Birth Control… What are My Options Beyond the Pill?

For many women with busy schedules daily dosing of birth control pills can be difficult, therefore there are a variety of other options to consider.  When discussing contraception in women with no contraindications I find it helpful to approach it based on how often an intervention is required:  daily, weekly, monthly, quarterly, or not for several years.

Oral contraceptive pills
Birth control pills can be taken as combined dosing (most common) with both estrogen and progesterone, or as progesterone only pills (commonly used in breast feeding women).  Pills must be taken daily to be effective, and can be tailored to elicit a period monthly or every 3 months.  This is the most flexible type of contraception in that there are many different doses, and they can be altered based on symptoms

Contraceptive Patch
The Ortho Evra patch contains both estrogen and progesterone.  It is replaced weekly for 3 continuous weeks, and then a patch is not worn during the 4th week; this is when you can be expected to begin your period.  Similar to the pill, with typical use, this method is 91% effective in preventing pregnancy.  This is not a good option for women who weigh 200 pounds or more as it may not be as effective in this population.

Contraceptive Ring
The Nuva ring also contain both estrogen and progesterone agents. The ring is placed vaginally and is replaced monthly.  It can be tailored such that you have a period monthly or every three months. The device fits comfortably, and most women are not aware that it is in place.  This is the longest acting agent available that contains both estrogen and progesterone therefore allowing for more predictable periods.

Injectable contraception
Depo Provera is an injection that is given once every 3 months. It contains a progesterone agent only. Women using this type of contraception may have infrequent or no periods while using it.

Contraceptive Implant
Nexplanon is a contraceptive agent that is implanted superficially in the arm, and is effective for 3 years. It releases a progesterone agent only. Women using this type of contraception may experience infrequent or irregular periods.  This device can be easily inserted in your doctor’s office, and it is greater than 99% effective at preventing pregnancy.

Intrauterine Devices
There are currently 3 IUDs available: the 3 year Skyla, the 5 year Mirena, and the 10 year Paragaurd.  These devices are all inserted into the uterus, a procedure that can be done quickly with minimal discomfort in your doctor’s office. Both Skyla and Mirena release a progesterone agent. When using one of these IUDs women may experience heavy or irregular bleeding for the first few months, then many women will have no periods at all until the device is taken out.  Mirena has been approved not only for contraception, but also for the treatment of heavy bleeding.  Paragaurd, or the copper IUD, is the only method of contraception discussed thus far that is completely hormone free. It is ideal for women desiring long term contraception who have contraindications to hormones such as previous blood clot or stroke.  All three of these devices are greater than 99% effective.

Permanent contraception
For women who are certain they never again desire pregnancy, they may want to consider permanent contraception, or having their tubes “tied”.  This can be done at the time of cesarean section or within 2-3 days after a vaginal delivery, and requires a small incision under the belly button.   A tubal ligation can also be at a later time laparoscopically (with a camera) as an outpatient surgery.  Some physicians are capable of doing this procedure in their office through the cervix by placing coils in the fallopian tubes, an Essure procedure. This can also be done as an outpatient surgery in the hospital.  Having a partner who has undergone a vasectomy is also a form of permanent contraception.

With numerous options available it is important to discuss with your physician your medical history, your plans for future pregnancies, and your current lifestyle to choose a contraception option that will be the most effective and convenient for you as an individual.

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