Birth Control Options

Understanding Today’s Birth Control Options

Perhaps one of the most convenient advances in modern healthcare for women is the ability for us to better manage our reproductive health through what we call “birth control.”  Today’s birth control options range from traditional barrier methods to the high-tech LARCs (long-acting reversible contraceptive) of the modern age. With many options available, you may be wondering which is best for you.

There are four primary methods of birth control:

Let’s walk through each of them.

Barrier Methods

For the male partner

The most commonly used barrier method for the male is the condom, as the condom collects sperm and acts as a barrier to pregnancy. Most are made of latex, but for those with allergies, non-latex varieties also exist. The condom gives the added benefit of protecting women from a variety of STDs, such as HIV, gonorrhea, and chlamydia.  As a result, it should be used in conjunction with other contraceptives.

Condoms are known to have a higher rate of failure; meaning, up to 15% of couples may experience an unplanned pregnancy when using condoms alone as their contraceptive method. For this reason, you may want to consider condoms that include a spermicide, which can help to immobilize or “kill” sperm before they have an opportunity to fertilize.

For the female partner

The diaphragm is also considered a barrier method. It is a soft, plastic dome with a flexible ring.  Spermicide is applied to the outer ring and cup. It is inserted into the vagina and hooked under the pubic bone. The diaphragm, if inserted correctly, will cover the cervix and, again, act as a barrier to sperm.  It is recommended that it be kept in for at least 6 hours after sex to ensure prevention of pregnancy, and can then be removed, cleaned, and reused. Unlike the condom, a diaphragm is prescribed by your gynecologist and requires a fitting in the office.

Finally, there is a contraceptive sponge, which also blocks sperm from reaching the uterus and has spermicide embedded in it (Seinfeld fans may recall Elaine’s humorous love of the sponge). The sponge is inserted into the vagina and pushed up against the cervix. Like condoms, the sponge, along with spermicidal gel, can be conveniently purchased at your local drug store without prescription.

Combination Hormonal Contraception (CHC)

Most commonly recognized in the form of the pill, ring, or patch, combination hormonal contraceptives (CHCs) are one of the most commonly used birth control methods in world. They are considered systemic birth control, as they are is absorbed into your body and work their magic on the pituitary gland in your brain, blocking your ability to release the hormones that make you ovulate (or, release an egg).

CHCs have undergone many changes over the past 60 years and, as a result, there are multiple options. Most contain the hormones estrogen and progesterone and vary in the amount of both. CHCs come in a variety of forms, such as the daily pill, weekly patch, or a monthly intravaginal ring.

One of the nicest things about the CHC is that it suppresses acne and reduces the risk for ovarian cancer (something we can’t say about the popular new intrauterine devices). It also reduces the risk for uterine cancer. CHC makes the period lighter, shorter, and less crampy for most women. In fact, the pills of today’s world are so low in hormones that some women stop getting a period after being on it for a while. Now that’s a pleasant side effect!

CHC can also be used to manipulate the menstrual cycle – from delaying to skipping the period altogether, based on how it is taken. However, it does have some short falls, some of which are quite serious, such as stroke or development of blood clots. As a result, it should not be the first choice for women who smoke or for those suffering from certain medical problems like migraines, hypertension, or clotting disorders.  You should discuss CHC with your gynecologist to determine if it is a good option for you.

Progesterone-only Systemic Contraception

Similar to CHC, progesterone-only systemic contraception works in your brain, blocking the hormones that cause ovulation. Progesterone-only systemic contraception is a favorite among nursing mothers, as it causes no reduction in breast milk that the estrogen in CHC may sometimes cause.  It is also a preferred method for women with hypertension, smokers, and other medical conditions where estrogen is contraindicated.

The most commonly used variety in this category is the mini-pill. It is called a mini-pill because it has no estrogen in it.  Unlike most of the CHC options, there are no placebo pills (pills without hormones) in the pack. You take the same amount of progesterone every day. As a result, you do not get a true period. An annoying side effect, with this pill, can be irregular bleeding and spotting which occurs for some women.  This is why the CHC, as a pill, is usually preferred.

Progesterone-only systemic birth control is also available as an implantable rod called Nexplanon. Nexplanon is a LARC (long-acting reversible contraceptive). Nexplanon was created as an option where you don’t have to worry about missing your pill.  The rod is injected under the skin of the upper arm and provides birth control for three years.  Nexplanon will not give most women the regular cycle we see with the CHC, and it requires a small surgical procedure to have it placed and removed. It is a favorite of young patients who do not like the IUD option (more about this later!).

Finally, there is a shot of a medicine called Depo Provera, which is given every three months. Depo Provera is not as popular of option as it can lead to weight gain and acne as side effects. It may also contribute to osteoporosis. Depo Provera can also cause long-lasting amenorrhea (absent menstrual period) once it is stopped. Unlike Depo Provera, once the Nexplanon rod is removed or the mini pill is stopped, the menstrual cycle returns to normal fairly quickly. Like all options, you should discuss this with your gynecologist to see if it right for you.

Intrauterine Device

The IUD is a small, plastic device inserted by your gynecologist as an in-office procedure. IUDs contain progesterone or copper as their active component. The slowly released progesterone or copper changes the cervical mucous and thins the uterine wall, killing sperm or making it immobile.  IUDs also change the uterine lining making it difficult for implantation to occur if fertilization has already happened. The IUD is also referred to as LARC birth control, as it can be left in for years and is reversible once removed.

Hormonal IUDs

There are four hormonal IUDs and one non-hormonal IUD. The hormonal IUDs are known as Liletta, Mirena, Kyleena, and Skyla.  The first three are currently protective for five years. Skyla is a three-year IUD.

The nicest bonus of the hormonal IUD is that periods are typically very light or disappear. Also, the systemic side effects of the other types of hormonal birth control are nearly non-existent, due to the fact that the IUD works as a local effect on the inside of the uterus.  It is one of the preferred methods of birth control for people with contraindications to estrogen containing birth control.

The hormonal IUDs do not release enough hormone to suppress ovulation. As a result, your ovaries still secrete hormones normally, but with this comes acne that some women experience after ovulation, PMS symptoms, and ovulation pain (the CHC can help with these if they are a problem for you).

Copper IUDs

The copper IUD is called Paragard. It can be left in for 10 years, but it has been my personal experience that removal after 10 years can be difficult in some women.  I have also seen an occasional pregnancy with Paragard. Periods are not made lighter with this option. It is a great option for women who want something with no hormones.  Paragard may be optimal for women who have breast cancer or an increased risk for breast cancer.

Please also keep in mind that it is very important to use condoms when using an IUD to protect against STDs such as gonorrhea and chlamydia.  As you can imagine, you do not want to get a pelvic infection when you have an IUD in place!

With so many options available, you can rest assured that your gynecologist would be happy to walk you through the pros and cons of each in your particular situation. That’s what we’re here for!

Author: Margaret Burns, MD, a physician with Byrn Mawr Women’s Health Associates.

 To schedule an appointment with Dr. Burns, call 610-525-6400.

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