Birth Control

There are more than a dozen methods of birth control, and the options vary in both their effectiveness and delivery approach. A primary care physician can help women of all ages set their course in terms of fertility. Birth control can be considered by women who aren’t ready to have children just yet, those in-between children, and women that no longer plan on having children. And some forms of birth control can provide extra benefits by helping women manage their menstrual cycles with less severity and cramping.

What birth control options are available to patients?

Birth control has been around since the 1960s, and women immediately took to it. Just two years after it was put on the market, 1.2 million women in the U.S. were on “the pill,” and after three years, that number was up to 2.3 million. Clearly, there are compelling reasons for women to consider birth control, as it provides a level of control and stability that is difficult to attain without it. Younger women who plan on pursuing education or a career, as well as women who are finished with their families can benefit greatly from its use. For these women, the decision regarding birth control is often elementary.

What isn’t so clear is what birth control method to opt for, as they vary in cost, effectiveness, how long they are effective and delivery method. Here is a closer look at each option:

1. Oral contraceptives – Among modern contraceptives, the pill is the oldest version of birth control, but it has been improved upon greatly in the last 50 years. The pill is made with a pair of synthetic hormones: progestin and estrogen. Together, they work to suppress some functions of the pituitary gland, which prevents ovulation, or the release of the egg from the ovary. Progestin also alters the lining of the uterus, making it difficult for sperm to get to the egg. Some forms of oral birth control only contain progestin, which can be easier on some women.

When taken as directed, birth control pills are extremely effective, with a success rate in excess of 99 percent. If oral contraceptives do fail, it’s almost always due to a missed or delayed dose. For this reason, the actual success rate of birth control pills is around 92 percent.

Oral contraceptives often provide some additional medical benefits. They help regulate the menstrual cycle, so women know when they are about start their cycle. It helps reduce the symptoms associated with menstruation, including cramping and bleeding. Oral contraceptives are also known to clear up acne and can reduce the chances of several types of cancer, including endometrial and ovarian cancer.

However, many women experience some side effects with birth control pills. These side effects may include nausea, headaches, sore or enlarged breasts, changes in weight and changes in mood. Oral birth control can occasionally result in irregular periods, though this is usually temporary or the result of a missed dose.

2. Intra-uterine devices, or IUDs – IUDs are inserted into the uterus, through the cervix, and most work by releasing small amounts of levonorgestrel, a form of progesterone. There are some exceptions, though, including the ParaGard, which does not release hormones. In all cases, the effect inside the cervix is thickened mucus, which acts like a spermicide. The levonorgestrel also alters the woman’s menstrual cycle.

IUDs are extremely effective and prevent pregnancy more than 99 percent of the time. It also provides protection as long as it is place, which can be for years. For this reason, it’s a popular choice for women who do not want to have children for an extended period of time.

There aren’t many side effects associated with IUDs, though they do have to be placed by a physician. There is a slight chance of infection in the weeks following insertion, and in rare cases, the IUD can migrate and potentially puncture the uterus. This is a medical emergency, so patients need to keep tabs on how the IUD feels and if there are any unusual symptoms like pelvic pain after insertion.

3. Hormonal implants – Birth control implants are very small tubes, each of which contains a version of progesterone. They are implanted under the skin, usually in the patient’s upper arm, and because they are made from a flexible plastic, they do not hurt once placed. The implantation procedure lasts only a few minutes and with only minimal discomfort.

Like IUDs, birth control implants are more than 99 percent effective and can provide years of protection. Most implants are designed to last for three years before they need to be replaced. If the patient decides they want to have children, the implant can be removed early, or the patient can wait until the three-year mark ends.

Birth control implants can produce some side effects, like weight gain, anxiety or depression, hair loss or irregular menstruation. The implant site also poses an infection risk, though this is minor. Hormonal implants are also not safe for use in women that are pregnant, experience unexplained vaginal bleeding, or have a history of liver disease or breast cancer.

4. Vaginal hormonal rings (the NuvaRing) – Vaginal hormonal rings contain progestin and estrogen and are inserted into the vagina like a tampon. It is safe to use in women of all ages, including teenagers, and it is effective for up to three weeks following insertion. It is another highly-effective form of birth control, preventing pregnancy in more than 99 percent of instances if it is used correctly.

Many women prefer the NuvaRing for its ease of use and comfort, as it cannot be felt if it is placed correctly. There is a popular fear that the ring may be pushed deeper into the vagina, and potentially through the cervix, but this is impossible. It’s more likely that the ring will fall out, though this is extremely rare.

As the NuvaRing uses the same combination of hormones found in birth control pills, any side effects are similar to those associated with oral contraceptives. They include nausea, headaches and changes in appetite. Increased blood pressure and a greater chance of blood clots are also associated with the vaginal hormonal ring, but like with most major complications, these are rare.

5. Injected contraceptive – The Depo-Provera injection is the most popular form of injected birth control and must be administered every three months to provide maximum effectiveness. If it is, the injection is more than 99 percent effective. There is some flexibility in when the injection can be administered, as women can get it up to two weeks early if they are going to be unavailable at the three-month mark.

The injection works like many other forms of birth control in that it reduces activity in the pituitary gland, preventing the development and release of eggs from the ovaries.

Women that don’t mind needles will find the Depo-Provera injection to be among the easiest and most convenient forms of birth control available. However, there are some adverse effects that come with the Depo-Provera. They include headaches, dizziness, mood changes, depression, bloating, abdominal pain or discomfort and weight gain.

Irregular periods or loss of periods altogether can occur with the Depo-Provera, and this can last for several months. The longer the patient undergoes injections, the greater the chance that their periods will stop. Also, bone mineral loss can occur in patients, and this is most concerning for teenagers who are still growing. Fortunately, this bone loss is almost always reversible.

6. Patch contraceptive – The hormone patch, also called Ortho-Evra or Xulane, is a 2-inch by 2-inch square that can be placed on the upper arm, back, lower abdomen or on the buttocks, though it must be moved to a new spot every week. It looks much like a Band-Aid and is applied as such, so it’s one of the easiest and most comfortable forms of birth control there is. If it is used properly, it is effective more than 90 percent of the time, though it is less-effective in women who weigh more than 198 pounds.

The patch is very convenient and will not fall off in the shower or when the patient sweats or goes swimming. However, because it uses estrogen and progestin to work, it can produce side effects similar to those seen in oral birth control, like nausea and irregular menstruation.

There are additional birth control methods beyond these, including diaphragms, cervical caps, male and female condoms, spermicides and fertility tracking. In some cases, they can be effective as well, though they are usually not as reliable as the above options.

Clearly, there is a lot to consider when choosing a birth control method, and factors like the patient’s health and age, future plans regarding children, cost and discomfort associated with the chosen method need to be considered.