Birth Control Options

The birth control patch that we prescribe the most is called Xulane. It contains estrogen and progestin, which act to prevent your ovaries from releasing an egg and also thicken your cervical mucus to keep sperm from reaching an egg. The patch is quite effective in preventing pregnancy: of 100 women who wear the patch in one year, about nine may become pregnant.

Advantages of the birth control patch

• No daily dosing is required: you wear the patch for three weeks, take it off for one week, and reapply it for your next 3-week cycle
• The patch allows for spontaneous intimacy because you do not have to apply anything before relations
• Like all hormone-containing birth control options, the patch helps reduce cramping, lightens menstrual bleeding, promotes regular periods, and protects you against PID
• Health benefits associated with patch use include improving acne, preventing ovarian and breast cysts, reducing the risk of ectopic pregnancies as well as endometrial and ovarian cancer, and reducing PMS symptoms
• The patch is an entirely reversible form of birth control: you can get pregnant as soon as you remove the patch.

Potential downsides of the birth control patch

• Some women can experience side effects such as breakthrough bleeding between periods, headaches, breast tenderness, and nausea
• Some women may have a skin reaction to the adhesive on the patch
• It can be challenging to keep up with the three weeks on, one week off usage schedule
• The patch is not as effective on very overweight women
• Sometimes the patch can fall off without you realizing it
• Certain medications can interfere with the patch’s effectiveness
• If you suffer from depression, patch use can worsen your symptoms
• The patch exposes women to higher levels of estrogen than either combined birth control pills or the vaginal ring. The consequence of this is not well studied.

Not everyone is a good candidate for patch use. It is contraindicated if you:

• Are a smoker over age 35
• Experience migraines with auras
• Have a history of breast cancer
• Have advanced diabetes or liver disease
• Have uncontrolled high blood pressure
• Have a clotting or venous disorder.

Birth control shots

Birth control shots are injections of the hormone progestin that prevents pregnancy in two ways: by keeping ovaries from releasing eggs and also by causing the cervical mucus to thicken and the lining of the uterus to thin. This prevents sperm from reaching and fertilizing an egg.

These injections are typically placed in your buttocks or your upper arm and are given at your doctor’s office every three months. The most commonly used birth control shot brand is Depo Provera. Shots are slightly more effective than birth control pills and patches in preventing pregnancy: of 100 women who get shots in one year, about six may become pregnant.

Advantages of birth control shots

• Because it requires just four shots per year, dosing is more convenient than other forms of birth control
• Shots allow you to have spontaneous sex because you don’t need to apply anything before intimacy
• Many women who get shots have lighter periods, or no periods at all, and experience fewer menstrual cramps
• It is private. It’s up to you whether your partner knows that you are on birth control.

Potential downsides of the birth control shot

• It requires a visit to your doctor every 12 weeks to get a shot
• Some women may have a reaction at their injection site, though this is usually temporary
• You cannot get shots if you’re breastfeeding
• It may take longer to get pregnant after stopping birth control shots than if you were on other birth control methods
• Taking birth control shots for more than 2 years can cause bone thinning, although normal bone growth returns once you are off the shots
• Some women can have side effects such as headaches, spotting, abdominal discomfort, breast tenderness, weight gain, joint pain, bloating, fatigue, hot flashes, and nervousness.

Intrauterine Device (IUD)

An IUD is a small T-shaped device that is placed inside your uterus by your doctor. Once it is inserted, you cannot feel it. IUDs can stay inside you and be effective for up to 10 years. IUDs are more effective at preventing pregnancy than birth control pills, condoms, patches, vaginal rings, or shots: of 100 women using IUDs for a year, less than one may become pregnant.

There are two kinds of IUDs: hormonal and non-hormonal. The hormonal ones continually release progestin, which causes your cervical mucus to thicken and your uterine lining to thin. This keeps sperm from reaching and fertilizing an egg. The non-hormonal IUD is made of plastic and copper. Any sperm that reach the uterus are neutralized in the presence of copper and, thus, can’t fertilize an egg.

Advantages of IUDs

• The IUD is very safe and well-tolerated by most women
• It’s more effective at preventing pregnancy than other reversible forms of birth control (like the pill, patch, shot, ring, or condom)
• Recent research has shown that IUD use dramatically decreases a woman’s risk of ovarian cancer, out-performing even birth control pills in decreasing ovarian cancer risk²
• It is convenient: once an IUD is inserted, you don’t need to think about birth control
• It is one of the most cost-effective long-acting forms of reversible contraception
• It does not interfere with sexual spontaneity and cannot be felt by your partner
• Depending on the type of IUD you choose, it can be effective from 3 to 10 years
• It is private; you can choose whether to tell your partner about your birth control
• The copper IUD can be used for emergency contraception to prevent pregnancy if it is inserted within 5 days of unprotected sex

Potential downsides of IUDs

• The IUD must be placed inside you by a doctor, so it requires an office visit
• Very rarely, an IUD can fall out of the uterus
• Shortly after insertion of the IUD, some women may experience cramping and irregular bleeding
• Extremely rarely, some women can get pelvic infections within 3 weeks of IUD placement

Other types of birth control

The morning-after pill

Emergency contraceptive pills (also called morning after pills). Emergency contraception should not be used as a routine form of birth control. It is intended for use after unprotected sex or when a primary birth control method fails, such as a condom breaking. Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. Some emergency contraceptive pills are available over the counter.

Female condom and male condom: barrier method

Male condoms are worn by men and prevent sperm from entering a woman’s body. Latex condoms are the most common and are effective in preventing both pregnancy and the transmission of HIV and other sexually transmitted infections. Synthetic condoms also provide similar protection. However, “natural” or “lambskin” condoms, while preventing pregnancy, may not protect against STIs, including HIV. The typical failure rate with average use is 13%.

Female condoms are worn by women and also prevent sperm from entering the body. They can be inserted up to eight hours before sex. With a typical use failure rate of 21%, female condoms also help reduce the risk of STDs.

Spermicide can be used with condoms to increase their effectiveness in preventing pregnancy.

Natural methods of contraception

Natural family planning (or fertility awareness) methods are overall not as effective as other forms of contraception. They are built on trust between partners and not having sex at times when you could get pregnant.

Some of these methods rely on having a regular menstrual cycle. If you have irregular periods, you have a higher chance of getting pregnant.

Permanent birth control

Permanent methods of birth control include female sterilization (tubal ligation of the fallopian tubes) and male sterilization (vasectomy).

References

1. Wheeler, L.J., Desanto, K., Teal, S.B., Sheeder, J., Guntupalli, S.R., Intrauterine Device Use and Ovarian Cancer Risk: A Systematic Review and Meta-Analysis. Obstetrics and Gynecology: 134 (4): 791-800, October 2019.

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