How to choose the best birth control for you!
So I received a lot of questions regarding which birth control is the best! I believe the best one for each mujer is the one you actually use and the one you use appropriately!
None of this skipping pills, being late to get your next Depo shot or forgetting to take the Nuvaring out on time! Yes we have all been there. Here are three questions to ask yourself in your search for the best birth control for you...
What's Your Personality? Are you good about taking medication on a schedule or do you need something that you can forget about? The pill is an easy, accessible choice for women who can remember to take it, but options like the ring or IUD may be better for women who want something they can forget about.
What's Your Pregnancy Outlook? If you want to get pregnant within the next couple of years, you may want to choose an easily reversible form. If you're done having children, you might want to consider sterilization.
Are You Concerned About Hormones? Women who are nursing may want a birth control that doesn't contain estrogen since it can lower supply. Women who want to avoid hormones all together may consider a copper IUD or condoms.
Other factors that women should consider. Does it reduce libido? It is easy to keep private? Easy to use? Easy to get? Does it reduce period? What about cost, health benefits, side effects and will it prevent STIs?
So review each method and then click below to take a quiz from Planned Parenthood which will also help you choose!
Combined hormonal birth control pills:
91% effective
Costs $0-50/month
Contains estrogen and progesterone
Works by suppressing ovulation and thickening of cervical mucus
Can decrease menstrual flow and pain
Can decrease risk of uterine and ovarian cancer
Can cause irregular cycles, absence of menses which is fine, nausea/vomiting, headaches, melasma or darkening discoloration of skin on face, no protection against STIs and can decrease libido
Complications can include blood clots in legs or lungs but less than the risk with pregnancy, hypertension or gallbladder disease
Women at risk are those who are over 35 and smoke (if you are over 35 but otherwise healthy birth control pills are still a good option for you), women with hypertension, diabetes, obesity and/or migraines
Progesterone-only pills/The mini-pill:
91% effective but requires more punctual dosing
Can sometimes cost more than combined birth control pills
Thickens cervical mucus to prevent sperm entry into upper reproductive tract, suppresses ovulation in about 50% of cycles
Can decrease menstrual flow and pain
Good option for women who can’t use estrogen but still want to take pills for contraception
Can be used in women over 35 who smoke
Recommended for breastfeeding women because it will not decrease milk supply like regular pills can
Can cause irregular bleeding or ovarian cysts
Must take daily within a three hour timeframe or if not it is considered a missed pill and you should use a back-up method for a few days such as abstinence or condoms
Does not protect against STIs
Hormone/progesterone containing IUD (Mirena, Liletta, Kyleena or Skyla):
Mirena contains 52mg of levonorgestrol and FDA approved for 5 years
Liletta contains 52mg and FDA approved for 6 years as of October 2019
Kyleena contains 19.5mg and FDA approved for 5 years
Skyla contains 13.5mg and FDA approved for 3 years
99% effective, more effective than sterilization
Cost is $0 to $1300 if you include office visit and fees, there are programs that a woman who doesn’t have insurance can apply for and can get a free IUD, ie ARCH Foundation Program with Bayer
Thickens cervical mucus, changes in uterotubal fluid which impair sperm and ovum migration, thinning of endometrium prevents implantation and suppresses ovulation in 5-15% of cycles, higher in first few years
Reduces bleeding and pain, no bleeding can develop in up to 60% of users for Mirena and Liletta; Mirena is actually FDA approved for abnormal uterine bleeding; immediate return to fertility at removal
Can cause irregular bleeding, ovarian cysts that can disappear on their own, headaches, acne, breast pain, moodiness and no protection against STIs
Called a LARC or long-acting reversible contraception which is great for teens or young women
Non-hormonal IUD (ParaGard)
99% effective
Cost is slightly less than hormonal IUDs
Works primary as a spermicide by the copper ions making sperm immotile as well as the inflammatory response it causes; it does not cause abortions!
Lasts for 10 years!, good option for women who can't use hormonal birth control and can be used for emergency contraception
Can increase blood loss during menses up to 50% as well as pain during periods
Called a LARC or long-acting reversible contraception which is great for teens or young women
Implant (Nexplanon)
99% effective
Costs $0- $1300
It is a single 4cm implant that is placed in the inner arm under the skin, it contains etonogestrol which is a progesterone
Works by thickening cervical mucus, inhibits ovulation and thins endometrial lining
Decreases blood flow and pain, ovarian cysts less common than with IUD
Main compliant is unpredictable and irregular bleeding that can persist, can cause headaches or acne
Does not protect against STIs
Great for women who can’t use birth control with estrogen
Rapid return to fertility when removed
Very rarely it is difficult to locate when being removed but it can be found with a special ultrasound probe or MRI and rarely requires surgical removal in the operating room
Called a LARC or long-acting reversible contraception which is great for teens or young women
Depo-Provera Injection
94% effective
Costs $0-$150
Contains only progesterone (medroxyprogesterone)
It is an injection a woman gets every 3 months into the shoulder or butt
It suppresses ovulation, thickens cervical mucus and thins the endometrial lining
Less blood flow, less pain, can improve endometrosis pain and after one year of use 50% of women can develop amenorrhea or no more periods
Can cause irregular and unpredictable bleeding for first several months
Can cause weight gain, studies say 5 pounds in first year and 15 pounds after 5 years of use
Can decrease your estrogen causing decrease in bone mineral density but can be reversible, so all women on Depo should increase calcium in their diet or take calcium supplements, exercise regularly and stop smoking!
Possible mood swings or changes
Good for women who can’t take estrogen
Can decrease return to fertility up to one year in some women
Vaginal contraceptive ring (NuvaRing)
91% effective
Costs $0-$200
It is a ring that is placed by the woman into the vagina for 3 weeks or 1 month, then removed for one week to allow for the withdrawal bleed or “period” and then a new ring is placed after that week to continue to cycle; compliance should be easier since it is not a daily task
It contains estrogen and progesterone
It is recommended to not remove during intercourse but if you do place it back into vaginal within 3 hours
It works by suppressing ovulation
There is no daily fluctuation in hormone levels such as with the pill so less chance of irregular bleeding and it is one of the lowest doses of combined hormonal contraception out there giving women only 15mcg of estrogen daily
Complications are the same as combined birth control pills
Can’t get lost in your body!, it is either in your vagina or it is not!
Patch (OrthoEvra or Xulane)
91% effective
Costs $0- $150
It is a patch worn for one week for each of 3 consecutive weeks on the lower abdomen, buttocks, upper outer arm and the fourth week is the patch-free week to allow for your “period” or withdrawal bleed
Contains estrogen and progesterone
Works by suppressing ovulation and thickening of cervical mucus
Can decrease blood flow and pain
Complications are the same as combined birth control pills
May not be as effective for women who weigh >200 pounds so consider another method
Female Sterilization (Tubal ligation or occlusion)
99% effective, permanent
Costs $0-$6000
Requires an outpatient surgery that is performed laparoscopically or right after delivery called a postpartum tubal
Works by interrupting the patency of the tubes therefore preventing fertilization
Young women have a higher risk of failure due to more years of potential fertility
There is no change to menstrual cycles! You still will have a period. Some women complain of heavier flow after the tubal but can be coincidental due to most women getting tubal performed at an older age when menstrual changes are more likely to be seen.
Some studies have shown a decrease in ovarian cancer
Risks include regret up to 30% if under 30 years of age at time of procedure and risks with surgery
Should only be done in women who are certain they no longer want children
Essure was a method to block the tubes and has been off the market as of July 20, 2018 due to risk in complications after procedure; I personally had patients do well with it and it was a safe and easy method of sterilization not requiring surgery in the hospital.
So of course ladies there are other options such as male and female condoms, diaphragm, sponge, cervical cap, fertility awareness, withdrawal, vasectomy and abstinence but I wanted to review the most common ones I deal with on a day to day basis.
Check out this link for a birth control quiz to see what might be a good option for you! FYI, Planned Parenthood’s website is amazing for birth control options so check it out after you take the quiz!
I hope this answered some questions for you and share with your friends!!
Love,
Dr. E