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Whether it’s the pill, the patch or something else, finding the right birth control means asking a lot of questions. So, we asked.

By Jill Case

In the 1950s, some women thought the carbonic acid in colas would kill sperm, so it became a popular feminine-hygiene product. In ancient Egypt, some women believed in a mixture of crocodile dung and honey and, well, you really don’t want to know anymore. Today, there is access to a wide variety of birth control that is scientifically proven to be effective, and women can choose the option that is right for them. Home remedies and old wives’ tales are a thing of the past.

In 1993, The Economist named the birth-control pill one of the seven wonders of the modern world. While “the pill” is still the most popular reversible form of birth control in use today, additional hormonal methods include the birth-control patch and the vaginal ring.

There are two types of hormonal birth-control methods: progestin only and combined (a combination of progestin and estrogen). Combined hormonal methods prevent pregnancy by stopping  the ovaries from releasing an egg, thereby stopping ovulation. These methods, including the pill, the patch and the ring, also thin the uterine lining, making it difficult for the egg to attach, and thicken cervical mucus, which makes it more difficult for sperm to enter the uterus.  Progestin-only methods work similarly to combined methods, except they do not always stop ovulation. However, they are still equally as effective.

Progestin-only methods include the birth-control implant, hormonal intrauterine devices and the birth-control shot, which is administered every 13 weeks. There are also progestin- only pills, sometimes known as the “mini pill.”

PROS AND CONS OF COMBINED HORMONAL BIRTH CONTROL

Pros: Combined hormonal birth control may help reduce cramps during menstruation and may make women’s periods lighter, shorter and/or more regular. It can improve acne and may be used to treat fibroids, endometriosis or other disorders that cause menstrual pain or heavy bleeding.

Cons: There is a slight risk for complications with combined hormonal birth control, including heart attack, stroke and deep vein thrombosis, or DVT. Risk increases in women with certain health factors, such as being 35 or older, being a heavy smoker (more than 15 cigarettes a day) or having high blood pressure, high cholesterol or other risk factors for cardiovascular disease. Potential unwanted side effects include breast tenderness and nausea.

THE PILL

Refresher: It’s available as a 21-, 28-, 90- or 365-day pill, each with specific usage guidelines.

You need to know:
• It’s not recommended for women who are breastfeeding.  ​
• Women should wait at least three weeks after giving birth to begin taking these pills again, and four to six weeks if they have other risk factors for DVT.  ​
• Antibiotics may reduce the effectiveness of the pill.

THE PATCH

Refresher: The small, adhesive patch releases hormones that are absorbed into the blood stream through the skin. The patch  is worn for three weeks, and then removed for one week for menstruation. After seven days, a new patch is applied. The patch can be worn on the upper arm, back, abdomen or buttocks.

You need to know:
• It may not be as effective for women weighing more than 198 pounds.
• It may cause skin irritation.

THE RING

Refresher: So named for its shape, the ring is a flexible device inserted into the vagina and worn continuously for three weeks, then removed for one week for menstruation. After seven days, a new ring is inserted.

You need to know:
• It can cause irritation or swelling of the vagina and may cause vaginal discharge
• The American College of Obstetricians and Gynecologists has deemed long-acting reversible contraception, such as IUDs and implants, to be 20 times more effective than birth-control pills, the patch or the ring in the long term.

PROS AND CONS OF LONG-ACTING REVERSIBLE CONTRACEPTION (LARC)

Pros: LARC methods are entirely reversible. They cause no interference or interruptions during sex. They can be used while breastfeeding and immediately after giving birth, a miscarriage or an abortion. These methods also decrease heavy menstrual flow and help lessen menstrual pain.

Cons: While side effects are rare, menstrual pain and bleeding might increase, and both these effects are generally more common in the first months of use.

HORMONAL OR COPPER IUDS

Refresher: IUDs, or intrauterine devices, prevent pregnancy by stopping the sperm from fertilizing the egg. Hormonal IUDs release the hormone progestin, with one brand approved for use for as many as three years and the other for as many as five years. Copper IUDs contain no hormones and can be effective for as many as 10 years.

You need to know: While very few serious complications occur, in some women, the device can come out of the uterus or perforate the uterine wall during insertion. (This occurs in only about one of every 1,000 procedures.) There is a slight increase during the first 20 days after the IUD is inserted for pelvic inflammatory disease, and it may cause irregular bleeding and/or spotting during the first three to six months after the device is inserted.

Overall, while women may feel some discomfort when their health- care provider inserts the IUD, serious IUD-related health problems of the past that received much media attention were caused by the Dalkon Shield, which is no longer on the market.

BIRTH-CONTROL IMPLANT

Refresher: About the size of a matchstick, the birth-control implant is a flexible little rod inserted under the skin of the upper arm (and under local anesthesia).

You need to know: Almost any woman can use an implant, and insertion does not require an incision. While the implant can cause depression and changes in mood, headaches and acne, less than 2 percent of women have problems when the implant is removed or inserted. Women should talk to their doctors about the risks of using the implant if they suffer from depression or other mental-health issues.

THE TRUTH ABOUT EMERGENCY CONTRACEPTION

Even when a woman is careful, sometimes, a couple may have unprotected sex. emergency contraception can provide a solution. many people think that it causes abortions, but that is patently untrue. emergency contraception prevents pregnancy from occurring at all when used five days after the incident or earlier.

Refresher: Some emergency-contraception pills are available over the counter at the pharmacy, such as Plan B one-Step, next Choice one Dose and Aftera. other pills require a prescription, including ulipristal and combined birth-control pills.

You need to know: The copper IUD, which is prescribed and placed by a doctor, is the most effective method of emergency contraception. A woman needs to have this device inserted by a physician no later than five days after she has had unprotected sexual intercourse.

THE BEST METHOD FOR …

protecting against sexually transmitted infections is: a polyurethane or latex condom. There is also a female condom women can use should a man refuse to wear one or not have a condom that protects against sexually transmitted infections, although it’s not as effective as the male condom.

providing long-term prevention is: the copper IUD. it can last for as long as 10 years.

women who are breastfeeding is: the IUD or birth-control implant, followed by progestin-only birth- control pills. Women should always discuss this with a doctor.

The most effective forms of birth control based on pregnancy rates out of 100 women within one year of use, according to the American College of obstetricians and gynecologists:

• Less than 1 percent: IUD and implant
• 6 percent: injection/shot
• 9 percent: pill, patch and ring
• 12 percent: diaphragm
• 18 percent: male condom
• 21 percent: female condom
• others: 17 to 23 percent: the cervical cap; and 12 to 24 percent: the sponge

Birth control has come a long way, and there are many options available to suit every woman’s needs. Other birth-control methods worth discussing in more detail with a health-care provider include progestin-only pills; birth-control shots; barrier methods, like the male and female condom, diaphragm, cervical cap, sponge and spermicide; and natural family planning.

It’s important to discuss the risks and benefits of each method to decide what is best for you. For more information, visit the contraception section at acog.org/patients or visit womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html.

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