What Birth Control Is Right For Me?

Birth Control Image

Between the commercials both promoting and vilifying contraception, social media posts sharing horror stories, and the vast number of options available it can be overwhelming trying to decide which contraception is right for you. Fortunately, there are a few simple questions that can help you decide what is best.

 

Do you have any medical conditions?
Certain methods of contraception may not be safe to use if you have medical conditions such as heart disease, high blood pressure, blood clots, liver disease or cancer. A discussion with a medical provider can help you determine what is safe for you.

 

Do you want to have children in the future? How far in the future?
Long-acting reversible contraception (or LARCs) include IUDs and the progesterone implant. These are placed by a healthcare provider in the office and are designed to provide highly effective contraception for 3-10 years. They require minimal maintenance and are easily removed if or when you decide to have children. Once these devices are removed, by a healthcare provider in the office, you return to your baseline fertility within 6 weeks.

• Nexplanon sits just under the skin in your upper arm and is effective for up to 3 years.
• The copper IUD (Paragard) has no hormones in it, sits in your uterus and can be in place for up to 10 years.
• The progesterone IUDs also sits in your uterus and comes in different doses providing efficacy for 3-7 years.


The Depo-Provera injection is administered by a healthcare provider every 12 weeks. After your last injection, a return to baseline fertility may be delayed up to one year.

For those looking to have children sooner rather than later the best options would be pills, the patch or the vaginal ring.


• The vaginal ring is placed by the patient into the vagina, left in place for 3 weeks, removed for a week for a period and then a new ring is placed.
• The patch is placed weekly for 3 weeks followed by 1 week without a patch for a period.
• The pill must be taken daily. Return to baseline fertility after stopping any of these medications occurs within 6 weeks.

If you are absolutely certain you are finished having children, more permanent options are
available. This includes tubal ligation for women and vasectomy for men. These are both surgical
procedures and should be discussed with a healthcare provider.

 

Do you want to have a regular period?
Some methods of contraception can help regulate your period while others can lighten, shorten or get rid of it altogether. The copper intrauterine device (IUD) contains no hormones and therefore will not affect the timing of your period. Methods such as pills, the patch and the vaginal ring are designed to give you a 28 day cycle. If you have irregular periods and want to be able to predict your period one of these methods may work for you. Long-acting contraception such as the Depo-provera injection, hormonal IUDs (Mirena, Skyla, Liletta) and the progesterone implant (Nexplanon) provide a constant steady level of progesterone at all times. This means that it may lighten, shorten or even stop your periods altogether. These methods may cause some irregular spotting. If you like having a regular period, these are not the methods for you.

 

How effective is each method?
Nothing is 100%. Each contraception method has a failure rate but the failure rate may depend on the patient. Therefore, each contraception method actually has 2 failure rates, a “perfect use failure rate” for those rare people that use their birth control perfectly every single time, and a “typical use failure rate” for those of us who may miss a dose from time to time.


• IUDs, progesterone implant, and tubal ligation have a “perfect use” failure rate <1% over 1 year

• The typical use failure rate for these is also <1% because these methods require no upkeep by the patient. In other words, there is no way to use it improperly once it is placed.
• This means that if 100 women used these methods for 1 year, <1 of them would become pregnant

• Birth control pills, the vaginal ring, the patch, and the Depo-provera injection all have perfect use failure rates <1% over 1 year


• The typical use failure rate is 3-9% over one 1 year because these methods
require upkeep by the patient. Failure examples include missing a pill,
mistiming removal/replacement of vaginal ring/patch etc.
• If 100 women use these methods, on average 3-9 of them will become pregnant over the course of 1 year.

• Condoms, diaphragms and fertility awareness have perfect use failure rates of 2-6%.

• The typical use failure rate of this category is 10-20%

• The withdrawal method has a typical use failure rate of 22%
• Having intercourse for one year without any contraception has a pregnancy rate of over 85%

 


If you have questions, concerns, or would like to discuss contraception please call your healthcare provider. Every woman is unique in her physiology, life goals, schedule and preferences and contraception is by no means one size fits all. However, through an open discussion with your healthcare provider about what you want out of your contraception, the right fit can be achieved.

Author
Dr. Gottschalk Dr. Kathryn Gottschalk OBGYN

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