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Sizing up birth control

What type of contraception is best for you?


These days, picking out birth control is almost like shoe shopping. You have to find the right fit for your lifestyle and decide what’s most comfortable for where you’re heading.

Nearly every sexually active woman in the United States between the ages of 15 and 44 has used one method of birth control, according to the Guttmacher Institute, a nonprofit organization that works to advance reproductive health. Among women of reproductive age, 62 percent are currently using birth control, the institute said.

The majority of women who use birth control primarily use nonpermanent methods of contraception, with the pill as the first choice. However, there are many methods to choose from. How do you know which one is best suited for you? And what are the side effects associated with each type of contraception?

Your doctor is a major player in assessing and tailoring what’s ideal for you.

“I ask them when their desired date of fertility is,” said Dr. Cheryl Onwuchuruba, an obstetrician and gynecologist with Novant Health Randolph OB-GYN in Charlotte, North Carolina. “It’s different for a teenager and a woman who is already a mother.”

Other factors the doctor considers are menstrual issues such as the heaviness of periods or whether a woman has a regular period. “It’s important to have an earnest conversation with the patient to determine how reliable she’ll be about taking pills,” Onwuchuruba said. “You don’t want her to fail.”

Types of birth control

According to the Centers for Disease Control and Prevention (CDC), your birth control choices  fall into three broad categories: long-acting reversible contraception (LARC), traditional hormonal methods and barrier methods.

Think of long-acting reversible contraception as flat shoes, a reliable and reassuring method of birth control that you may even forget you’re using. Traditional hormonal methods are more like the high heels in your closet with lots of variety, while barrier methods are like boots worn to protect you from, well, the elements.

With birth control, much like shoes, sometimes you have to try them out to see what fits.

Long-acting reversible contraception

The first category includes intrauterine devices such as the copper T intrauterine device, also known as an IUD, and the levonorgestrel IUD. The copper IUD is a small device in the shape of a “T” that a doctor places in the uterus. The CDC says it is effective for up to 10 years.

The levonorgestrel IUD is also a T-shaped device that a doctor places in the uterus. It releases a small amount of the hormone progestin each day to prevent pregnancy. There are now two forms of this IUD: one lasting three years and another that is approved for up to five years of use.

The last form of long-acting reversible contraception is an implant called Nexplanon, a thin rod placed under the skin of a women’s upper arm. The rod contains progestin that is released through the body over three years.

“LARC is an underutilized form of birth control in the United States,” Onwuchuruba said, adding that its effectiveness is similar to that of a tubal ligation, but it is reversible, meaning that once a woman decides she would like to conceive, the device can be removed with an immediate return to fertility.

LARC side effects

The side effects of the various LARC methods vary depending on the method chosen. The American College of Obstetricians and Gynecologists has reported possible risks associated with using IUDS. In 5 percent of users, the IUDS have come out of the vagina. In some rare instances, the IUDS will pierce the uterine wall during insertion and there is a risk that 1 in 100 users will develop pelvic inflammatory disease, a condition that causes internal scarring and may affect fertility.

“This risk if lowered by testing patients for sexually transmitted diseases that commonly cause pelvic inflammatory disease prior to insertion, and this increased risk is only for the first 21 days following insertion,” Onwuchuruba said.

The copper IUD is nonhormonal and is also approved by the Food and Drug Administration for emergency contraception. “This may be a good option for those who cannot use or tolerate hormones,” Onwuchuruba said. “However, bleeding can be excessive with this method.”

Nexplanon is also known to cause unpredictable bleeding, and while some women have regular periods with its use, about one-third of women using the product will experience heavy and irregular periods.

Hormonal methods

There are a number of hormonal methods of contraception. Again, think heels and pumps with different heights, styles and shapes to choose from.

Birth control pills, commonly known as the pill, are combined oral contraceptives that contain the hormones progestin and estrogen. Prescribed by a doctor, the pill has to be taken every day at the same time in order to work effectively. “There are many varieties of oral contraceptives with different types and amounts of progestin and estrogen,” Onwuchuruba said. “Just because one oral contraceptive does not work for you does not mean you cannot try another formulation.”

The doctor added that oral contraceptives are known to be about 83 percent effective based on the typical use of patients. It is important to make sure that if you miss more than two pills in a row that you use some form of backup method, she warned.

A doctor may not recommend the pill to women who are over age 35 and smoke or who have a history of blood clots or breast cancer.

Pill side effects

Common side effects from taking the pill are bleeding between periods and missed periods, nausea, breast tenderness, headache, weight gain and mood changes. Combination hormone pills slightly increase the risk of stroke, heart attack and deep vein thrombosis, or blood clots. Women with a history of these conditions should not take the pill.

The mini-pill is an oral contraceptive that only has progestin. It is available by prescription and must be taken at the same time each day. This form of birth control has a much tighter window for which it must be taken. A lapse of even three hours in time can lead to an unplanned pregnancy. The CDC says it may be a good option for women who can’t take estrogen, such as those who are breastfeeding or those with strong risk factors for blood clotting. 

A vaginal ring is prescribed by a doctor but is inserted in the vagina by the user. The ring releases estrogen and progestin into the uterine walls. The ring is used for 21 days before being removed. After seven days, a new ring is inserted.

Vaginal ring side effects

The side effects and warnings about using the vaginal ring are similar to the pill. Some women may experience increased vaginal discharge when initially using the ring, but this side effect usually improves with time. This method of birth control should not be used by women with cardiovascular problems, blood-clotting issues and diabetes, as well as women over 35 who smoke.

A hormone patch releases estrogen and progestin through the skin. Prescribed by a doctor, this method of birth control is used by applying a patch weekly for three weeks. On the fourth week, no patch is worn so that the patient can have her period.

The hormone patch can cause skin irritation, breast tenderness, headache and spotting. It is important to change the site of application with each placement to decrease skin irritation. Since this is an estrogen-containing form of contraception, there is still an increased risk for blood clot formation, said Onwuchuruba.

Some women opt for progestin shots every three months from their doctor. “This is excellent contraception method,” Onwuchuruba said, though she added that “it can cause irregular bleeding for the first several months of use.”

Most women will no longer have periods with long-term use. The biggest side effect with the Depo-Provera shot is known bone loss for the duration of its use. “We now know that you regain the bone loss after discontinuation of the shot,” Onwuchuruba said. This may not be a great choice for those who wish to conceive within a short interval as there is known delayed return of fertility, she added.

“It is important to remember that none of the hormonal methods of contraception prevent STDs,” she said. “This can only be accomplished with barrier methods.”

Barrier methods

Barrier contraception methods include the use of a diaphragm, cervical cap or condoms. A diaphragm and cervical cap are cup-shaped devices that are placed in the vagina prior to sexual intercourse to block sperm from entering the cervix. They are used with spermicide. Patients need to visit with their doctors for a fitting because diaphragms and cervical caps come in various sizes.

Latex condoms for men are worn to prevent sperm from entering a woman’s body. Women can also use female condoms purchased at a drug store. The female condom comes with a lubricant and can be inserted in the vagina up to eight hours before intercourse, according to the CDC.

Finding the right birth control

With so many options, it can be confusing to decide what method of contraception to use. Your doctor will help you make a decision based on a number of factors. In picking what’s best for you, heed to the CDC’s advice and consider “safety, effectiveness, availability and acceptability.”

In other words, size up all of the options and decide what works best for you.





Published: 5/12/2015
 

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