Navigating birth control options

One of the main reasons a patient comes to my office is to discuss birth control. Many patients believe that this term is synonymous with oral contraceptive pills. In reality, the term is meant to encompass all options for contraception. Options range from barrier methods to sterilization! Beyond protecting against pregnancy, many methods have other uses and benefits as well. Let’s explore the various options.

Barrier Methods

Perhaps the least invasive methods of birth control are barrier methods, classically, condoms. Condoms are 98 percent effective when used correctly. Another benefit is that they protect against some STDs. This is a good form of contraception for a couple that wishes to avoid pregnancy for a short duration. If you wish to avoid pregnancy beyond a few months, there are more effective methods.

Oral Contraceptives

Oral contraceptives (OCPs) are the most common form of contraception. They are generally given in a pill pack, with approximately 3 weeks of hormone-containing pills followed by approximately 5 days of placebo or non-hormone containing pills. OCPs are also used for patients with painful or heavy periods as well as in patients who have endometriosis. Also, some patients are candidates for taking OCPs and only having a menstrual cycle 3-4 times per year!

Nuvaring

The Nuvaring is an estrogen-only vaginal insert that is placed for three weeks and removed for one week while you have a menstrual period. Most patients choose this method if they have trouble remembering to take the pill every day, but want something short term and that can be stopped easily.

Depo-Provera Shot

This method is nice because it is a shot that needs to be given every three months. It has a high amenorrhea, or absent period, rate. The downside for people is that it is not recommended in patients with a significant history of major depression. It also should only be used for two to three years in a row due to progressive, but reversible loss of bone strength. Many of my patients have complained about worsening of acne after stopping injections as well. It also should be noted that it might take up to 18 months to resume normal fertility after stopping the injections

Long-Acting, Reversible Contraception

Some new and very popular methods are the intra-uterine device (IUD) and the Nexplanon. The IUD comes in two forms, the first being progesterone containing IUD (Mirena) and the second being a copper IUD. I recommend the copper IUD for people who have contra-indications to hormonal contraception. The Mirena is very popular because it lasts for 5 years. Also, it is the most effective form of birth control other than a tubal ligation. It also causes little to no periods in most women! The Nexplanon is a progesterone insert that is placed just under the skin in the inner upper arm. It lasts for three years. It is very effective but can cause some irregular and unpredictable vaginal bleeding in patients.

Sterilization

There are two methods to accomplish sterilization. First is the classic laparoscopic tubal ligation. This is effective immediately but does require some modifications in your activity while you are recovering from surgery. A newer technique is done vaginally. The recovery for this is significantly less painful. It is not considered effective for 3 months until an X-ray is done to confirm that the tubes have closed. However, it is nice to confirm that the procedure worked and your tubes are definitely blocked!

As you can see, there are many options when you are considering birth control. It is good to have your goals in mind as far as how long you want to achieve contraception and what you have liked and disliked about previous methods used.