Back in 1850 BC, men and women would use a pessary of crocodile dung and fermented dough to prevent pregnancy. In second century Rome, they concocted a highly acidic mix of fruits, nuts, and wool that was placed at the cervical os to create a spermicidal barrier. Now, I don’t know about ya’ll, (yes, it seems I’ve converted my Minnesota oooo’s to the southern drawl) but crocodile dung and acidic wool doesn’t exactly scream romance to me. Thankfully, with advances in technology, we are afforded much more modest (and probably less smelly) forms of contraception. As consistent in this day and age however, we are bombarded and overloaded with choices, making it difficult to decide which method works best for each individual. Below are some pearls to help you decide.

Can you be trusted to take a pill every day?

If you are like me, and have a bottle of dusty multivitamins in your medicine cabinet from the 90s, taking a birth control pill everyday may not be in your best interest. Missing doses decreases the efficacy of this method, and you may need to have a backup plan in place. On the other hand, it is an easy and effective form to use.

Is your BMI over 30?

The birth control patch is a fine alternative to the pill, containing the same hormones and requiring work only once a week, but it is not as effective at certain weights. It can also irritate the skin, so if you suffer from sensitive skin, might be best to stay away.

Are you afraid to put things in your vagina?

By things I mean rings, namely, the NuvaRing. Many women shy away from this effective method of contraception because they feel icky about putting things ‘up there.’ Let me put it this way, it’s the process of putting things ‘up there’ that’s fueling your search for birth control, so stop being a baby (we are taking contraception here…) and don’t be afraid to get to know your body, it is not as scary as you think.

Are you trying to lose weight? Planning on trying to get pregnant soon?

The Depo shot is proficient and efficacious, consisting of only one shot every three months. Sounds like a dream, right? Well, unfortunately, this is the ONLY form of birth control that has been correlated with weight gain. But let me be clear – the shot itself is NOT going to make you gain weight; the shot may stimulate your appetite, which may make you feel hungry, so you stop at the local McDonald’s and order a Big Mac with extra cheese, and THAT is what will make you gain weight. The Depo also can cause demineralization of your bones, so it is important to be on calcium and Vitamin D while using this method. Finally, it can take up to 10 months for a female to return to fertility after being on the Depo shot, so if you are looking for short term contraception, this may not be the way to go.

Do you mind having foreign objects in your body?

I mean, let’s think about it, people put braces in their mouths all the time. Pacemakers save lives and IUDs prevent birth. The intrauterine device (IUD) comes in two forms; Mirena and Paragard. The Mirena has the hormone progesterone in it, and can be kept in the uterus for up to 5 years; the Paragard has no hormone and can be left in for up to 10 years. Let me repeat, UP TO 5 or 10 years. That means that if you want to have all of your children two years apart, you can remove the IUD in 2 years, and you return immediately to fertility. Let’s talk hypothetically here, let’s say you just gave birth to your first child; you were in labor for 36 hours straight, and can’t even stand that thought of going through all that again. The Mirena or Paragard offer stupendous opportunity for you to enjoy your newborn with the peace of mind knowing that you won’t have to deal with the morning sickness, back pain and heartburn until you are ready. (I am obliged to report that there is a 0.2% failure rate) The IUD can also be helpful for those without any babies, who simply do not want to take a pill, change a patch, or pull a ring out of their vagina, but still want to have contraception. I also want to throw out there that about 20% of females report no menstrual periods on the Mirena, which I think, would be just fabulous.

Are you breastfeeding?

Your choices during this time are limited to progesterone-only forms of contraception. This narrows it down the progesterone-only pill, Depo shot, Implanon, or IUD. It should be noted that the progesterone-only pill is incredibly sensitive to missed doses, down to the hour upon which it was taken. Something to think about during the period of your life when you get the least amount of sleep.

Let’s recap. There are 6 different forms of contraception for women:

• Birth control pills (also known as Oral Contraceptive Pills or OCPs)
• The patch
• The NuvaRing
• The Depo Shot
• The Implanon (soon to be called the Nexplanon)
• The Intrauterine Device

The pills, patch and ring all have estrogen and progesterone in them. The Depo, Implanon and Mirena have progesterone only, and the Paragard has no hormone at all. You should not be taking contraception with estrogen in it if you have a history of uncontrolled high blood pressure, a history of blood clots, a history of classic migraines with aura, or are breast feeding. It is important that you speak to your doctor to decide what is best for you. None of these forms protect against sexually transmitted diseases, only condoms and abstinence do that. And possibly trying to use crocodile dung for birth control.