
progestin
• Hormones are
absorbed through (actual size)
the lining of the vagina
• Stops the ovaries from releasing eggs (ovulation)
• Thickens the cervical mucus and makes it more
difficult for the sperm to travel into the uterus
• Changes the lining of the uterus and makes
it difficult for the egg to attach to the wall of
the uterus
• Stays in the vagina for 21 days then removed for
seven days and you will have your regular period
• Females must feel comfortable to insert and
remove the ring on their own

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 Advantages
• 91 to 99.7 per cent effective
• Regulates periods
• Does not need to be removed before or after
intercourse
• Rarely felt by females and/or partner
• Less nausea than other hormonal choices
• Allows for spontaneous sex
• One size fits all females
• Easily reversible
• Do not have to remember to take a pill every day

Disadvantages
• No protection against STIs
• May be some side effects (stomach upset,
bleeding between periods, headaches,
breast tenderness)
• May accidentally slip out
• Women with certain conditions may not be able
to use the ring due to increased risk of a blood
clot (e.g., smokers over the age of 35 years, high
blood pressure)
• May cause vaginal irritation (e.g., some women
may get bacterial vaginosis [BV] more often)

Birth Control Methods 15

Hormonal Methods of Birth Control

Injection Method
Prescription needed

How does it work?

• Injection that
contains only the
female hormone
progesterone (there
is no estrogen)
• Must have the injection every 12
weeks by your health care provider
• Stops the ovaries from releasing eggs (ovulation)
• Thickens the cervical mucus and makes it more
difficult for the sperm to travel into the uterus

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 Advantages
• 94 to 99.8 per cent effective
• Each injection lasts 12 weeks
• Effective right away if you get your first injection
during the first five days of a normal period
• Only you know you are using this method
• Allows for spontaneous sex
• Periods may be shorter in length and lighter in
flow or you may not have a regular period
• Can be used by women who are unable to use
estrogen (for example, women who are 35 and
older and smoke, or breastfeeding females)
• Reversible
• Do not have to remember to take a pill every day

Disadvantages
• No protection against STIs
• Side effects may include changes in menstrual
bleeding patterns, weight gain, breast
tenderness, mood changes,headaches
• Slower return of fertility – not recommended if
you plan to become pregnant in the next one to
two years
• Side effects can last up to six to eight months
after the last injection

Birth Control Methods 17

Hormonal Methods of Birth Control

Intrauterine Device (IUD)

Intrauterine System (IUS)
Prescription needed

How does it work?

• Small t-shaped
device inserted
into the uterus by
your health care provider
• May or may not contain
hormones
Non-Hormonal (IUD):
• Prevents the egg from meeting the sperm
and attaching to the wall of the uterus
Hormonal (IUS):
• Contains the hormone progesterone, which is
released slowly into the bloodstream
• Thickens the cervical mucus and makes it more
difficult for the sperm to travel into the uterus
• Changes the lining of the uterus and makes it
difficult for the egg to attach to the wall of the uterus
• May also prevent ovulation

Advantages
• 99.2 to 99.8 per cent effective
• Once inserted, nothing to be remembered
• Once IUD/IUS removed by a health care provider,
fertility returns to normal
• Can be inserted six weeks after giving birth
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 • Allows for spontaneous sex
• Can be used by women who are unable to use
estrogen due to health risks, women over 35
years who smoke, or breastfeeding women
• Can be left in place for up to five years before it
needs to be changed, depending on brand
• Do not have to remember to take a pill every day
Non-Hormonal:
• Can be used by women who who have experienced
side effects when taking hormonal contraception
Hormonal:
• May reduce the amount of bleeding during
periods, therefore better for women with
heavier periods

Disadvantages
• No protection against STIs
• Strings may need to be checked to make sure
that the IUD/IUS is in place
• Damage to the uterus at the time of insertion and
infections are rare
• It is possible that the IUD/IUS can slip out of the
uterus (most likely just after insertion)
Non-Hormonal:
• May cause increased bleeding during periods,
longer lasting periods or more cramping
Hormonal:
• May cause irregular menstrual periods
• May experience side effects from the hormone,
such as changes in menstrual bleeding patterns,
weight gain, breast tenderness

Birth Control Methods 19

Emergency Contraceptive Pill (ECP)

Emergency
Contraceptive Pill (ECP)
Prescription needed

How does it work?

• Must be taken as
soon as possible
after unprotected
sex to help prevent
pregnancy
• Prevents ovary from
releasing an egg,
prevents sperm and
egg from meeting or
prevents a fertilized egg from attaching to the
wall of the uterus
• One pill containing the hormone progesterone
• The pill does not replace your regular method of
birth control

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 Advantages
• 95 per cent effective within the first 24 hours, and
61 per cent effective between 48 and 72 hours
• No need to see a doctor, available from
pharmacists and on the shelf in some pharmacies
• If you are already pregnant, the ECP will not
cause an abortion or harm the fetus

Disadvantages
• No protection against STIs
• Must be taken within 72 hours of
vaginal intercourse
• Side effects may include nausea, mild stomach
upset, tiredness, headache or spotting
• No protection from pregnancy with future
sexual intercourse
• May be less effective in women over 75-80 kgs

Birth Control Methods 21

Barrier Methods of Birth Control

Condom
How does it work?
• Thin sheath usually made of latex
• Also available in polyurethane (for people with
latex sensitivity)
• Covers an erect penis
• Prevents the sperm from meeting the egg
• Can be used with a water-based lubricant
• Can be used with other birth control methods to
increase effectiveness

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 Advantages
• 82 to 98 per cent effective
• Helps prevent pregnancy
• Helps prevent STIs
• Available from a variety of locations, such as
pharmacies, grocery stores, sexual health clinics
• No need to see a doctor or health care provider
• Both partners can buy and carry condoms

Disadvantages
• Can only be used once
• Need to put the condom on correctly before any
sexual contact takes place
• Spermicides in condoms or latex sensitivity may
cause irritation to the skin
• May break or slip if not used correctly
• Novelty or joke condoms are not meant to
protect against STIs

Birth Control Methods 23

Barrier Methods of Birth Control

Female (Internal)
Condom
How does it work?
• Polyurethane sheath that contains two rings
• One ring is inserted all the way up into the top
of the vagina and the other ring sits outside the
opening of the vagina
• Penis then goes inside the female condom
during sex

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 Advantages
• 79 to 95 per cent effective
• Available from a variety of locations, such as
pharmacies, sexual health clinics
• No need to see a doctor or health care provider
• Helps prevent STIs
• Helps prevent pregnancy
• Non-latex so may be used by people who have
latex sensitivity

Disadvantages
• Can only be used once
• User must feel comfortable inserting the condom
into the vagina
• Need to insert female condom correctly before
any sexual contact takes place
• Must be cautious that the penis goes into the
condom, not in beside the condom during
intercourse
• May cause noise during intercourse

Birth Control Methods 25

Barrier Methods of Birth Control

Sponge
How does it work?
• Small, soft foam
sponge is inserted
into the vagina to
cover the cervix
• Must be moistened
with water before
being inserted into
the vagina to activate
spermicide that kills sperm
• Helps prevent the sperm from reaching the cervix
• Can be inserted any time before sex but:
i. must stay in place for at least six hours after
last intercourse
ii. must not be left in the vagina for more than
30 hours total
• Review instructions that come with package
• Can be used with condoms to increase
protection against pregnancy and STIs

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 Advantages
• 76 to 91 per cent effective
• No need to see a doctor or health care provider
• Available at pharmacies, grocery stores, sexual
health clinics
• Non-latex
• May be used for more than one act of intercourse
without adding more spermicide
• One size fits all females

Disadvantages
• No protection against STIs
• Spermicide may cause some irritation, therefore
increasing risk of HIV or STIs, if exposed
• If left in the vagina for more than 30 hours, may
lead to toxic shock syndrome
• Cannot be used during menstrual period
• Female must be comfortable with insertion
and removal
• Frequent use can cause vaginal irritation,
increasing risk of infections

Birth Control Methods 27

Barrier Methods of Birth Control

Spermicides
How do they work?
• Chemicals that kill sperm or make the sperm
unable to move towards the egg
• Comes in several different forms, including foam,
gel and film
• All methods are inserted into the vagina before
sexual activity
• Read instructions for each method before use as
insertion times may vary
• Can be used alone or with other birth control
methods to increase effectiveness

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 Advantages
• 72 to 82 per cent effective when used alone,
without condoms
• No need to see a doctor or healthcare provider
• Available at pharmacy section of many stores and
at sexual health clinics
• Spermicide may act as a lubricant

Disadvantages
• No protection against STIs
• Spermicide may cause some irritation, therefore
increasing risk of HIV or STIs, if exposed

Birth Control Methods 29

Other Methods of Birth Control

Abstinence
What is it?
• Decision to not have anal, oral or vaginal sex
• Need to decide on your sexual limits and talk
about them with your partner
• May wish to avoid situations where you feel
pressured or unable to stick to your limits

Advantages
• 100 per cent effective in preventing pregnancy
• Can protect against STIs (depending on your
limits and other activities)
• No need to see a doctor or health care provider
• No cost

Disadvantages
• May need to confront the pressure from friends
and partner
• May feel an inability to express some aspects of
sexuality or relationship

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Fertility Awareness
What is it?
• Various ways of recognizing the changes in your
body to determine when you will ovulate so you
do not have intercourse and become pregnant
• Can use methods such as daily temperature
taking or checking cervical mucus changes
• Partners need to work together to ensure this
method is effective

Advantages
• 75 to 99 per cent effective with perfect use
• Can be used to plan or avoid a pregnancy
• Helps females to learn more about their body
• No cost
• No side effects

Disadvantages
• Requires time and commitment
• No protection from STIs
• Requires abstinence or condom use during the
time in the ovulatory cycle when you are most
likely to get pregnant
• Illness or stress may change your ovulatory cycle,
making this method less reliable

Birth Control Methods 31

Other Methods of Birth Control

Withdrawal
What is it?
• Penis is withdrawn or removed from the vagina
before ejaculation
• Requires trust and commitment from both
partners

Advantages
• 78 to 96 per cent effective
• Better than using no birth control method at all
• No cost
• No need to see a doctor or health care provider
• No use of chemicals or hormones
• Can be used anytime

Disadvantages
• Males cannot always accurately control when they
will ejaculate
• Judgement may be impaired by alcohol or drugs,
which can effect self-control
• May be some sperm in the pre-ejaculate
• Should be used with another method of birth
control, such as spermicides
• No protection against STIs

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Sterilization
What is it?
Female sterilization (also called a tubal ligation):
• Both of the tubes where an egg would become
fertilized by the sperm (fallopian tubes) are
closed, either cut, tied or clipped
Male sterilization (also called a vasectomy):
• Tubes that carry the sperm (vas deferens) are
closed, either cut, tied or clipped
• Will not interfere with sexual desire, performance
or enjoyment of sex for either male or female

Advantages
• 99.5 to 99.9 per cent effective
• Long-term method of birth control (considered
permanent)
• A good choice if a male or a female is sure that
they do not want to have any/more children
• Surgical procedure performed in a doctor’s
office (male) or hospital under local or general
anesthesia (female)

Disadvantages
• Some minor risks associated with surgery include pain,
bleeding, infection and complications with anaesthetic
• No protection against STIs
• Very difficult and expensive to reverse the
procedure, and often is not successful

Birth Control Methods 33

Cost and Availability
The cost of birth control varies depending on the
method and where it is purchased. Shop around to
compare prices. Remember to check expiry dates.

Diaphragms, a soft rubber dome that the woman

inserts to cover the cervix, are hard to find. Other
methods are advised.

Healthy Sexuality Clinics offer many of the birth

control methods at reduced cost. Condoms are
always free.

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More Resources
For more information check out the following:

Phone lines
Peel Public Health
905-799-7700

Websites
[Link]
[Link]

Healthy Sexuality Clinics

(Appointment and Drop-In available)
Brampton
150 Central Park Dr., Suite 9
(Civic Centre beside Bramalea City Centre)
905-791-5905
Caledon (Bolton)
18 King St. E., 2nd Floor Bolton
905-791-5905
Mississauga
325 Central Pkwy. W., Unit 21
(Central Parkway West and Confederation)
905-270-0587

7205 Goreway Dr., Suite B7, Lower Level (Malton)

Westwood Square Mall
905-678-0788

6975 Meadowvale Town Centre Cir., Suite N03

(Meadowvale Town Centre)
905-270-5662

Birth Control Methods 35

 For more information,
contact Peel Public Health
905-799-7700

[Link]
CDS-0024 18/02