10 Surprising Facts About Contraception

Nearly every woman will use contraception at some point in her life, according to the Centers for Disease Control and Prevention (CDC), and some will use more than one type in the same month. Over the years, certain types of birth control have gained popularity, while others have declined.

For example, while the pill is still the most common form of reversible contraception used by women in the U.S., intrauterine device (IUD) use is increasing, too, according to a 2018 report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention (CDC). And after the passage of the Affordable Care Act, more birth control options than ever were covered by health insurance, with no copay.

Here are 10 additional facts about contraception that may surprise you.

1. Most American women ages 15 to 44 use contraception. Nearly two thirds of women in this age group currently use some form of contraception, according to the CDC. Their number one nonsurgical choice is the pill, closely followed by long-acting reversible contraceptives, such as an IUD or implant.

2. Young women are less likely to use contraception than older women. About 62 percent of women 20 to 29 currently use birth control. Compare this with the 72 percent of women 30 to 39 who report using contraceptives and the nearly 74 percent of women 40 and older who are currently on birth control, according to the CDC.

That trend concerns Lindsey Longerot, MD, an ob-gyn at the Texas Children’s Pavilion for Women in Houston, because younger women, she says — including those in their early 20s — “would likely be impacted the most by an unintended pregnancy.”

3. Although female sterilization is permanent, it’s also popular. Tying your tubes is actually the most popular form of contraception among American women, according to the CDC, currently used by 18.6 percent of them. The use increases with age, from about 1 in 20 women ages 20 to 29 to nearly two in five women over 40. The procedure permanently prevents pregnancy by closing or blocking the fallopian tubes so eggs can’t be fertilized by sperm. Still, there is a low risk of ectopic pregnancy after sterilization, warns Dr. Longerot.

4. The pill is popular, but it’s not for everyone. While the pill is still the most popular reversible form of birth control, the CDC’s data found that use decreases with age: It’s used by 19.5 percent of women in their 20s, 11 percent of women in their 30s, and 5.1 percent of women in their 40s. An advantage, Longerot says, is that it can be easily stopped if a woman wants to get pregnant. Taking the pill can also ease symptoms of difficult periods, PMS, and acne, says Linda Rice, a certified nurse midwife at Boston Medical Center.

But combination birth control pills, which contain the hormones estrogen and progestin, are not the best choice for every woman. Not only do these oral contraceptives have to be taken every day, preferably at the same time, but they can also raise the risk for a blood clot, according to the National Blood Clot Alliance. Smokers over 35 and women with a history of blood clots or breast cancer should opt for another contraceptive, the CDC says.

5. The mini-pill could be a better choice for some women. Because the mini-pill contains only progestin, Rice says, it’s a good choice for women who need to avoid estrogen, such as those who might be at risk for blood clots or are breastfeeding. Possible side effects include irregular or nonexistent periods, mood changes, nausea, and headaches. But the progestin-only pills are not for women who have breast cancer, advises the American College of Obstetricians and Gynecologists (ACOG).

6. Contraceptive patches or rings may be easier to stick to than pills. These have the same hormones found in most combination birth control pills (estrogen and progestin) and carry the same risks and benefits, Longerot says, but they have a more favorable dosing schedule. In general, says Sally Rafie, PharmD, a pharmacy specialist at the University of California San Diego Health System and birth control expert, “the patch is replaced weekly, and the ring is replaced monthly, which is a lot less remembering than the daily pill.” Another type of vaginal ring that needs to be replaced only once a year is also available.

7. A progestin shot is another form of birth control for women. These injections are given in the buttocks or arm four times a year, according to the CDC, but because the shot can reduce bone density, it’s usually not recommended. If there’s no birth control alternative for you, it’s important to get enough calcium and vitamin D, Dr. Rafie says.

In addition, the injection can increase risk for cardiovascular disease, especially among women with preexisting risk factors or a history of stroke, vascular disease, or poorly controlled high blood pressure. Some women also have irregular bleeding after the injection, notes the ACOG.

8. IUD use has tripled in recent years. Among women ages 15 to 44, 2.4 percent reported using an IUD in 2002. That rate rose to 7.9 percent between 2015 and 2017, according to the most recent data from the National Survey of Family Growth.

IUDs have been available for decades, but they fell out of favor in the 1970s and ’80s. That’s because older devices had a design flaw that pulled bacteria into the uterus, which caused pelvic inflammatory disease that could lead to infertility and even death, according to the National Women’s Health Network.

Today’s redesigned devices are extremely safe and 20 times more effective than the pill, although they still carry a small risk for uterine perforation and infection. “It’s essentially ‘get it and forget it’ for a few years at least,” says Rafie. “They are perfect options for women who are not planning on becoming pregnant for several years.” The American Academy of Pediatrics and ACOG now recommend IUDs for sexually active teens.

9. The latex male condom is the only method that protects against some STIs. Latex and polyurethane condoms are the only forms of contraception that have been shown to protect against some STIs, including HIV. “The benefit of condoms is that they can protect against sexually transmitted infections and are available without a prescription,” Rice says. But condoms alone have a failure rate of about 13 percent, notes the CDC. And they don’t offer 100 percent protection against STIs, especially the human papillomavirus (HPV).

10. The best birth control is the one that’s right for you. Before you settle on a birth control method, think about your ability to take medication consistently, whether you plan to have children (and when), and your preexisting medical conditions, Longerot says. Then, talk openly with your doctor about your needs and options.