Though the mission seems straightforward enough — prevent a sperm from fertilizing an egg — an ever-growing array of birth control options exists that rivals the Kama Sutra's positions for diversity and sheer quantity. The task of choosing the right birth control method can seem overwhelming, but if you do a little homework and seek professional advice, it can be easier than you expect.
Dr. Greg Berault, an obstetrician/gynecologist in private practice in Slidell, says the best way to start is by discussing all the different choices with your doctor. "When a patient wants to start using contraception for the first time, I always like to go over all the options," Berault says. "A lot of women don't know what's out there, and I like to help them find the contraceptive that fits best with their lifestyle."
Birth control pills are the most commonly used form of contraception in the United States and are highly effective when taken correctly. Most pills contain the hormones estrogen and progesterone, which prevent a woman from ovulating, make the lining of the uterus inhospitable to a fertilized egg, or change the mucus of the cervix to make it difficult for sperm to connect with an egg.
Even birth control pills come in a multitude of varieties. Some are taken every day, with the last four to seven being placebos to produce a regulated menstrual cycle. For women who want to go longer than a month without a period, there are birth control pills that are taken for 90 days before the seven placebos. Patients also may choose Lybrel, a pill that is taken daily without any placebos at the end. This pill, however, can produce unwanted spotting.
Berault says these options are best for patients younger than 50 who don't smoke and don't have a history of breast cancer or deep vein thrombosis. Patients older than 50 have an increased risk of developing a blood clot when taking most birth control pills, but many can safely take the "mini pill," which contains only progesterone. Because the mini pill lacks estrogen, it is also safe for women who are breastfeeding.
Common side effects of birth control pills include nausea, bloating, mood swings and breakthrough bleeding, Berault says, adding that some of the side effects may lessen with time. "When first starting a hormonal contraception, it takes a while to get adjusted," he says. "We advise the patients to allow three months for the body to adjust before trying something else."
Obstetrician/gynecologist Dr. Diana Clavin, who has a private practice in Slidell, says at least 50 percent of her patients choose the pill, but many are concerned they won't remember to take it every day. "Nowadays, everyone has a cell phone," Clavin says. "I tell my patients to use their alarms, which come on almost every phone." If that doesn't work, she says, other options should be explored. "A lot of women don't know about the more convenient options," she says.
One is a Depo-Provera shot, a progesterone-only injection taken once every three months. Berault says it is best suited for younger women who are concerned about forgetting to take a daily pill — or mothers worried their daughters won't remember. The shot prevents menstrual bleeding or produces occasional light periods. The time it takes to return to fertility is variable, however, sometimes stretching up to 18 months. "It's not a good option for someone considering pregnancy in the near future," Berault says. Common side effects include weight gain and acne.
The Intrauterine Device
Another long-lasting option is the Intrauterine Device (IUD), a small, T-shaped implement that is inserted into the uterus to prevent pregnancy and can be removed by a doctor at any time. There are currently two types available: Mirena, a hormonal IUD that is effective up to five years, and ParaGard T, a nonhormonal IUD that lasts up to 10 years. An IUD acts as a foreign body within the uterus, causing the body to create a hostile environment for sperm. With Mirena, the progesterone also prevents ovulation. According to Berault, Mirena is the most effective form of contraception. "There is no user error," he says. "It's been shown to be even more effective than tubal ligation." It's not for everyone, however. IUDs are suggested for women who have had children because their uteruses tend to be larger, which makes IUD placement easier.
The Vaginal Ring
An increasingly popular choice is the vaginal ring, which women can insert on their own and leave in for three weeks. It is removed every fourth week to allow menstruation. The ring contains both estrogen and progesterone, but Clavin says patients tend to experience fewer side effects because the hormone levels are lower than in some other options.
The Ortho Evra Patch
A less common choice is the Ortho Evra contraceptive patch. The small transdermal patch is applied to the skin, typically on the upper arm or abdomen, and releases progesterone and estrogen. The patch is changed once a week for three weeks, then removed for menstruation during the fourth. The patch has been shown to be as effective as the pill, Clavin says, and side effects are similar. Some women have reported problems with the adhesive, and because the patch is topical, greater amounts of estrogen are released, which increases the likelihood of blood clots in high-risk patients.
A newer contraceptive for women who want long-lasting protection is Implanon. A doctor implants the small, flexible plastic rod under the skin of the arm, and it lasts for three years. The rod contains only progestrone and works similarly to the Depo-Provera shot. "Most women aren't hesitant to have the rod placed under their skin," Clavin says. "It's the irregular spotting that they worry about." While the longer-lasting contraceptives like IUDs and implants are easier and more effective, Berault says they tend to carry higher risks for breakthrough bleeding, which many women find aggravating.
Birth control methods have come a long way since oral contraceptives were introduced 50 years ago. While many women prefer the pill, doctors posit that the future of birth control lies new and more convenient forms. "Implants and IUDs are definitely more effective than the pill," Clavin says. "Anything people have less chance of forgetting, they'll do better with."