Women today have a variety of options to choose from when it comes to preventing pregnancy. However, each woman has her own unique health considerations, family needs and lifestyle that affect which option is optimal for her. The method that has always worked for your best friend or sister may not be safe or effective for you.
The first step in selecting a form of contraception should be a conversation with your doctor. Your physician can talk with you about your health history and concerns to help determine what types of birth control best suit you.
Women should take into consideration what effect an unplanned pregnancy would have on their life and look at the effectiveness of each method. If the goal is to delay pregnancy a few years then failure of the method may not be a significant concern. Whereas major health problems or age may make preventing pregnancy crucial so that best efficacy is of the utmost importance. Cost or the ease of use can impact which type of birth control is most appealing. Each method has advantages and disadvantages and the goal is to match these distinctions to a woman's priorities.
Below are the various options that you can discuss with your doctor.
The following contraceptives contain both estrogen and progesterone. Estrogen containing contraceptives are contraindicated (should not be used) in women who have increased risk of thromboembolism - blood clots in veins that may travel to the heart or lungs - or in women with increased risk of heart attack or stroke. Personal and family history is essential in determining risk.
Birth Control Pills
This very common and familiar option is inexpensive, very effective and can have other positive effects such as helping to control heavy periods and acne. Birth control options are not a good option for women who have trouble remembering to take the pill every day.
Birth Control Patches
Birth control patches may be easier to remember as they are applied once weekly. They do have higher levels of estrogen and although the overall risk for blood clots is still low with the patches, it is twice that seen with birth control pills.
Vaginal rings have a lower dose of hormones than birth control pills or patches and can be a good option for women who have side effects from higher hormone levels. The continuous steady release of hormones by rings provides excellent efficacy and cycle control. Rings are convenient as you only need to remove and insert a new device once a month. The factor that limits their use most is their cost, which is significantly greater than that of pills.
There is increased risk with estrogen use for women who smoke or have high blood pressure, a history of blood clotting conditions or other health factors. The following methods of contraception use only progesterone and in most cases can be used by women who cannot use estrogen.
When using a progesterone intrauterine device most women experience either very light periods or none at all. It’s a user friendly and highly effective device that your doctor inserts in the office. A small number of women using the progesterone IUD have persistent cramping and 3% experience spontaneous expulsion where the uterus pushes the device out with cramping. A few women have increased acne or facial hair. The progesterone IUD remains effective for five years and has become very popular as word spreads about women's satisfaction with the device.
Hormone implants are inserted and removed by your doctor just under the skin of your arm. The implants are effective for three years. Some women using the hormone implants will have lighter periods, some may stop menstruating and others may have ongoing spotting which can be bothersome.
Birth Control Shots
Women only need to get birth control shots once every three months. However, since the hormone dose is quite high, there can be a variety of side effects, such as frequent spotting, acne, weight gain and depressed moods. Bone density levels may decline while using this method. If you are planning to start a family soon it is not ideal because it can take as long as18 months for fertility to return after stopping the injections. Menstrual bleeding may cease or become infrequent and most often is light.
Progesterone-only Birth Control Pills
The progesterone-only pills are often used by nursing mothers since they have no effect on the milk supply. During nursing, these pills are equally effective to “combination-style” birth control pills. When not nursing, they are less effective (95%) and need to be used with a barrier method for the best effectiveness.
The following non-hormonal methods of birth control do not use either estrogen or progesterone to prevent pregnancy.
The copper IUD is a long-term birth control method that can be used for up to 10 years. Since it doesn’t contain hormones, women who cannot use hormones can still use the copper IUD. The disadvantage of this method is that many women experience heavier periods with stronger cramping.
Barrier methods include condoms and diaphragms. Diaphragms may be preferred over condoms because they can be inserted ahead of time and don’t decrease sensation. However, they are not as effective as condoms. For best efficacy, condoms must be used consistently with every episode of intercourse regardless of timing in the menstrual cycle. With optimal use condoms can be highly effective. With typical use they have a fairly high failure rate of about 15%. Condoms can also confer protection from sexually transmitted infections although still do not eliminate risk.
Your annual exam is a great time to talk your doctor about all of your concerns and needs when it comes to birth control. Your doctor can screen you for any conditions that could affect your fertility and overall health, making birth control part of your overall wellness checkup.